32.0 Synovial Fluid Gout (Urate Crystals)


Title of Manual: Specimen Collection

Version No: 2.0

Title: Synovial Fluid

Effective Date: 11/01/09
Revised Date: 01/02/14

Document #: GPA.SPC.32.0


I. PURPOSE

To provide proper collection protocol for the SurePath Liquid Based Pap Test.

II. MATERIALS

Amount

Tube

Test

Note

0.5 – 2 ML

Syringe or Sterile Tube

Culture, Gram stain & Crystal analysis

Cap syringe w/o needle or use Sodium polyanethol sulfate (SPS) tube w/o anticoagulant

0.5 – 2 ML

EDTA
(lavender top) Tube

Cell count, Differential, Crystal analysis, and Viscosity

Aliquot fluid from syringe into tube. Mix gently.

0.5 – 1 ML

Sodium Heparin
(green top) Tube

Special Chemistries,
Protein & Immunological

Aliquot fluid from syringe into tube. Mix gently.

0.5 – 1 ML

Fluoride (gray top) Tube

Glucose

Without anticoagulant. Aliquot fluid from
syringe into tube.


Tissue submitted for gout must be placed in 100% (absolute) alcohol. If absolute alcohol is not available the tissue may be submitted fresh in a tissue container and transported, being kept cool with wet ice (ice pack). Fixatives containing water will destroy the crystals.


III. PROCEDURE

Complete test requisition including last and first name of patient, patient’s date of birth, body site and source of specimen collected. Include pertinent clinical information, i.e., previous malignancy, therapy, drugs, rule out crystals, etc. If possible, the examining physician should record a brief gross description of the fluid including volume, color, clarity, and viscosity. Viscosity can be checked by observing the length of the string formed as the syringe is pulled away from the needle or tube. Normal fluid will form a string 5 to 8 cm in length before breaking. Label specimen container with two patient identifiers. Place container in a specimen bag with a biohazard label. Place the requisition in the side pocket of the specimen bag.

Routine joint fluid analysis can include a white blood cell count with differential, a microscopic examination under polarized light for crystals, a gram stain and bacteriologic cultures. Fluid should be expelled into the appropriate tube for test desired and/or left in the syringe kept cold. Synovial fluid from inflamed joints can clot when collected and therefore should be collected into an anticoagulant for accurate cell counts, differential counts, and crystal analysis. Glucose and protein are ordered only if there is sufficient fluid and need. If a glucose test is to be performed, the patient should be fasting for at least 6 hours prior to collection of joint fluid. A 6-hour fast is necessary to establish an equilibrium between plasma and joint glucose levels. Special chemistries may be indicated in certain circumstances.

The examining physician should record a gross description of the fluid (volume, color, clarity, and viscosity).

IV. QUALITY CONTROL

• Minimum Volume:
    • 0.1 X 0.1 X 0.4 cm tissue
    • 0.5 – 2.0 mL fluid
• Storage Requirements:
    • Refrigerated
• Stability Requirements:
    • Synovial fluid specimens should be sent to the laboratory promptly. Fresh specimens are typically
      stable at room temperature for 4 hours and refrigerated for 24 hours. Sterile tube and syringe must
      be kept cold (refrigerated). All other anticoagulant tubes are kept at room temperature.

V. CALCULATIONS/CALIBRATION

VI. INTERPRETATIONS

VII. METHOD PERFORMANCE SPECIFICATIONS

VIII. REFERENCES

IX. RELATED DOCUMENTS

X. DOCUMENT HISTORY

MINOR REVISION
(Laboratory Director’s Signature on Original Subsequent Document Attached)

X - MAJOR REVISION
(Requires Laboratory Director & Department Director Signature - where applicable)

Reason for Change

1/2/14 New Document Control Format



Laboratory Director

(Signature)

Date

Natalie Depcik-Smith, MD
(Print)



Department Director

(Signature)

Date


(Print)



Designee

Date

(Print)

(Signature)

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(Signature)

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(Signature)

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