SYNONYM/ACRONYM: Thoracentesis fluid analysis.

COMMON USE: To assess and categorize fluid obtained from within the pleural space for infection,
cancer, and blood as well as identify the cause of its accumulation.
SPECIMEN: Pleural fluid (5 mL) collected in a green-top (heparin) tube for amylase, cholesterol,
glucose, lactate dehydrogenase (LDH), pH, protein, and triglycerides; lavender-top (EDTA) tube for cell
count; sterile containers for microbiology specimens; 200 to 500 mL of fluid in a clear container with
anticoagulant for cytology. Ensure that there is an equal amount of fixative and fluid in the container
for cytology.
NORMAL FINDINGS: (Method: Spectrophotometry for amylase, cholesterol, glucose, LDH, protein,
and triglycerides; ion-selective electrode for pH; automated or manual cell count; macroscopic and
microscopic examination of cultured microorganisms; microscopic examination of specimen for
microbiology and cytology)

Peritoneal Fluid Reference Value

Appearance Clear
Color Pale yellow
Amylase Parallels serum values
Alkaline phosphatase Parallels serum values
CEA Parallels serum values
Glucose Parallels serum values
Red blood cell count None seen
White blood cell count Less than 300/microL
Culture No growth
Acid-fast stain No organisms seen
Gram stain No organisms seen
Cytology No abnormal cells seen

DESCRIPTION: The peritoneal cavity and organs within it are lined with a protective membrane. The
fluid between the membranes is called serous fluid. Normally only a small amount of fluid is present
because the rates of fluid production and absorption are about the same. Many abnormal conditions
can result in the buildup of fluid within the peritoneal cavity. Specific tests are usually ordered in
addition to a common battery of tests used to distinguish a transudate from an exudate. Transudates
are effusions that form as a result of a systemic disorder that disrupts the regulation of fluid balance,
such as a suspected perforation. Exudates are caused by conditions involving the tissue of the
membrane itself, such as an infection or malignancy. Fluid is withdrawn from the peritoneal cavity by
needle aspiration and tested as listed in the previous and following tables.

Characteristic Transudate Exudate

Appearance Clear Cloudy or turbid
Specific gravity Less than 1.015 Greater than 1.015
Total protein Less than 2.5 g/dL Greater than 3 g/dL
Fluid-to-serum protein ratio Less than 0.5 Greater than 0.5
LDH Parallels serum value Less than 200 units/L
Fluid-to-serum LDH ratio Less than 0.6 Greater than 0.6
Fluid cholesterol Less than 55 mg/dL Greater than 55 mg/dL
White blood cell count Less than 100/microL Greater than 1,000/microL

This procedure is contraindicated for: N/A

INDICATIONS
Evaluate ascites of unknown cause
Investigate suspected peritoneal rupture, perforation, malignancy, or infection

POTENTIAL DIAGNOSIS
Increased in
Condition/Test Showing Increased Result
Abdominal malignancy (red blood cell [RBC] count, carcinoembryonic antigen, abnormal cytology)
Abdominal trauma (RBC count)
Ascites caused by cirrhosis (white blood cell [WBC] count, neutrophils greater than 25% but less
than 50%)
Bacterial peritonitis (WBC count, neutrophils greater than 50%)
Peritoneal effusion due to gastric strangulation, perforation, or necrosis (amylase, ammonia, alkaline
phosphatase)
Peritoneal effusion due to pancreatitis, pancreatic trauma, or pancreatic pseudocyst (amylase)
Rupture or perforation of urinary bladder (ammonia, creatinine, urea)
Tuberculous effusion (elevated lymphocyte count, positive acid-fast bacillus smear and culture [25%
to 50% of cases])
Decreased in
Condition/Test Showing Decreased Result
Abdominal malignancy (glucose)
Tuberculous effusion (glucose)