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SYNOVIAL FLUID
A.C.O.I. Board Review 2018Howard L. Feinberg, D.O., F.A.C.O.I., F.A.C.R.
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OBJECTIVESReview the nomenclature and classification
system for synovial fluid analysis
– Review the classic classification system for synovial
fluid
– learn the common diseases for each class
Learn the appearance of normal and common
abnormalities in synovial fluid
– Differentiate gout crystals in synovial fluid
– Identify various crystals and inclusions in synovial
fluid
Learn the basic and some of the specialized
tests which can be performed on Synovial Fluid
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COMPONENTS OF SYNOVIAL
FLUID ANALYSISStandard Tests
Gross appearance
Volume
Cell count
Polarized light
microscopy
Viscosity
Gram stain
Culture and Sensitivity
Specialized testsAlizarin red or Von Kossa
black stain
Cytology
X-ray diffraction
Mucin Clot
Viscosity
Glucose
NAAT (nucleic acid
amplification test)
PCR (polymerase Chain
Reaction)
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SYNOVIAL FLUID
Group I Noninflammatory
Group II Inflammatory
Group III Septic
Group IV Hemmorhagic
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SYNOVIAL FLUIDGroup I– Osteoarthritis
– Thyroid
– Amyloid
– Osteonecrosis
Group III– Infection
Group II– Rheumatoid
– Psoriatic
– Crystal disease
– Reiters/Reactive Arthritis
– Enteropathic
– Bechets
Group IV– Trauma
– Bleeding disorders
– Villonodular Synovitis
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SYNOVIAL FLUID
Normal Group I Group II Group III
Volume Low Low High High
Viscosity High High Low Variable
Color Clear Clear/Y Yellow Variable
Clarity Trans. Trans. Cloudy Opaque
Mucin Clot Firm Firm Friable Friable
WBC 200 200 2-100,000 50-100,000
Culture Neg Neg. Neg. Variable
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SYNOVIAL FLUID
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SYNOVIAL FLUID
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SYNOVIAL FLUID
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SYNOVIAL FLUID
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SYNOVIAL FLUID
CHOLESTEROL LIPID
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CALCIUM OXALATE
Light Microscopy Alizarin Red
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Calcium Apatite Crystals
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STEROID CRYSTALS
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OCHRONOSIS
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Contact Information
Howard Feinberg, D.O., F.A.C.O.I., F.A.C.R.
1310 Club Drive
Vallejo, CA 94592