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'{{under construction}} {{short description|Medical test for cells in body fluids}} {{Infobox diagnostic | name = Body fluid cell count | image = Body fluid cell count testing on automated analyzer.jpg | alt = Body fluid cell count testing performed on an automated hematology analyzer | caption = Body fluid cell count testing performed on an automated [[hematology analyzer]] | pronounce = | purpose = Analyzing white and red blood cells in body fluids | test of = | based on = | synonyms = | reference_range = | calculator = | DiseasesDB = | ICD10 = | ICD9 = | ICDO = | MedlinePlus = | eMedicine = | MeshID = | OPS301 = | LOINC = }} A '''body fluid cell count''' is a medical [[laboratory test]] involving the analysis of [[white blood cell|white]] and [[red blood cells]] in samples of [[serous fluid]], [[synovial fluid]] and [[cerebrospinal fluid]]. The white and red blood cell counts may be determined by manual or automated methods. A '''body fluid differential count''', which enumerates the different types of white blood cells in the fluid, can also be performed. The cell count and differential can help determine the cause of an effusion (an abnormal collection of serous or synovial fluid), or, in the case of cerebrospinal fluid, help to diagnose conditions like [[meningitis]] or [[brain hemorrhage]]. ==Medical uses== Cell counts are typically performed on [[serous fluid]]s—a classification that includes [[peritoneal fluid|peritoneal]], [[pleural fluid|pleural]], and [[pericardial fluid|pericardial fluid]]—and on [[synovial fluid]] and [[cerebrospinal fluid]], which are non-serous.{{r|Kottke2012|pp=615-6}} Except for cerebrospinal fluid, these fluids are not present in volumes large enough to sample in healthy people. An increased level of serous or synovial fluid is referred to as an effusion (or [[ascites]] in the case of peritoneal fluid) and indicates a pathological process.{{r|Keohane2015|p=271}} When an effusion is present, cell count testing can provide information about the underlying medical condition.{{r|Harmening2009|p=727}} Cerebrospinal fluid cell counts are usually performed when a patient has symptoms that suggest [[meningitis]], [[encephalitis]], [[intracranial hemorrhage]], neurological disorders like [[multiple sclerosis]], or [[malignancy|malignancies]] involving the [[central nervous system]].{{r|Brunzel2013|p=315}} ===Interpretation of results=== {{further|Cerebrospinal fluid analysis#Clinical significance}} [[File:4_vials_of_human_cerebrospinal_fluid.jpg|thumb|left|Four vials of human cerebrospinal fluid]] In serous fluids, a white blood cell count above 1000/μL is one of the criteria that suggest a fluid may be an [[exudate]], meaning that it is caused by an [[inflammation|inflammatory]] process, as opposed to a [[transudate]], which is generally caused by increased blood pressure in the [[capillaries]] or decreased [[oncotic pressure]].{{r|Harmening2009|p=727}} A white blood cell count greater than 1000/μL in pericardial fluid can suggest [[pericarditis]].{{r|Brunzel2013|p=352}} In peritoneal fluids, a [[neutrophil]] count above 500/μL is suggestive of [[Spontaneous bacterial peritonitis|bacterial peritonitis]], which is a medical emergency.{{r|Harmening2009|p=737}} An elevated RBC count in pericardial and pleural fluids may indicate a [[hemorrhagic effusion]]. The pleural fluid RBC count may also be elevated in cases of pleural neoplasms or trauma.{{r|Brunzel2013|p=352}} The white blood cell count in cerebrospinal fluid is normally up to 5/μL in adults and up to 30/μL in neonates.{{r|Ciesla2018|p=365}} A markedly increased WBC count in CSF is termed ''pleocytosis'' and can be caused by a variety of conditions.{{r|Brunzel2013|p=320}} CSF white blood cell counts above 1000/μL are suggestive of bacterial or fungal meningitis.{{r|Harmening2009|p=739}} The presence of red blood cells in CSF is abnormal, but usually signifies contamination of the sample with blood during the [[lumbar puncture]] rather than any actual pathology. In rare cases, RBCs may be present due to a recent subarachnoid or cerebral hemorrhage.{{r|Harmening2009|p=738}} A contaminated sample may also have a falsely elevated WBC count, as white blood cells from peripheral blood will be present in the CSF specimen.{{r|Harmening2009|pp=738-9}} To help differentiate a contaminated draw from a hemorrhage, the amount of blood in each CSF tube can be examined. In a traumatic draw, the amount of blood in the CSF often decreases from the first tube drawn to the last, while in a hemorrhage, the amount of blood is often constant. However, this method is not always reliable.{{r|Brunzel2013|p=318}} In cerebrospinal fluid, the white blood cell differential is useful in determining the cause of an elevated WBC count. A CSF differential that predominantly contains neutrophils is associated with [[bacterial meningitis]], [[brain abscess]], and hemorrhage, while one that predominantly contains lymphocytes is associated with other infectious conditions like [[viral meningitis|viral]], [[tuberculosis|tubercular]], [[fungal meningitis|fungal]] and [[syphilis|syphilitic]] meningitis, as well as neurological disorders like [[multiple sclerosis]] and [[Guillain-Barre syndrome]]. Increased monocytes can be seen in tubercular and fungal meningitis as well as in response to brain trauma or drug treatment. [[Eosinophils]] may be increased in parasitic and fungal infections, idiopathic eosinophilic meningitis, and allergic reactions (e.g. to [[cerebral shunt]]s or intrathecally administered drugs).{{r|Brunzel2013|p=320}} Malignant cells may be observed in serous and cerebrospinal fluids. Tumour cells in body fluids indicate the presence of a primary or metastatic tumour. In [[lymphoma]] and [[leukemia]] with central nervous system involvement, [[blast cells]] can be present in the CSF.{{r|Keohane2015|pp=274-8}} ===Reference ranges=== {| class="wikitable" |+ Reference ranges for body fluids<ref group=note>Reference ranges for individual laboratories may vary due to different patient populations and testing methods.</ref> |- ! Fluid type !! WBC reference range !! RBC reference range !! Appearance {{r|Ciesla2018|p=365}} |- | Cerebrospinal|| ≤5/μL (adults); ≤30/μL (neonates) || ≤1/μL (adults); ≤3/μL (neonates) || Clear and colourless |- | Synovial|| ≤200/μL || ≤1/μL || Clear and pale yellow |- | Serous (peritoneal, pleural, pericardial) || ≤200/μL || ≤1/μL || Clear and pale yellow |} ==Procedure== ===Cell count=== {{multiple image |align=left | width = 150 | image1 = Hemocytometer.jpg | alt1 = Filling a hemocytometer | image2 = Neubauer_improved_with_cells.jpg | alt2 = Microscopic view of manual cell count on hemocytometer | footer = Left: filling a hemocytometer; right: microscopic view of manual cell count }} Body fluid cell counts can be performed manually, using a [[hemocytometer]] to count the cells under a microscope, or automatically, using an [[automated analyzer]] designed for [[complete blood count]] analysis.{{r|Keohane2015|p=370}} Because the number of cells in body fluids is much lower than in blood, automated analyzers have special modes for body fluid analysis that increase the volume of fluid analyzed in order to improve accuracy and precision.<ref name="Sandhaus2015"/> Most hematology analyzers are not suitable for the analysis of cerebrospinal fluid, as cell counts in CSF are typically extremely low; however, some specialized analyzers offer this capability.<ref name="HodBrugnara2018"/> The analysis begins with visual examination of the fluid. The colour and clarity of the body fluid, which provides information about the cell counts, is recorded. A white blood cell count greater than 200 per microlitre, or a red cell count greater than 400 per microlitre, can cause the fluid to be slightly cloudy. If the fluid is grossly bloody or cloudy, it can be diluted to make manual counting easier. Appropriate diluents include [[isotonic saline]], which preserves the structure of both WBCs and RBCs, and reagents containing [[glacial acetic acid]] such as [[Turk's solution]], which destroy RBCs so that they can be easily distinguished from WBCs. However, acetic acid reagents cannot be used for synovial fluids, as acetic acid reacts with the [[hyaluronic acid]] present in these fluids.{{r|Keohane2015|p=270}} ===Differential=== {{for|differential counts on blood samples|White blood cell differential}} [[File:Cytospin slide of peritoneal fluid (Wright Giemsa stain).jpg|thumb|Cytocentrifuge slide of peritoneal fluid, showing monocytes, lymphocytes, neutrophils and mesothelial cell]] A differential count identifies and enumerates the types of white blood cells found in the fluid. Body fluid differential counts are performed by using a specialized centrifuge (a [[:wikt:cytocentrifuge|cytocentrifuge]]) to concentrate the cells on a microscope slide, then [[Staining (biology)|staining]] the slide with [[Wright's stain]] or Wright-Giemsa{{r|Harmening2009|p=724}} so that the cells can be identified. If the cell count is very high, the sample can be diluted before making a cytocentrifuge slide so that the cells are not distorted by crowding.{{r|Keohane2015|p=270-1}} A technologist counts 100 cells on the slide, then multiplies the resulting percentages by the total white blood cell count to determine the absolute number of each white blood cell type in the fluid.{{cn}} Some analyzers can provide an automated differential count, but it is limited to two types of cells - mononuclear and polymorphonuclear cells -<ref name="Sandhaus2015"/> while the manual method can differentiate neutrophils, lymphocytes, monocytes, eosinophils, basophils, mesothelial cells, malignant cells and more.{{cn}} ==Notes== {{reflist|group=note}} ==References== {{reflist|30em|refs= <ref name="Keohane2015">{{cite book|author1=Elaine M. Keohane|author2=Larry Smith|author3=Jeanine M. Walenga|title=Rodak's Hematology: Clinical Principles and Applications|url=https://books.google.com/books?id=jjBTBwAAQBAJ|date=19 February 2015|publisher=Elsevier Health Sciences|isbn=978-0-323-32716-9}}</ref> <ref name="Kottke2012">{{cite book|author1=Kandice Kottke-Marchant|author2=Bruce Davis|title=Laboratory Hematology Practice|url=https://books.google.com/books?id=dlZDhbXDuOQC|date=6 June 2012|publisher=John Wiley & Sons|isbn=978-1-4443-9857-1}}</ref> <ref name="Brunzel2013">{{cite book|author=Nancy A. Brunzel|title=Fundamentals of Urine and Body Fluid Analysis|url=https://books.google.com/books?id=hV1PAQAAQBAJ|edition=3rd|date=13 August 2013|publisher=Elsevier Health Sciences|isbn=978-0-323-27774-7}}</ref> <ref name="Harmening2009">{{cite book|author=Denise Harmening|title=Clinical Hematology and Fundamentals of Hemostasis|url=https://books.google.com/books?id=W_NGPgAACAAJ|edition=5th|year=2009|publisher=F. A. Davis Company|isbn=978-0-8036-1732-2}}</ref> <ref name="HodBrugnara2018">{{cite journal|last1=Hod|first1=E. A.|last2=Brugnara|first2=C.|last3=Pilichowska|first3=M.|last4=Sandhaus|first4=L. M.|last5=Luu|first5=H. S.|last6=Forest|first6=S. K.|last7=Netterwald|first7=J. C.|last8=Reynafarje|first8=G. M.|last9=Kratz|first9=A.|title=Automated cell counts on CSF samples: A multicenter performance evaluation of the GloCyte system|journal=International Journal of Laboratory Hematology|volume=40|issue=1|year=2018|pages=56–65|issn=17515521|doi=10.1111/ijlh.12728}}</ref> <ref name="Ciesla2018">{{cite book|author=Betty Ciesla|title=Hematology in Practice|url=https://books.google.com/books?id=5td7DwAAQBAJ|date=27 November 2018|publisher=F.A. Davis|isbn=978-0-8036-6825-6|}}</ref> <ref name="Sandhaus2015">{{cite journal|last1=Sandhaus|first1=Linda M.|title=Body Fluid Cell Counts by Automated Methods|journal=Clinics in Laboratory Medicine|volume=35|issue=1|year=2015|pages=93–103|issn=02722712|doi=10.1016/j.cll.2014.10.003}}</ref> }} <ref name="Jan M Keppel2018">{{cite journal|last1=Jan M Keppel|first1=Hesselink|title=Kambo and its Multitude of Biological Effects: Adverse Events or Pharmacological Effects?|journal=International Archives of Clinical Pharmacology|volume=4|issue=1|year=2018|issn=25723987|doi=10.23937/2572-3987.1510017}}</ref>'