Q: Mention at least one precaution that should be taken while evaluating crystals in synovial (SV) fluid analysis.
Answer: Talc-free gloves
Synovial fluid analysis is a delicate process that requires strict precautions when handling the specimen. Talc gloves are still the norm in many countries. Contamination of the slide with birefringent talc particles can make microscopic examination for pathogenetically important crystals difficult. A few other important precautions are:
- Aspiration under aseptic conditions
- Quick transfer of specimen to sterile tubes*
- As early as possible platation
- Avoid contamination of the synovial fluid sample with injectable corticosteroid
- Either EDTA or heparinized tubes should be used for inflammatory joint fluids, which often contain high fibrinogen and fibrin
* Some experts directly place a drop of fresh synovial fluid on a slide with a cover slip and expedite viewing under a microscope in the lab.
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References:
1. Dieppe P, Swan A. Identification of crystals in synovial fluid. Ann Rheum Dis 1999; 58:261.
2. Miller JM, Binnicker MJ, Campbell S, et al. A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology. Clin Infect Dis 2018; 67:e1.
3. Freemont AJ. Microscopic analysis of synovial fluid--the perfect diagnostic test? Ann Rheum Dis 1996; 55:695.
4. Graf SW, Buchbinder R, Zochling J, Whittle SL. The accuracy of methods for urate crystal detection in synovial fluid and the effect of sample handling: a systematic review. Clin Rheumatol 2013; 32:225.
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