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🧪 ADA (Adenosine Deaminase) – Ascitic Fluid

Aspect	Details
Fasting Required?	❌ Not required
Sample Type	Ascitic fluid (fluid from the abdominal cavity)
Main Organs Involved	Peritoneum, lymphatic system, immune system
Primary Use	To diagnose tuberculous peritonitis in patients with ascites

🔬 What is ADA?

Adenosine Deaminase (ADA) is an enzyme involved in purine metabolism, essential for T-cell activity.
In tuberculous infections, T-cell activation in the peritoneal cavity causes elevated ADA levels in ascitic fluid.

🧠 Why Measure ADA in Ascitic Fluid?

ADA testing in ascitic fluid helps:

Differentiate tuberculous peritonitis from other causes of ascites like cirrhosis, malignancy, or pancreatitis.
Support early TB diagnosis, especially when smear/culture are negative or take time.

📈 Interpretation of ADA in Ascitic Fluid

ADA Level (U/L)	Interpretation
< 30 U/L	TB unlikely; consider cirrhosis or malignancy
30–40 U/L	Borderline; interpret with clinical signs and cell counts
> 40 U/L	Suggestive of tuberculous peritonitis
> 60 U/L	Strongly supports TB in high-prevalence settings

🔹 Best interpreted with lymphocyte-predominant ascitic fluid and high protein content.

⚠️ False Positives / Considerations

Condition	How it affects ADA
Lymphoma, carcinomatosis	May elevate ADA (false positive)
Cirrhosis or low protein ascites	May show low ADA even with TB (false negative)
Children / immunocompromised	May have variable ADA responses

🧪 Recommended Conjunction Tests

Test	Purpose
Ascitic Fluid Cytology	Rule out malignancy
AFB Smear & Culture	Detect TB bacteria (may be low yield)
GeneXpert / PCR for MTB	Molecular confirmation of Mycobacterium tuberculosis
Serum-Ascitic Albumin Gradient (SAAG)	Helps classify ascites as exudate/transudate
ESR, CRP	General inflammation markers
Ultrasound / CT Abdomen	Detect peritoneal thickening, lymphadenopathy

✅ Summary Table

Parameter	ADA – Ascitic Fluid
Purpose	Evaluate for TB peritonitis in patients with ascites
Sample	Ascitic fluid (paracentesis)
Normal Range	Typically <30 U/L
Critical Threshold	>40 U/L highly suggestive of TB (with clinical correlation)
Supports Diagnosis Of	Extrapulmonary TB (peritoneal)
Conjunction Tests	Cytology, GeneXpert, SAAG, imaging

Adenosine Deaminase (ADA)(Ascitic fluid)