Examination of Body Fluids/Arthrocentesis/Cerebrospinal Fluid Analysis
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What are other names for bronchial wash?
- transtracheal aspiration (TTA)
- branchoalveolar lavage (BAL)
What is bronchial wash?
a diagnostic aid for lower respiratory tract disease
What do we use to collect a bronchial wash?
collect thru an endoscope or thru a long sterile catheter
What type of long sterile catheter should we use for a bronchial wash?
intra catheter - has a needle in the catheter
Why do we usually do usually do the bronchial wash while the patient is awake? Can it be done with the patient anesthetized?
- to preserve the cough reflex
Where do we insert the catheter for a bronchial wash?
insert catheter between tracheal rings to the bifurcation
After we have inserted the catheter for a bronchial wash, what do we do?
- inject warm saline (5 - 15ml)
- aspirate when the patient coughs
- if the patient is anesthetized, then aspirate quickly after injecting the saline
When would we anethetize the patient when doing a bronchial wash?
when we use an endoscope
Once we inject the saline and aspirate, where does our sample end up?
not in the syringe, but in the catheter
What should we do with some of the sample from the bronchial wash if we suspect the patient has pneumonia?
How do we measure the length of where the catheter needs to go for large animals for a bronchial wash?
from midthorax to trachea, enter between tracheal rings
Is the sample from the bronchial wash large or small?
How do we prepare a sample for a cytology from a bronchial wash?
- smear sample onto slide
- air dry
- observe cells
Should the sample from a bronchial wash have lots of cells or a few cells?
a few cells (acellular)
What kind of cells will we see on a bronchial wash cytology?
- columnar cells
- cuboidal cells
If we see squamous epithelial cells on the cytology from a bronchial cells what does it mean?
we went the wrong direction and into the pharynx
What are some abnormal findings we would find on a cytology from a bronchial wash?
- abnormal neoplastic cells
- bacteria and yeast (macrophages with yeast and hyphae)
- parasites and/or ova
What would be the cause of having a fungal infection but unable to see any parasites on a bronchial wash cytology?
the organism may have been walled off by granulomas tissue
What is arthrocentesis?
analysis of synovial fluid
What do we use arthrocentesis to help diagnose?
What are some of the clinical signs of joint disease?
- swelling of joint
Should we use aseptic technique when doing arthrocentesis?
yes, shave and scrub
What do we need in order to do an arthrocentesis?
needle and syringe
If we need to do a culture of the synovial fluid, should we do that first?
What kind of anticoagulant can we use after collecting fluid from an arthrocentesis?
EDTA to make sure fluid does not clot
What does normal synovial fluid look like to the naked eye and how many cells should we see on a cytology?
- clear/colorless to straw colored (pale yellow in herbivores)
- no turbidity (cloudiness)
- viscous (if it comes out like water then it is not normal) - drop should hang 2 cm from needle
- total protein < 2.5 gm/dl
- low cell count (< 3,000/ul)
How do we tell the difference between old blood and fresh blood from an arthrocentesis?
- centrifuge the blood down and look at the supernatant
- fresh blood: clear supernatant, will see platelets
- old blood: yellow-red fluid after being centrifuged, will not see platelets
Can we run the fluid from an arthrocentesis through a blood counting machine?
yes, some of them will count the cells and some will not
If we can't use a blood counting machine, how do we count the cells?
- use WBC pipettes to count
- diluet using 20 cc saline, 2 drops crystal violet, and 0.2 ml Wydase
- count on a hemocytometer
Can we estimate our cell count from synovial fluid?
yes, thats what most people do
If we see an increase in cells from synovial fluid, is this a significant problem?
How do we do the mucin clot test of synovial fluid?
- mix 0.1 ml of 7-N glacial acetic acid to 4 ml of water
- add 1 ml synovial fluid (no EDTA) and leave for 1 hour
What is "normal" for a mucin clot test of synovial fluid?
ropy white clump
What does an abnormal mucin clot test look like and what is usually the cause?
- bacterial infection is usually the cause
What is an alternative way to do the mucin clot test?
- add a few drops of synovial fluid to 10 ml of 5% acetic acid
- let stand for 5 minutes
- if WNL then we will see a tight clot and clear fluid
What does a normal cytology of synovial fluid look like?
- 90% of cells are mononuclear (lymphs/monos/macros)
- cells are often aligned linearly (line up)
- granular eosinophilic background due to mucin
What does a traumatic/degenerative arthropathy look like?
- increase in mononuclear cells and large macrophages
- osteoclasts seen if there is erosion of cartilage
- fluid may be red or cloudy
What does infectious arthritis look like?
- many cells, mostly segs
- poor mucin clot or none at all
- the sample itself may clot or see turbidity
- may find organisms
What does CSF stand for?
Where is cerebrospinal fluid?
bathes the exterior of the brain and spinal cord
Why do we do cerebrospinal fluid analysis?
- patient is showing CNS signs and we can't pin it on any other cause
- patient is showing neck/back pain
- suspicious of equine protozoal myeloencephalititis (EPM)
Is CSF stable fluid?
Where can we collect CSF in small animals and large animals?
- small animals: cisterna magna (where head joins the neck)
- large animals: lumbosacral space
Where is the CSF fluid?
in the subarachnoid space below the duramator
What kind of needle do we use to collect CSF?
spinal needle with stylet
When we are collecting CSF do we need to have the animal anesthetized?
we anesthetize for small animals and just use a local anesthetic for large animals
Should we use aseptic technique when collecting CSF?
What types of practices typically do CSF pressures?
What kind of disease conditions should we look for in CSF?
What are the different parts of analyzing CSF?
- protein content
- cell morphology
Describe normal CSF.
- celar and colorless
- few cells - < 25 cells/ul in dogs and < 5 cells/ul in horses
- lymphocytes is typically the cell you will see
- low protein (<50 - 60 mg/dl)
How do we measure total protein of CSF?
- we can not use a refractometer because it will not measure that low
- we can use urine dipsticks
- 1+ mild, 3+ marked
What is the pandy test?
- crude test to detect globulins
- abnormal if globulins are present
How do we do the pandy test?
- mix 1ml phenol to 1-2 drops of CSF
- normal - no turbidity
- turbidity - there are globulins present
What is the time frame for counting cells of the CSF?
within 30 minutes
What are the different methods to counting cells in the CSF?
- with a hemocytometer - count wbcs in all 9 primary squares and then multiply by 1.1
- cytocentrifuge fluid, draw circle with wax pencil on silde, fill with CSF, let settle for 25 minutes, draw off fluid, dry, stain
- micropore filter
- special sedimentation slides
What do abnormal CSF results look like?
- increased cell count
- increase in immunoglobulins
- bacteria, other organisms
Even if you have an animal with CNS signs can we still have normal CSF results?
yes, negative does not necessarily mean nothing is wrong
What is the carrier of EPM?
What are we looking for in the CSF when testing for EPM?
looking for antibodies to sarcocystis
What would you like to do?
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