![]() ![]() Pleural fluid pH (Low glucose and pH = infection or malignancy).Repeated testing confirms continuation or cessation of process.LDH level – This is classically high in exudates.Common: Infection (pneumonia) and malignancy.Cytology useful in cases of suspected malignancy.Use blood culture bottles and specimen jars – especially if chronic illness or suspect TB or fungus.Mononuclear cells – Chronic inflammatory process.Eosinophila – Pneumothorax, haemothorax, asbestosis, Churg-Strauss.Neutrophils – PTE, pancreatitis, pneumonia, empyema.Differential cell count (predominance of white cells).If exudate is confirmed, further testing required to evaluate cause of exudate Serum albumin – pleural fluid albumin Additional criteria – Confirm exudate if results equivocal.Pleural fluid level >2/3 of upper value for serum LDH.Pleural fluid LDH to serum LDH ratio >0.6.Pleural fluid protein to serum protein ratio >0.5.Lights criteria (High protein and LDH = exudate), determines presence of exudate with protein and LDH levels.Use Light’s criteria is moderately sensitive for differentiation, further tests are then required to further define the exudate.Aims to identify local from systemic illness. Common causes can then be actively sought and treated.Renal – Glomerulonephritis, Nephrotic syndromeĭifferentiation of exudate and transudate fluid.Imbalance between oncotic and hydrostatic pressures Transudate (systemic illness) (Low protein Infection – Pneumonia, empyema, pleuritis, viral disease.Exudate ( local disease) (High protein). Local factors influence the accumulation or clearance of fluid.Pleural Fluid may be examined by a pleural tap or thoracocentesis.Pleural effusions are most commonly caused by CCF, Infection (pneumonia) and Malignancy.A pleural effusion is a collection of fluid in the pleural space. ![]()
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