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synovial fluid findings in disease states

Laboratory: 1) Normal - appearance: clear to straw colored - 0-150 WBC/mm3 (0-0.15 x 10E9/L): neutrophils < 25% - no RBC - glucose within 10 mg/dL (0-0.56 mmol/L) of plasma glucose 2) non-inflammatory conditions - appearance: yellow, transparent - < 3000 WBC/mm3 (< 3 x 10E9/L): < 30% neutrophils - no RBC - glucose within 10 mg/dL (0-0.56 mmol/L) of plasma glucose - examples: osteoarthritis, traumatic arthritis, neuropathic osteoarthropathy, pigmented villonodular synovitis, early rheumatic fever, early rheumatoid arthritis, early bacterial infection 3) inflammatory - appearance: yellow, cloudy, turbid - 3000-75,000 WBC/mm3 (3-75 x 10E9/L): > 50% neutrophils - no RBC - glucose may be diminished up to 40 mg/dL (2.22 mmol/L) relative to plasma glucose - examples: rheumatoid arthritis, lupus erythematosus, Reiter's syndrome, rheumatic fever, gout, pseudogout, arthritis associated with inflammatory bowel disease, psoriatic arthritis, fat droplet synovitis 4) infectious - appearance: yellow, purulent, or bloody - 50,000-200,000 WBC/mm3 (50-200 x 10E9/L): > 90% neutrophils - RBCs present - glucose diminished 20-100 mg/dL (1.11-5.55 mmol/L) relative to plasma glucose - examples: bacterial, fungal & tuberculous infections 5) lymphocytic predominance (up to 20,000/uL) - Mycobacterium (tuberculous arthritis) - mycosis - Borrelia - sarcoidosis [2] 6) hemorrhagic - red-brown or xanthochromic - 50-10,000 WBC/mm3 (0.05-10 x 10E9/L): < 50% neutrophils - RBCs present - glucose within 20 mg/dL (0-1.11 mmol/L) of plasma glucose - examples: hemorrhagic effusions associated with traumatic arthritis, pigmented villonodular synovitis, synovial hemangioma, neuropathic osteoarthropathy, joint prostheses, hematologic disorders including: hemophilia, thrombocytopenia, anticoagulation, sickle cell disease or sickle cell trait, myeloproliferative disorder * SI units in parentheses

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synovial fluid synovial fluid analysis

References

  1. Clinical Diagnosis & Management by Laboratory Methods, 19th edition, J.B. Henry (ed), W.B. Saunders Co., Philadelphia, PA. 1996, pg 472
  2. Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018