Biochemical analysis of pleural fluid: what should we measure?

Tarn, A. C.; Lapworth, Ruth

doi:10.1258/0004563011900812

Cited by 43 publications

(50 citation statements)

References 79 publications

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“…2 The cut-off values used have varied but mostly lie between 25 and 30 g/ L. 12 -14 The transudate/exudate concept in ascites has, however, resulted in many problems and exceptions. The pathophysiology operating in the formation of ascites does not always follow the expected pattern.…”

Section: Causes Of Ascites and Differential Diagnosismentioning

confidence: 99%

Biochemical analysis of ascitic (peritoneal) fluid: what should we measure?

Tarn

Lapworth

2010

Ann Clin Biochem

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Ascitic fluid samples are frequently sent to the laboratory for analysis. Although the underlying cause of the ascites is often thought to be clinically obvious, it is important to establish a definitive diagnosis. The value of a cell count and bacterial culture of the ascitic fluid is not disputed, but the role of biochemical testing is less clear. The use of ascitic fluid total protein to try to classify ascitic fluids as either an exudate or a transudate has contributed to this. The use of the physiologically based serum ascites albumin gradient to differentiate ascites caused by portal hypertension from other causes provides a better diagnostic approach. We recommend that the serum ascites albumin gradient is performed by laboratories as the first-line test and that interpretative reports are provided. Additional testing should be restricted to specific diagnostic queries and requires close collaboration between the laboratory and the clinician.

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Section: Causes Of Ascites and Differential Diagnosismentioning

confidence: 99%

Biochemical analysis of ascitic (peritoneal) fluid: what should we measure?

Tarn

Lapworth

2010

Ann Clin Biochem

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“…There is no need for ice as they are measured immediately, while Tarn and Lapworth [5], reported that pleural fluid samples should be handled as carefully as arterial samples for gas analysis, with fluid collected in heparinized syringes and ideally transported on ice for measurement within 6 h. However, they have shown that when collected in heparinized syringes, pleural fluid pH does not change significantly even at room temperature over several hours.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic significance of pleural fluid pH and pCO2

Sobhey

Naglaa

2015

Egyptian Journal of Chest Diseases and Tuberculosis

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The diagnosis of pleural effusion is still difficult. The presence of pleural effusion can be confirmed by radiological studies including simple chest radiography, ultrasonography, or computed tomography. Identifying the causes of pleural effusions by pleural fluid analysis is essential.Aim of this work: The aim of this work is to assess the role of pleural fluid pH and pCO 2 in differentiating the etiologies of pleural effusion and to study the correlation between pleural fluid pH and pCO 2 and cellular content of the effusion.Results: We conducted this study on 50 patients with pleural effusions of different causes. The patients were classified into 5 groups according to the cause. For all the patients, measurement of pleural pH, pCO 2 , pO 2 , HCO 3 , protein, LDH, glucose and WBC was done. We observed lowest pH in complicated parapneumonic effusion (empyema) 6.80 ± 0.15 and highest pH was observed in transudative effusion 7.47 ± 0.07. Tuberculous effusion has pH lower than pH of malignant effusion 7.17 ± 0.017 and 7.39 ± 0.08, respectively. Post pleurodesis malignant effusion has pH lower than pH of malignant effusion 7.28 ± 0.17 and 7.39 ± 0.08, respectively. There is a strong inverse correlation between pH and pCO 2 , WBC, LDH and protein (r = À0.813 and p < 0.001), (r = À0.796 and p, 0.001), (r = À0.829 and p, 0.001) and (r = À.837 and p, 0.001), respectively. While there is a weak correlation between pH and glucose of pleural fluid (r = 0.249 and p = 0.066). The highest increase of PNL numbers was in empyema (20169 ± 8094.8 cells/cc). The highest increase of lymphocytes was in malignant effusions (4285.00 ± 2948.20 cells/cc) and tuberculous effusion (3977.7 ± 3169 cells/cc).

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“…Other prospective studies, however, reported much lower diagnostic specificities, ranging from 65% to 86% (2)(3)(4). The high sensitivity and specificity reported in the original study by Light et al (1 ) could be the result of their stringent diagnostic requirements, which led to the exclusion of 33 of the total 183 cases (5 ). The most commonly used modification to the criteria of Light et al (1 ) is the use of pleural fluid LDH more than two-thirds of the upper limit Molecular Diagnostics and Genetics of the reference interval for serum as a criterion to replace an absolute pleural fluid LDH Ͼ200 U/L.…”

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confidence: 94%