Atlas of Synovial Fluid Cytopathology by A. J. Freemont MD, FRCP(E), MRCPath, J. Denton MSc (auth.)

By A. J. Freemont MD, FRCP(E), MRCPath, J. Denton MSc (auth.)

Like all really good parts of drugs, that of joint affliction informative. The ideas, useful and interpretive, has develop into surrounded by way of a realistic mystique and are hugely reproducible and easy, letting them be utilized in any laboratory. jargon particular to itself. The variety of clinicians operating even if we see this quantity as being of worth to all within the box is big however the variety of pathologists small. attracted to joint sickness it's particularly aimed toward It follows that almost all of pathologists are at a little laboratory employees wishing to supply a synovial fluid analytical of an instantaneous drawback while discussing and ana­ provider. Like such a lot cytology we think a lot of the phone lysing articular issues of their rheumatological and and non-cell id and quantitation can, and orthopaedic colleagues. may still, be undertaken by means of expert technical employees. The publication within the particular zone of synovial fluid exam the is for that reason aimed essentially at teams: pathologists problems for the pathologist are compounded simply because who don't focus on joint disorder and technical employees so far there were no easy texts that aspect the who might be producing the knowledge on which interpretation equipment, findings and interpretation of the macroscopic might be established. it really is consequently either a textual content publication and a bench and microscopic features of the fluid within the universal reference guide. arthropathies. during this e-book we are hoping to head a way we don't think our facts or technique characterize in the direction of rectifying this omission.

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Calcium oxalate) and many others. As a general rule, anyone type of crystal tends to have a predictable structure along the lines outlined above. Unfortunately, this is not always the cases (see description of individual crystals below). Birefringence I n addition to crystal shape, it is essential to be able to tell the nature of the birefringence of the crystal. For this, some sort of polarizing attachment is required on the diagnostic microscope, preferably one in which a firstorder red compensator can be interposed between the polarizer and the specimen.

Secondly, there is the major problem of recognition of bacteria, particularly Gram-negative organisms (including Gram-positive organisms that have been rendered Gramnegative by partial antibiotic therapy; Fig. 6). In all 57 58 CYTOCENTRIFUGE PREPARATIONS. 1. ORGI\NISMS . '~ • .... v. II .. I Fig. 1 Staphylococci within synovial fluid macrophages. JennerGiemsa stain. x 750 Fig. 2 Staphylococci in a cytocentrifuge preparation. ionally bacteria congregate around and within individual cells. Gram stain.

Of course, form with dic81lcium pyrophosphate and so, before identifying a crystal as hydroxyapatite, it is necessary to exclude fully the presence of birefringent crystals within the unstained synavial fluid. Often both crystals may coexist in one synovial fluid sample and the problem becomes one of demanstrating the existence of both. By and large, crystals af hydroxyapatite are much more numeraus than those of calcium pyrophasphate, and a camparison of the numbers seen with the conventional palarizing microscope before and after treatment of the fluid with alizarin red S may be the only way to resalve this prablem.

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