Question 1

Which of the following is a feature of malignant cells in fluids?

Accepted Answer

Mesothelial cells are the lining cells of body cavities and are shed into these cavities.They can be confused with malignant cells.However,when mesothelial cells appear in clumps (a frequent occurrence),usually windows are noted between the cells.This is not true of malignant cells that are also commonly found in clumps.

Question 2

Which of the following is normal in a CSF?

Accepted Answer

Ependymal cells,along with choroids plexus cells,are lining cells of the central nervous system and are seen in CSF.None of the other findings would be normal in CSF.

Question 3

Three CSF tubes are received in the laboratory numbered 1 through 3 based on the order in which they were obtained,with 1 being the first.The first tube is cloudy pink,but this color diminishes and clearing occurs with each successive tube.What does this suggest?

Accepted Answer

The turbid and pink color is due to the presence of red cells in the fluid.Because each succeeding tube becomes clearer and the pink color diminishes,a traumatic tap is most likely the cause.If there had been internal bleeding into the CSF,each tube would appear the same.The presence of bacterial infection or metastatic tumor cells cannot be determined by simply a gross examination of the fluid.

Question 4

Which of the following is true regarding bronchoalveolar lavage (BAL)fluids?

Accepted Answer

BAL examination is performed on patients with severe lung dysfunction.They may contain airborne organisms because they are taken from the interior of the lung;they often contain bacteria and/or yeast when cytocentrifuge slides are examined.Aerosol production is a real risk;thus it is critical to wear a mask when working with these specimens.

Question 5

What determines whether or not body fluids are diluted before counting?

Accepted Answer

The appearance of the fluid is used to determine whether or not a body fluid is diluted before counting.If the fluid is clear,no dilution is made.If it is hazy or cloudy,an appropriate dilution is made.

Question 6

Nucleated red blood cells (NRBCs)and immature white cells in a CSF most likely mean

Accepted Answer

When immature bone marrow cells are seen in the CSF,it most likely means that bone marrow contamination of the specimen has occurred.If a significant number exist,the CSF differential will be a reflection of what is in the marrow,not the CSF.

Question 7

A synovial fluid has a high white cell count and large intracellular needlelike crystals that are yellow when the crystals are parallel to the y-axis of a red compensator.What is the likely diagnosis?

Accepted Answer

These are monosodium urate crystals and are seen in gout.

Question 8

What determines the amount of fluid used for a cytocentrifuge preparation?

Accepted Answer

The number of cells,determined when the cell count is done on the body fluid,determines how much fluid should be used in making the cytocentrifuge preparation.This preparation concentrates the cells so that a representative number of them can be morphologically evaluated.

Question 9

Why should spinal fluid tests be performed within 30 minutes of collection?

Accepted Answer

Spinal fluid tests should be performed within 30 minutes of collection for all the reasons listed.

Question 10

A CSF is equally bloody in all tubes collected and has a yellowish supernatant.On the differential,macrophages with hemosiderin are noted.Which of the following is most likely?

Accepted Answer

All tubes being equally bloody indicates hemorrhage.If it had been a traumatic tap,there should have been a gradual decrease in the number of red cells in successive tubes with gradual clearing.The yellow tinge to the supernatant suggests a subarachnoid hemorrhage.

Question 11

A cloudy cerebrospinal fluid (CSF)is diluted 1:20.In nine large squares,99 white cells are counted.What is the total white blood count/mm³ or /mL?

Accepted Answer

The same formula used for calculating manual cell counts in blood is used for body fluids.Thus this cell count = (99 × 20)/(9 mm² × 0.1 mm)= 2200/mL.

Question 12

A patient has a pleural fluid with 2000 WBCs per mL.Seventy percent of the cells are neutrophils.Which of the following is most likely?

Accepted Answer

Exudates are formed in response to an infection (viral or bacterial),malignancy,pulmonary embolus,and systemic lupus erythematosus.They generally have a white count greater than 1000/mL.Because the primary cells seen in this fluid are neutrophils,the infection is bacterial.

Question 13

Which of the following is true regarding malignant cells in serous fluids?

Accepted Answer

Both malignant and mesothelial cells can be found in clumps in serous fluids.Mesothelial cells are normal lining cells of body cavities that are shed into these cavities;they are a normal finding in serous fluids.They can be confused with malignant cells.However,when mesothelial cells appear in clumps (a frequent occurrence),usually windows are noted between the cells.This is not true of malignant cells that are also commonly found in clumps.

Question 14

If most of the white cells are neutrophils on the previously discussed CSF,what additional test should be performed?

Accepted Answer

Neutrophils increase in response to a bacterial infection.Thus if most of the cells seen in a CSF are neutrophils,a Gram stain and bacterial cultures should be performed on the CSF.It is critical that the specimen be handled in a sterile manner until these tests have been performed;often a separate CSF tube is used for culture than that for cell counts.

Question 15

How must synovial fluids be handled differently than other fluids?

Accepted Answer

Synovial fluid contains hyaluronic acid,making it very viscous.Adding a small amount of hyaluronidase powder to the fluid will cause it to liquefy.Cell counts and/or cytocentrifuge slides can then be made.

Question 16

One clinical laboratory scientist is covering the "manual bench" in the hematology laboratory,which is where body fluid examinations are done.Just as she is preparing to go on break,she simultaneously receives two specimens,one a CSF and one a BAL fluid.Both are marked "stat." What should she do first?

Accepted Answer

A CSF fluid is always "stat," and evaluation is critical for good patient care.The cells will rapidly disintegrate,just as for all body fluid specimens,and so they must be examined within 30 minutes of draw.Diagnostic information obtained from examination of CSF fluid can be extremely important for timely and appropriate patient care;therefore,in this scenario the CSF must be examined first and immediately.The clinical relevance of information obtained from hematologic examination of BAL fluid is minimal,and some hematology laboratories no longer perform counts and/or cytocentrifuge preparations on these specimens because the biohazard risk outweighs the clinical usefulness.

Question 17

A hazy spinal fluid has 400 white cells per mm³ that are mostly lymphocytes and reactive lymphocytes.Which of the following is most likely?

Accepted Answer

Meningitis can be either bacterial or viral.When it is viral,lymphocytes respond and some of them will be reactive.In bacterial meningitis,neutrophils would predominate.

Question 18

Which of the following are normal in serous fluids?

Accepted Answer

Of the findings listed,only macrophages are a normal finding in serous fluids.Other normal cells are lymphocytes and mesothelial cells.

Quiz 18: Body Fluid Analysis in the Hematology Laboratory