Ascitic fluid, analysis

Gerbes, A.L., Jiingst, D., Xie, Y., Permanetter, W., Panmgartner, G. Ascitic fluid analysis for the differentiation of mahgnancy-related and nonmahgnant ascites. Proposal of a diagnostic sequence. Cancer 1991 68 1808-1814... 

In adult patients with new-onset ascites as determined by physical exam or radiographic studies, abdominal paracentesis should be performed and ascitic fluid analysis should include a cell count with differential and a serum-ascites albumin gradient (SAG). If infection is suspected, ascitic fluid cultures should be obtained at the time of the paracentesis. The SAG can accurately determine whether ascites is a result of portal hypertension or another process. If the SAG is >1.1 g/dL, portal hypertension is present with 97% accuracy. If the SAG is <1.1 g/dL, with similar certainty the patient does not have portal hypertension. This is important because patients without portal hypertension will not respond to salt restriction and diuretics. The treatment of ascites secondary to portal hypertension is relatively straightforward and includes abstinence from alcohol, sodium restriction, and diuretics. This strategy is effective in approximately 90% of patients. Fifteen percent of patients will respond to dietary sodium restriction alone, and an additional 75% of patients will respond to the addition of diuretics. ... 

Gerbes A (1991) Ascitic fluid analysis for the differentiation of malignancy-related and non-malignant ascites. Cancer 68 1808-1812... 

Runyon B, Hoefs JC, Morgan TR (1988) Ascitic fluid analysis in malignancy related ascites. Hepatology 8 1104-1109 Sistrom CL, Abbitt PL, Feldman PS (1992) Ultrasound guidance for biopsy of omental abnormahties. J Clin Ultrasound 20 27-31... 

Greco, A. V., Mingrone, G., Gasbarrini, G. Clin. Chim. Acta 239, 1995, 13-22. Free fatty acid analysis in ascitic fluid improves diagnosis in malignant abdominal tumors. 

Affinity chromatography and related techniques (e.g., thiol chromatography and IMAC) are widely used for preparative isolation because they enable a single protein or class of proteins to be selectively purified from very complex mixtures. They may be occasionally used as analytical tools. For example, protein A affinity chromatography has been used for quantitative analysis of immunoglobulins in ascites fluid.45 Information about surface-accessible histidine and phosphate groups may be obtained using IMAC. 

Many errors can occur during the collection, processing, and transport of biological specimens. Minimizing these errors win result in more reliable information for use by healthcare professionals. Examples of biological specimens that are analyzed in clinical laboratories include whole blood serum plasma urine feces saliva spinal, synovial, amniotic, pleural, pericardial, and ascitic fluids and various types of solid tissue. The National Committee for CMnical Laboratory Standards (NCCLS) has published several procedures for collecting many of these specimens under standardized conditio ns.In addition, the NCCLS has published documents related to sample collection and analysis for specialized tests, such as sweat chloride (see also Chapter 27). 

Engel H, Bac DJ, Brouwer R, Blijenberg BG, Linde-mans J. Diagnostic analysis of total protein, albumin, white cell count and differential in ascitic fluid. Eur J Clin Chem Clin Biochem 1995 33 239-42. 

Diagnosis of peritoneal metastatic involvement is often based on fluid analysis and ultrasound-guided aspiration of ascites is frequently used in patients with small amounts of liquid (Fig. 18.5). 

The nucleotide patterns of cultured animal cells and ascites tumor cells are generally less vulnerable than those of tissues however, if washing is required, a medium capable of supporting energy metabolism should be employed. If cells are to be packed by centrifugation prior to extraction, cultures or ascitic fluids may first have to be cooled. Cells are extracted in the cold some procedures employ alternate freezing and thawing in the presence of acidic extractants. Extraction of cultured mouse embryo cells with 60% methanol for 16 hours at — 20 C has been employed in the analysis of deoxyribonucleoside triphosphates 9). 

Xiao, Y.J., Schwartz, B., Washington, M., Kennedy, A., Webster, K., Belinson, J. and Xu, Y., Electrospray ionization mass spectrometry analysis of lysophospholipids in human ascitic flnids comparison of the lysophospholipid contents in malignant vs nonmalignant ascitic fluids. Anal. Biochem., 290, 302-313 (2001). 

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