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PERICARDIAL FLUID
1.
2. ο Ultrafiltrate of plasma that lies within the pericardial sac,
acting as a lubricant between the visceral and parietal layer of
the pericardium.
ο The space normally contains 15-50 mL of thin, clear, straw-
colored fluid
ο Enriched in molecules from the myocardial interstitial fluid and
lymphatic drainage
3. ο Abnormal accumulation of pericardial fluid can be
secondary to obstruction of fluid drainage, injury or
insult to the pericardium, infection, malignancy,
systemic or autoimmune processes, drugs, or
procedures.
4. ο The etiology of pericardial effusion includes the following:
ο Idiopathic pericarditis
ο Infection
ο Bacteria
ο Staphylococcus, Streptococcus, Haemophilus, Neisseria, Chlamydia
ο M tuberculosis (still prevalent in developing countries)
ο Viral (coxsackievirus A and B, echovirus, adenovirus, HIV)
ο Fungal β Aspergillus, Candida, Histoplasma, Blastomycosis,
Coccidioidomycosis
ο Protozoan β Echinococcus, Amebiasis, Toxoplasmosis
ο Neoplasms
ο Metastatic/paraneoplastic (breast, lung, leukemia, lymphoma)
ο Primary β Teratoma, lipoma, angioma, rhabdomyosarcoma
ο Autoimmune connective tissue disease
5. ο The following conditions are associated with elevated WBC
counts:
ο Elevated levels of leukocytes (>10,000/mcl) with neutrophil
predominance suggests a bacterial or rheumatic cause.
ο The monocyte count is noted to be highest in malignant
effusions.
ο Myxedema is associated with low WBC count.
ο Elevated pericardial ADA activity is suggestive of TB
pericarditis.
6. ο A low ratio of pericardial effusion (PE) and serum glucose
suggests infection. This low ratio, along with an elevated
neutrophil count in pericardial fluid, is suggestive for bacterial
pericardial effusion
7. ο Routine panels are as follows:
ο Cell count with differential
ο Glucose level
ο Pericardial fluid total protein
ο Pericardial fluid lactate dehydrogenase (LDH)
ο Serum Complement (anti-dsDNA, rheumatoid factor [RF],
antinuclear antibody [ANA])
ο Gram stain and culture (at least 3 culture bottles from
pericardial fluid)
8. ο Cytology (if malignancy is suspected)
ο Tumor markers (if malignancy is suspected)
ο Adenosine deaminase (if tuberculosis [TB] is suspected)
ο Polymerase chain reaction (PCR) for Mycobacterium tuberculi
(if TB is suspected)
ο Pericardial interferon-gamma (interferon-gamma) if TB is
suspected
ο Viral cultures
ο Molecular analysis (PCR) for bacteriological, viral, or fungal
agents
ο B-type natriuretic peptide (BNP)