Question

A 48-year old woman presents with ascites and pleural effusion. Blood is collected, along with peritoneal fluid. The following results were obtained:

Blood chemistry results:

•Total protein - 6.5 g/dL

•LD - 300 U/L

•Glucose, fasting - 82 mg/dL

•Liver enzymes – normal

Peritoneal fluid results:

•Color – yellow

•Clarity – clear

•Clots present – no

•WBC count – 8/µL

•Total protein – 2.9 g/dL

•LD – 125 U/L

•Glucose – 85 mg/dL

Questions

1. Calculate the fluid-to-serum total protein ratio.

2. Calculate the fluid-to-serum LD ratio.

3. Would this fluid be classified as a transudate or an exudate? What results led to your decision? BE SPECIFIC!!

4. State 1 physiologic mechanism that can cause this type of effusion.

Answer 1

1. Fluid to serum total protein ratio = 2.9/6.5 = 0.45

2. Fluid to serum LD ratio = 125/300 = 0.42

3. Fluid is transudate as Glucose content of peritoneal fluid is similar to blood levels, fluid to serum LDH ratio < 0.6, Fluid to serum total protein ratio < 0.6, WBC count is normal in fluid, hence it is transudate.

4. Transudative fluid appears when hydrostatic force of capillary increased more than colloid osmotic pressure (example - Congestive cardiac failure) or low colloid osmotic pressure (example - nephrotic syndrome, liver cirrhosis)