Question

BODY FLUIDS CASE STUDY

A 60 year-old women visits her physician with abdominal swelling. It has been determined she has ascites. Paracentesis is performed and patient's blood is drawn after which the specimens are submitted to the lab for testing. Blood Chemistry Testing Parameters Result Range Total Protein 6.5 g/dL (6.0 – 8.5) LDH 300 U/L (275 - 630) Glucose (fasting) 85 mg/dL (70 - 100) AST 20 U/L (10 - 40) ALT 32 U/L (10 - 60) GGT 15 U/L (0 - 45) ALP 60 U/L (45 - 145) Total Bilirubin 0.6 mg/dL (0.2 – 1.2) Peritoneal Fluid Testing      Examination Parameters Result      Physical Color yellow Clarity clear Clots none observed      Chemical Total Protein 2.9 g/dL LDH 125 U/L Glucose 70 mg/dL      Microscopic Leukocyte count 1200 cells/mL Cytology exam no malignant cells observed Gram stain no organisms observed (1) Calculate the fluid-to-serum total protein and fluid-to-serum LDH ratios. (2) Classify this effusion as a transudate or an exudate. (3) State at least two physiologic mechanisms which might cause this type of effusion.

Answer 1

Fluid accumulation in the abdominal cavity is called ascites.

Paracentesis is the removal of fluid from the peritoneal cavity through a small surgical incision or puncture made through the abdominal wall under sterile conditions.

(1) Calculate the fluid-to-serum total protein and fluid-to-serum LDH ratios.

Peritoneal fluid total protein = 2.9 g/dL

Serum total protein= 6.5 g/dL

Fluid to serum total protein = 2.9/6.5= 0.45 g/dl

Peritoneal fluid LDH = 125U/L

Serum LDH= 300U/L

Fluid to serum LDH= 125/300=0.42 U/L

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(2) Classify this effusion as a transudate or an exudate.

Transudate is accumulation of fluid due to varied pressure within blood vessels and volume of protein in blood .

Exudate is abnormal accumulation of fluid in abdomen due to injury or any inflammation.

Fluid to serum total protein = 2.9/6.5= 0.45 g/dl (If this is >0.5 then this may be exudate)

Fluid to serum LDH= 125/300=0.42 U/L ( If this is > 0.6 then this may be exudate)

But as these both donot satisfy the criteria for being exudate , this effusion is transudate.

Also transudate appears as clear, pale yellow fluid, the total protein will be < 3 g/dL .Fluid / serum protein will be <0.5 g/dl , fluid / serum LDH will be <0.6 U/L and glucose levels stays same as in blood in transudates.

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(3) State at least two physiologic mechanisms which might cause this type of effusion

Congestive cardiac failure, Nephrotic syndrome and hepatic cirrhosis leads to transudate .