doi:10.1258/0004563011900812
© 2001 Association for Clinical Biochemistry
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Review Articles
Anne C Tarn and
Ruth Lapworth
Biochemical examination of pleural fluid is usually done totry to identify the cause of a pleural effusion. The variousanalytes that have been suggested for this are reviewed andevaluated.
Distinguishing whether the effusion is an exudate or transudateis a pragmatic first step, with further investigations dictatedby the clinical features and these results. Total protein andlactate dehydrogenase were used first; Light’s criteria werepublished in 1972 and since then additional markers includingcholesterol, bilirubin and albumin gradient plus combinationsof these have been proposed. Although combination testing doesimprove the sensitivity for diagnosis of an exudate, this isat the expense of specificity. Measurement of fluid to serumratios appears to confer no advantage, and if a single testis required total protein performs as well as any.
Additional tests may be useful in specific circumstances: pleuralfluid pH may aid decisions over drainage of a parapneumoniceffusion; glucose may indicate an effusion associated with rheumatoidarthritis; and adenosine deaminase may help with the diagnosisof tuberculous effusions.
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