Protein, Total, Body Fluid


Sunquest Code:FTPP  
Epic Code:LAB196Epic Name:Protein Fluid
Methodology:Bichromatic rate
CPT Code:84157
Turnaround Time:Performed and reported 24 hours/day.
Special Instructions:Indicate type of fluid on request form. Blood protein level should be collected simultaneously.


Collection Instructions

Specimen:Fluid (pleural, peritoneal, pericardial, synovial)
Optimal Volume:1.25 mL
Minimum\Peds Volume:0.2 mL
Causes for Rejection:Moderate hemolysis


Processing and Shipping

Specimen Processing:Aliquot 1.25 mL, 0.2 mL minimum. Store in refrigerator.
Shipping Instructions:Ship at refrigerated temperature.
Test Performed at or Referral Lab Chemistry  (Fairview Range - FRMC, UMMC-East Bank, Fairview Lakes - FLMC, Fairview Ridges - FRH, Fairview Northland - FNMC, Fairview Southdale - FSH, UMMC/UMMCH-West Bank)


Interpretive

Reference Range:No reference ranges have been established. This result should be interpreted in the context of the patient's clinical condition and compared to simultaneous measurement in the patient's blood. Pleural fluid: transudate: protein less than 3.0 g/dL; exudate: protein greater than 3.0 g/dL; a greater than 0.5 g/dL pleural fluid to serum protein ratio is indicative of an exudate in hypoproteinemic states. Peritoneal fluid: exudate: greater than 2.5 g/dL; note: there are many exceptions to this figure.
Use:

For differentiation of transudates from exudates, test blood for protein, lactate dehydrogenase (LD), and glucose for comparison with fluid levels. Transudates (plasma ultrafiltrate) may be seen in congestive heart failure, cirrhosis, nephrosis; exudates (inflammatory response) may be seen in infections, infarcts, cancer, rheumatoid arthritis (lung), acute pancreatitis with left pleural effusion and ascites.

 

 

Transudate

Exudate

Appearance

Watery, clear or yellow; does not clot

Cloudy, yellow, purulent, blood (cancer, infarcts), green (infections bile), glittery (old effusion, cholesterol crystals); may clot (high fibrinogen)

Cell Count, leukocyte

Less than 1000 mL with greater than 50% lymphocytes and monocytes

500 to greater than 1000 mL with increased neutrophils’ lymphocytes with Tbc or Rh arthritis

Cell Count, red cell

Low (or from puncture)

Greater than 200,000 mL especially with cancer

Glucose

Varies with serum level

Lower than serum level with some infections and high cell counts; very low with Rh arthritis (pleural fluid)

LD

Low

Increased greater than 60% of serum level, due to cell debris

Protein

Less than 1 g/dL

Greater than 3 g/dL (pleural) or greater than 50% of serum level

Specific Gravity*

Less than 1.016

Greater than 1.016

*Roughly correlates with protein in serous fluids, but technically unsatisfactory and not recommended.

Pleural Fluid

Protein 3 g/dL or greater, or greater than 50% of serum protein or LD greater than 60% of serum level are indicative of exudate

Pericardial Fluid

Protein level is not helpful in differentiation

Peritoneal Fluid

Total protein consistent with peritoneal exudate is usually considered to be lower than for pleural fluid exudate, 2 to 2.5 g/dL

 

 



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