biochimica clinica

en_US English
en_US English it_IT Italian

CASI CLINICI – Case Reports

Volume:

Biochimica Clinica, vol.47, n.4 pag E62-5

Pubblicato on-line:

July 7, 2023

DOI:

10.19186/BC_2023.044

Scarica in PDF:
Autenticazione richiesta

Un liquido sinoviale da indagare attentamente
A synovial fluid to be looked with care

AUTORI

Paolo Salari1 Lara Mosconi2, Sabrina Buoro3, Andrea Baldini1, Fiamma Balboni2
1UO Ortopedia, Istituto Fiorentino Cura e Assistenza IFCA Firenze
2Laboratorio Analisi, Istituto Fiorentino Cura e Assistenza IFCA Firenze
3Centro di Riferimento Regionale per la qualità dei servizi di medicina di laboratorio ASST Grande Ospedale Metropolitano Niguarda Milano

ABSTRACT

A synovial fluid to be looked with care

A 82 years old female patient with total knee replacement, attended to our clinic with a swollen knee, pain and signs suggesting periprosthetic joint infection (PJI). An automated cell count of the synovial fluid was performed showing significantly elevated number of cells (85 000/µL) and a particular distribution of the scatter-plots. The count was compatible with PJI but, due to very particular scattergrams, the synovial fluid was consequently examined at the optical microscopy (OM) displaying an abundant amount of amorphous debris compatible with plastic fragments. An interference from plastic debris with the analytic system of the automated cell counter (sheath flow direct current and flow cytometry) has been confirmed. Only the OM could catch this interference, avoiding wrong diagnosis and additional unnecessary surgery to the patient.

BIBLIOGRAFIA

  1. Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF, et al. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty 2018;5:1309-14.
  2. Seghezzi M, Buoro S, Manenti B, Mecca T, Ferrari R, Zappalà G, et al. Optimization of Cellular analysis of Synovial Fluids by optical microscopy and automated count using the Sysmex XN Body Fluid Mode. Clin Chim Acta 2016;462:41-8.
  3. Clinical and Laboratory Standard Institute. Body Fluid analysis for cellular composition; approved guidelines. CLSI document H56-A. CLSI Wayne, PA, 2006
  4. Bourner G., De La Salle B., George T., Tabe Y., Baum H, Culp N, et al. ICSH guidelines for the verification and performance of automated cell counters for body fluids, Int J Lab Hematol 2014; 36:598-612.
  5. Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM , et al. Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2013;56:1-10.
  6. Lavernia CJ, D’Apuzzo MR, Hernandez VH, Lee DJ, Rossi MD. Postdischarge costs in arthroplasty surgery. J Arthroplasty 2006;21:144-50.
  7. Carpenter CR, Schuur JD, Everett WW, Pines JM. . Evidence-based diagnostics: adult septic arthritis. Acad Emerg Med 2011;18:781-96.
  8. Zmistowski B, Della Valle C, Bauer TW, Malizos KN, Alavi A, Bedair H , et al. Diagnosis of periprosthetic joint infection. J Arthroplasty 2014;29:77-83.