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- Normal serous fluid is pale yellow and clear. Transudates are pale yellow and hazy to cloudy depending on the number of cells present. Exudates are cloudy and may be bloody.
www.thefreelibrary.com/Examination of body fluids: evaluating gross appearance; performing...-a0231094833
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A cloudy or turbid fluid indicates increased WBCs or protein. A bloody fluid can indicate a traumatic tap in which a blood vessel is inadvertently punctured in the process of collection or blood can mean an intracranial hem-orrhage or pathologic bleed.
Sep 1, 2020 · Chylothorax appears as milky or cloudy pleural fluid. 1, 2 When evaluating pleural fluid, Light criteria can be used to distinguish between an exudate and a transudate.
- Normal Pleural Fluid
- Transudate vs Exudate
- Light’s Criteria
- Worked Examples
- References
Typical findings of normal pleural fluidare as follows: 1. Appearance:clear 2. pH:7.60-7.64 3. Protein:< 2% (1-2 g/dL) 4. White blood cells (WBC):< 1000/mm³ 5. Glucose:similar to that of plasma 6. LDH:<50% plasma concentration 7. Amylase:30-110 U/L 8. Triglycerides:<2 mmol/l 9. Cholesterol:3.5–6.5 mmol/l
Transudate
Transudative pleural effusions are defined as effusions that are caused by factors that alter hydrostatic pressure, pleural permeability, and oncotic pressure. Conditions associated with transudative pleural effusionsinclude: 1. Congestive heart failure 2. Liver cirrhosis 3. Severe hypoalbuminemia 4. Nephrotic syndrome
Exudate
Exudative pleural effusions are caused by changes to the local factors that influence the formation and absorption of pleural fluid. Conditions associated with exudative pleural effusions include: 1. Malignancy 2. Infection (e.g. empyema due to bacterial pneumonia) 3. Trauma 4. Pulmonary infarction 5. Pulmonary embolism
Light’s criteriaare more accurate for the diagnosis of exudative effusions. The fluid is considered an exudate if any of the following are present: 1. The ratio of pleural fluid to serum protein is greater than 0.5 2. The ratio of pleural fluid to serum LDH is greater than 0.6 3. The pleural fluid LDH value is greater than two-thirds of the upper l...
Case 1
A 52-year-old male presents with a cough, shortness of breath and fever. CXR shows a right-sided pleural effusion. A thoracentesis is performed and the results of the pleural fluid analysis are as follows: 1. Colour: purulent 2. Pleural/serum total protein ratio:>0.5 3. pH:7.1 4. WBC count:67,000 cells/µL 5. Glucose: 1.5 mmol/l 6. LDH: 1430 IU/L
Case 2
A 56 -year-old, previously well woman was admitted with a 4-week history of a cough, night sweats and 1-week history of progressive breathlessness. She had never smoked and has no history of heart disease or rheumatological disease. Pleural fluid results are as follows: 1. Colour: milky-white, odourless 2. Triglyceride: 0.5 mmol/l 3. Cholesterol: 12.4 mmol/l
Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med1972;77:507-13.Pettersson T, Riska H. Diagnostic value of total and differential leukocyte counts in pleural effusions. Acta Med Scand 1981;210:129–35. (3)Saraya T; Light RW; Takizawa H; Goto H, Black pleural effusion. Am J Med. 2013; 126(7):641.e1-6 (ISSN: 1555-7162)Sahn S. Pleural fluid analysis: narrowing the differential diagnosis. Semin Respir Med1987;9:22–9. (4).Interpreting pleural fluid results correctly requires an awareness of the possible aetiologies of a pleural effusion and an understanding of the reliability of the outcome of each investigation.
- Rachel M Mercer, John P Corcoran, Jose M Porcel, Najib M Rahman, Ioannis Psallidas
- 10.7861/clinmedicine.19-3-213
- 2019
- Clin Med (Lond). 2019 May; 19(3): 213-217.
The transudation of fluid is due to increased pressure driving a protein-free fluid across an intact barrier between capillary and pleural space. Note the clarity and lack of foam in this beer. Beer two : BJ’s Harvest Hefeweizen®, a wheat beer, is much cloudier but is still light in color.
- Taylor Warmoth, Gilbert Berdine
- 2016
Aug 23, 2018 · Pleural fluid analysis is the examination of pleural fluid collected from a pleural tap, or thoracentesis. This is a procedure that drains excess fluid from the space outside of the lungs but...
Several laboratory tests are helpful in distinguishing transudates from exudates including pH, total protein, lactate dehydrogenase (LD), amylase, glucose, white cell count and differential. Only one of these values has to fall into the exudate range for the effusion to be classified as an exudate.
