Biochemical analysis of pleural and ascitic fluid: effect of sample timing on interpretation of results

Ann Clin Biochem 2007;44:471-473
doi:10.1258/000456307781645978
© 2007 Association for Clinical Biochemistry

 

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Original Articles


Fiona Jenkinson and
Michael J Murphy


Department of Biochemical Medicine, Ninewells Hospital & Medical School, Dundee DD1 9SY, Scotland


Background: Modified Light’s criteria are widely used to categorizepleural fluids as either exudates or transudates. Similarly,the serum-ascites albumin gradient (SAAG) is used in the differentialdiagnosis of ascites, particularly with reference to the predictionof portal hypertension. Fluid and serum samples are requiredfor both of these to be applied. The effect of the time intervalbetween fluid and serum samples on the interpretation of resultshas not been studied.

Methods: We examined the effect of sample timing on (a) the application of modified Light’s criteria, and (b) the categorization of SAAG as wide (≥11 g/L) or narrow (<11 g/L). Specifically,we compared the use of a ‘routine’ serum sample, i.e. one thatwas not formally paired by the requesting clinician with thefluid sample, with serum samples collected within 2 h of thefluid sample.

Results: Of 77 pleural fluids included for analysis, 45/47 were categorized as exudates, and 32/30 as transudates, using near-simultaneous/routine serum samples respectively. Discrepant categorization was observed in two cases (P=0.74). Of 109 ascitic fluids, SAAG was ≥11 g/L in 100/95 cases, and <11 g/L in 9/14, using near-simultaneous/routine serum samples respectively. Discrepant categorization was observed in five cases (P=0.27).

Conclusions: With reference to categorizing pleural and asciticfluids as described above under (a) and (b), in most cases theuse of routine serum samples does not alter the fluid categorizationcompared with the use of serum samples collected within 2 h.


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