Synovial Fluid

SYNOVIAL FLUID
Class Prayer
Prayer Leader:
Let us bow our heads and remember that we are in the Holy
Presence of God.
All:
Dear God, we know You are with us in this class. Bless us with
your Grace and help us become better Laurelians constantly
engaged in scholarly pursuits and continually finding optimal
and innovative solutions to challenge concerns that confront us.
Help us to be considerate, compassionate, and mindful of each
other as we strive to accomplish our common objective of
bolstering our knowledge and sharpening our skills with the
active participation of students and with guidance of faculty. We
pray that You bless our beloved LPU Davao so it will continue to
grow and last for generations to come; will be true to Laurelian
values; and will be faithful to our credo
PRO DEO ET PATRIA, VERITAS ET FORTITUDO.
Amen.
Objectives:
• Describe the formation and function of synovial
fluid.
• To discuss the importance of synovial fluid

examination; and
• To familiarize the significant values of the test and

its clinical importance.
Synovial Fluid
• Often referred as “JOINT FLUID”
• A viscous liquid found in the cavities of the movable joints
• formed as an ultrafiltrate of plasma across the synovial membrane
 FUNCTIONS: - Provides nutrients to thr articular cartilage

- Lessens the shock of the joint compression occurring such as
walking and jogging.
TERMS:
 Synoviocytes – cells lining the synovial membrane and secrete a
mucopolysaccharide containing hyalorunic acid
 Hyalorunic Acid – causes noticeable viscosity of synovial fluid
 Arthitis – damage to the articular membrane produces pain and stifness
in the joints.
Synovial Fluid
COLLECTION AND HANDLING OF SPECIMEN
• Collection through needle aspiration called “ ARTHROCENTHESIS ”
• Volume varies depending on the :
a. size of the joint
b. fluid built up in the joint
• Normal synovial fluid does not clot; however diseased joint may contain
fibrinogen and will clot - fluid is often collected in a syringe that has been
moistened with heparin.
AVOID USING ANTICOAGULANTS THAT CAN PRODUCE ARTIFACTS

 Powdered EDTA
 Oxalate
 Sodium Heparin
Fluid into 3 tubes: 1. sterile heparinized tube – microbiology

2. liquid EDTA – hematology
3. tube w/o anticoagulant – other test
Synovial Fluid
APPEARANCE AND VISCOSITY
APPEARANCE VISCOSITY
 Clear to pale Normal synovial  due to polymerization of
yellow fluid Hyaluronic acid
 Milky Crystals are o Good – solid clot
 Deeper yellow present o Low – Friable clot
Presence of o Poor – no clot
 Greenish tinge inflammation
 Turbid Bacterial infection
Presence of WBC’s
VISCOSITY : Synovial fluid viscosity comes from polymerization of the

hyaluronic acid
: Arthritis affects both the production of hyaluronate and its
ability to polymerize
: Hyaluronate polymerization –measured by mucin clot test
by adding 2% to 5% acetic acid.
Synovial Fluid
CELL COUNT
 Total leukocyte count most performed; RBC are seldom requested
 Vey viscous fluid : pretreated by adding 1 drop of 0.05% hyaluronidase
in phosphate buffer - 37°C for 5 minutes
 Neubauer counting chamber
 Diluting fluid commonly used : Hypotonic saline (0.3%)
 WBC : NV- < 200cells/µl
DIFFERENTIAL COUNT
 FLUID - incubated with hyaluronidase
 Neutrophils < 25% ; and lymphocytes < 15%15%.
CRYSTAL INDENTIFICATION
 Diagnostic test in evaluating arthritis.
 Crystal formation in a joint result in acute, painful inflammation, causes of
crystal formation include metabolic disorder and decreased renal
excretion.
Synovial Fluid
CRYSTAL INDENTIFICATION
PRIMARY CRYSTALS SEEN IN SYNOVIAL FLUID:
 Monosodium urate (Uric acid; MSU) - cases of gout

 Calcium pyrophosphate dihydrate (CPPD) – pseudogout
 Hydroxyapatite(basic calcium phosphate) – calcified cartilage
degeneration
 Cholesterol crystals – chronic inflammation, corticosteroids
after injection
 Calcium Oxalate – renal dialysis patients
Synovial Fluid
CHEMISTRY TEST
Synovial is chemically an ultrafiltrate of plasma chemistry
test value are the approximately same with serum values.
 GLUCOSE COMMONLY
 PROTEIN PERFORMED
 URIC ACID SIMULTANEOUSLY WITH
 LACTATE OR ACID PHOSPHATASE BLOOD SAMPLES
TEST CLINICAL IMPORTANCE

Glucose inflammatory (group I); septic (group III)
Protein inflammatory and hemorrhagic disorders
Uric acid cases of gout; confirmatory test for gout if crystal are
not found.
Lactate/acid to monitor the severity and prognosis of rheumatoid
phosphatase arthritis (RA)
Synovial Fluid
NORMAL SYNOVIAL FLUID VALUES
Volume Adults : 3.5 ml
Color Colorless to Pale yellow
Clarity Clear
Viscosity Forms a string 4-6 cm long
Erythrocyte count < 2000 cells/µl
Leukocyte count < 200 cells/µl
Neutrophils < 20 % of the diff count
Lymphocytes < 15 % of the diff. count
Monocytes and Macrophages 65 % of the diff count
Crystals None present
Glucose < 10 mg/dl, lower than blood
Lactate < 220 mg/dl
Total protein < 3 g/dl
Uric Acid Equal to blood
Synovial Fluid
CLASSIFICATION AND PATHOLOGIC SIGNIFICANCE
OF JOINT DISORDER
GROUP CLASSIFICATION PATHOLOGIC WBC/mL
SIGNIFICANCE
NON-INFLAMMATORY DEGENERATIVE JOINT < 3000
DISORDER
INFLAMMATORY IMMUNOLOGIC PROBLEM, 3000-75,000
INCLUDING RHEUMATOID
ARTHRITIS (REGOCYTES)
AND LUPUS
ERYTHEMATOSUS
CRYSTAL INDUCED GOUT
AND PSEUDOGOUT
SEPTIC MICROBIAL INFECTION 50,000 – 200,000

HEMMORRHAGIC TRAUMATIC INJURY 50,000-10,000
COAGULATION
DEFICIENCES
Thank you!

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SYNOVIAL FLUID

PRO DEO ET PATRIA, VERITAS ET FORTITUDO.

• To discuss the importance of synovial fluid

• To familiarize the significant values of the test and

 FUNCTIONS: - Provides nutrients to thr articular cartilage

AVOID USING ANTICOAGULANTS THAT CAN PRODUCE ARTIFACTS

Fluid into 3 tubes: 1. sterile heparinized tube – microbiology

VISCOSITY : Synovial fluid viscosity comes from polymerization of the

PRIMARY CRYSTALS SEEN IN SYNOVIAL FLUID:

 Monosodium urate (Uric acid; MSU) - cases of gout

TEST CLINICAL IMPORTANCE

SEPTIC MICROBIAL INFECTION 50,000 – 200,000

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