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Body Fluids

Test indication: Any excess amount of fluid, an effusion is always an indication of a pathologic process. Thus the presence of an effusion indicates that the patient has a disease. Laboratory investigation of the effusion fluid including examination of the exfoliated cells may provide the key to the patient’s diagnosis. Body cavity fluids are commonly evaluated for the presence of malignant cells from metastatic disease. These fluids include pleural, peritoneal, pericardial, synovial and pelvic washing.

Specimen types: Body fluids (Pericardial, Peritoneal, Ascites, and Pleural fluids, Paracentesis, Thoracentesis)

Methodology: Routine cytopathologic evaluation.
Performed: Monday-Friday.
TAT: 1 day (24 hours).

Specimen requirements: 10 mL (or more) of fluid for small fluid accumulations the entire specimen is submitted for laboratory evaluation. For larger effusions, 50-200 mL of well-mixed fluid should be sent for cytologic evaluation. However the entire specimen is acceptable.

Supplies: Non-sterile specimen container, test requisition, biohazard bag.

Collection procedure: Using standard aseptic technique by needle puncture, saline washing and/or aspiration to obtain a fluid specimen from the desired body cavity. If necessary, move the patient into multiple positions to suspend cellular material in the fluid. A minimum of 10 mL of specimen is desirable for optimal cytologic evaluation. If other studies are required, withdraw a fraction of the specimen and submit it to the appropriate laboratory separately following their guidelines for specimen collection. Heparin may be added to the specimen to reduce clotting. Place 3 units of heparin per mL capacity of the collection container. Agitate the container to coat the sides with heparin. Label the container with the patient’s first and last name, date of birth, specimen type and collection date. Submit the specimen to the Cytopathology Laboratory along with the completed Cytology test request form.

Fixation: Submit fresh sample (no fixative preferred). If delay in transportation to laboratory, refrigerate 4°C (or 39°F) up to 72 hours. The exception is cerebrospinal fluid, which begins to degrade shortly after collection if stored at room temperature or refrigerated. Add 50% ethanol equal to the volume of specimen if transport is delayed or use proprietary transport medium supplied by the manufacturers of liquid based medium systems. Any fixative added should be noted on the requisition.

Transport: Each specimen should be placed in a clearly labeled container that is leak proof. Place specimen in a biohazard transport bag. The paper requisition(s) that accompanies the specimen should be placed in the outside pocket of the biohazard bag to avoid exposure to any leakage.

Causes for rejection: Incomplete patient requisitions, unlabeled/incorrectly labeled specimen, frozen specimen, incorrect test ordered for specimen, specimen in incorrect or expired fixative, specimen from unauthorized person.

Specimen stability: Varies; if some delay is unavoidable (12-24 hours) body fluids may be refrigerated at 4°C (or 39°F) up to 72 hours.

Reference interval: By report

CPT code(s): 88108 Concentration and interpretation, or 88112 Selective cellular enhancement with interpretation and 88312 x3. Special stains. Additional CPT codes may apply if special studies are required.

References:
1. DeMay Richard M. “Fluids” The Art & Science of Cytopathology. Chicago:ASCP Press, 1996
2. Non-gynecological Cytology Practice Guidelines; American Society of Cytotechnology, CytoPathology Practice Committee, Adopted by: ASC Executive Board, March 2, 2004. http://www.cytopathology.org/guidelines/nongynecological.php

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