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Body Fluid Analysis -Ascitic Fluid

Blood
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Report in 12Hrs

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At Home

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No Fasting Required

Details

Antinuclear antibody test screens for autoimmune diseases such as lupus or Sjögren’s syndrome.

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Body Fluid Analysis - Ascitic Fluid

  • Why is it done?
    • To evaluate abnormal accumulation of fluid (ascites) in the peritoneal cavity
    • To determine the underlying cause of ascites (cirrhosis, malignancy, infection, heart failure, kidney disease)
    • To diagnose spontaneous bacterial peritonitis (SBP) or other peritoneal infections
    • To detect malignant cells or ascites related to cancer
    • To assess protein levels and determine if ascites is transudative or exudative
    • To provide symptomatic relief through therapeutic paracentesis in patients with large volume ascites
    • Typically performed when ascites is first detected or when clinical deterioration occurs
  • Normal Range
    • Cell Count: WBC <500 cells/µL (normal range 0-500 cells/µL), RBC <5,000 cells/µL, Neutrophils <250 cells/µL (absolute neutrophil count <250/µL)
    • Protein: Normal is variable; serum-ascites albumin gradient (SAAG) <1.1 g/dL suggests portal hypertension is not cause
    • Appearance: Clear to pale yellow
    • Glucose: Similar to serum glucose (60-100 mg/dL)
    • LDH: <400 IU/L or less than serum LDH
    • Bacterial Culture: Negative (no growth)
    • Cytology: Negative for malignant cells
    • Albumin: <1.1 g/dL difference between serum and ascitic fluid (SAAG <1.1 indicates non-portal hypertension cause)
  • Interpretation
    • Elevated Neutrophils (>250 cells/µL): Suggests spontaneous bacterial peritonitis (SBP) or other bacterial infection; requires antibiotic therapy
    • Positive Bacterial Culture: Confirms bacterial peritonitis; culture and sensitivity guide antibiotic selection
    • Positive Cytology: Indicates malignant ascites; helps diagnose peritoneal carcinomatosis from primary cancers (gastric, ovarian, pancreatic, breast)
    • High Protein (>2.5 g/dL) / Exudative Pattern: Suggests malignancy, infection, pancreatitis, or peritoneal carcinomatosis; LDH >serum and glucose <60 mg/dL support exudate
    • Low Protein (<2.5 g/dL) / Transudative Pattern: Suggests portal hypertension (cirrhosis), congestive heart failure, nephrotic syndrome, or malnutrition; SAAG >1.1 indicates portal hypertension
    • Blood-Tinged or Hemorrhagic Appearance: May indicate malignancy, traumatic tap, or bleeding disorder; elevated RBC count supports this
    • Low Glucose (<60 mg/dL): Suggests bacterial infection, fungal infection, malignancy, or tuberculosis; warrants further investigation
    • Elevated Lymphocytes: May indicate tuberculous peritonitis, malignancy, or viral infections
    • Factors Affecting Results: Sample contamination, delayed processing, antibiotic use before sampling, traumatic tap (RBC contamination), dilution with blood
  • Associated Organs
    • Primary Organ System: Peritoneum (peritoneal cavity lining and abdominal organs)
    • Liver-Related Conditions: Cirrhosis (most common cause of ascites worldwide), hepatitis, fatty liver disease, cirrhosis with portal hypertension, hepatic fibrosis, Budd-Chiari syndrome
    • Cardiac-Related Conditions: Congestive heart failure, constrictive pericarditis, restrictive cardiomyopathy
    • Malignancy-Associated: Gastric cancer, ovarian cancer, pancreatic cancer, colorectal cancer, breast cancer, peritoneal mesothelioma, metastatic disease to peritoneum
    • Renal/Metabolic Conditions: Nephrotic syndrome, renal failure, malnutrition, hypoalbuminemia
    • Infectious Conditions: Spontaneous bacterial peritonitis (SBP), tuberculous peritonitis, fungal infections, secondary bacterial peritonitis from perforation
    • Other Associated Conditions: Acute pancreatitis, pancreatic insufficiency, peritoneal dialysis peritonitis, inflammatory bowel disease complications
    • Potential Complications from Abnormal Results: Untreated bacterial peritonitis can lead to sepsis and death; malignant ascites indicates advanced disease; portal hypertension complications include variceal bleeding; respiratory compromise from large volume ascites
  • Follow-up Tests
    • If Elevated Neutrophils Suspected (SBP): Repeat ascitic fluid analysis to assess response to therapy; blood cultures; serum creatinine, BUN, and albumin; prothrombin time (INR)
    • If Positive Cytology (Malignancy Suspected): CT or MRI imaging of abdomen/pelvis; tumor markers (CEA, CA-125, others as clinically indicated); PET scan if indicated; colonoscopy, upper endoscopy, or imaging to identify primary cancer; oncology consultation
    • If Portal Hypertension Suspected: Liver function tests (AST, ALT, bilirubin, albumin); hepatitis serology (A, B, C); abdominal ultrasound or Doppler ultrasound; liver biopsy if diagnosis unclear; assessment for esophageal varices
    • If Tuberculosis Suspected: AFB smear and culture of ascitic fluid; Xpert MTB/RIF assay; chest X-ray; tuberculin skin test (TST) or interferon-gamma release assay (IGRA)
    • If Pancreatitis Suspected: Serum lipase and amylase; liver function tests; imaging (CT or MRCP) of pancreas; triglyceride and glucose levels
    • Monitoring and Follow-up Frequency: For cirrhotic patients with ascites: monitoring every 3-6 months or with clinical changes; repeat paracentesis if new fever or abdominal symptoms develop; for malignant ascites: depends on treatment response; for SBP: therapeutic follow-up within 48-72 hours after antibiotic initiation
    • Complementary Tests: Serum albumin and total protein (for SAAG calculation); serum LDH and glucose (to support exudate vs. transudate classification); serum bilirubin and prothrombin time (for liver function); imaging studies (ultrasound, CT, MRI)
  • Fasting Required?
    • Fasting Required: No
    • Patient Preparation Requirements: Empty bladder and bowel before procedure; patient gown for procedure access; informed consent required; patient positioned supine or semi-upright as directed
    • Medications: Continue regular medications unless otherwise instructed; anticoagulants should be discussed with provider (INR should be <1.5 and platelets >50,000 for safe procedure)
    • Special Instructions: Paracentesis procedure uses local anesthesia at needle insertion site; ultrasound guidance typically used to identify ascitic fluid collection and select safest entry point; explain any significant allergies, especially to anesthetics or iodine (if iodine-based preparation used); arrange transportation home if sedation used; do not drive for 24 hours after procedure if sedation administered

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