Pleural Fluid - Amylase:
Why Pleural Fluid Amylase Test?
CLINICAL INFORMATION
Pleura are a membrane lining the thoracic cavity (parietal pleura) and covering the lungs (visceral pleura). The parietal pleura folds back on itself at the root of the lung to become the visceral pleura. A small amount of space between the two pleurae and lubricating fluid at their contact points allow the lungs to expand. The pleura exude a thin fluid that keeps it moist and lubricated. Thus the pleura with two thin layers of tissues protect and cushion the lungs. The pleural fluid lubricates the pleural cavity so that the pleural tissue can slide against each other. Pleural fluid analysis is required in pathologies including chylous effusion, chyliform effusions, hemothorax, empyema, trapped lung, iatrogenic effusions, malignancy in lungs, certain cancers such as lymphoma, mesothelioma, and blood cancers (metastatic cancers), inflammation (pleuritis), infections, injuries, pulmonary embolism etc. Indication for pleural fluid for analysis arise when clinical manifestations with signs and symptom of chest pain, dyspnea, orthopnea, non-productive cough, trouble breathing, fatigue, X-ray findings - fluid blunts the posterior costophrenic angle, blunting of lateral costophrenic angle, effusion causing opacity portions of the hemithorax causing a mediastinal shift to contralateral side etc, and thus the imaging studies like X-rays are required for the confirmation of pleural effusion (compared with Light’s criteria protocol).Untreated chronic cases may lead to complications such as collapsed lung, pulmonary edema etc. Pleural fluid testing involves certain tests such as visual examination, odour analysis, microscopic evaluation, cytology, markers of pleural inflammation (CRP, IL-6 induced by lipopolysaccharide, TNF-tumor marker, procalcitonin, ADA, tumour markers – CEA, CA 125, CA 15-3, CYFRA 21-1 i.e it is a cytokeratin tumour marker in non-small cell lung cancer, ANA in rheumatoid arthritis and SLE, RF titers), culture and sensitivity tests, acidity (pH paper), cell count, total protein, LDH, glucose, based on patient’s history the test may also include lipid profile, creatinine, amylase, NT-proBNP, imaging studies, examination and radiology etc. A pleural fluid test is performed to analyse for differential diagnosis for transudative effusion (i.e extra fluid leak into the pleural space - fluid accumulation is caused due to mostly non-infectious origin such as severe malnourishment or rarely by pathologies like hepatic fibrosis, heart failure eg congestive heart failure, cirrhosis etc - i.e occurs due to the change in oncotic pressure exerted by serum albumin) and exudative effusion (fluid accumulation is caused due to some pathological origin i.e due to mainly infectious microbes and other causes like cancers, kidney diseases, auto-immune diseases, pneumonia etc) for treatment. This differentiation is based on fluid albumin level i.e the Serum-Ascites Albumin Gradient (SAAG) calculation, which is serum albumin level minus the fluid albumin level will distinguish if it is a case of exudate or transudate. The most common causes of lung and pleural injuries include injuries of the chest (physical trauma), viral, fungal, and bacterial causes of pleural effusion due to Streptococcus milleri group, Streptococcus pneumonia, Streptococcal aureus etc and also autoimmune diseases, rheumatoid arthritis, tuberculosis etc. Symptoms of pleural effusion include chest pain, dry and non-productive cough, dyspnea, orthopnea etc. Thoracentesis is a procedure where the needle is inserted through the chest wall into the pleural space to remove fluid or air from around the lungs. Pleural fluid testing is used to help diagnose the cause of fluid build-up in the chest (pleural cavity) which includes fluid appearance, cell count and fluid protein, albumin or LD level. The common complication of thoracentesis are pneumothorax, fluid build-up in the lung, excessive bleeding while specimen collection, re-accumulation of fluid in lung, infection at the site of thoracentesis, respiratory distress or breathing difficulties etc. Culture and Sensitivity – Pleural Fluid Specimen test: This test specimen of Pleural fluid examines the aspirated fluid sample specimen from the pleural space in case of suspected infection and/or to diagnose the cause of fluid build-up in the space of chest wall (for differential diagnosis to differentiate between exudates and/or transudate). Inflammation of the pleura causing exudates include infections, bleeding (bleeding disorders, trauma, pulmonary embolism, lung diseases eg. Sarcoidosis) and other causes like heart surgery, heart or lung transplant, pancreatitis and/or abscess in the abdomen etc. The non-infectious causes behind pleural effusion also include transudate (due to altered levels in the protein i.e low protein levels in the blood and/or due to injury or inflammation to the pleura - an imbalance between the pressure of the liquid within the blood vessels, drives fluid out of blood vessel), due to congestive heart failure or cirrhosis, tuberculosis, sarcoidosis, lung cancer, metastatic cancer, lymphoma, mesothelioma, RA, SLE etc. Gram stain also called as Gram stain method used for staining to classify two groups of bacterial species such as gram positive and gram negative bacteria. Bacteria with gram positive cell walls have a thick peptidoglycan which retains the primary stain crystal violet and Lugol’s iodine solution is added to strengthen the bonds of the stain. While the gram negative bacteria since they have a thinner bacterial cell wall allow the crystal violet to wash out on addition of ethanol, hence their cell membrane are stained pink or red by the counter stain (safranin or fuchsine). In certain cases pleural decortication is performed by the surgeons to operate inside the pleural space to remove unhealthy cells (potentially dangerous inflammation). Moreover pleurodesis may be required in patients with frequent pleural effusion. Pleurodesis procedure involves the placement of certain substances such as doxycycline into the pleural space that inflames the pleura and on healing the two layers merge together.Amylaseis an enzyme (amylase is a digestive enzyme that catalyzes the hydrolysis of starch) which digests the carbohydrates. There are main classes of amylase such as: α – amylase, β – amylase, γ – amylase etc. Iso-enzyme are different forms of same enzyme with similar functions. There are two main types of amylases present in the body, one is synthesized by the pancreas and the other by the salivary glands (α – amylase also called as ptyalin is produced by salivary glands). Since these levels gets altered in disorders of the pancreas, alcoholism, infection or other medical conditions like stress – estimation of amylase helps in as an important screening tool for diagnosis. Hyper-amylasemia is a pathological or a medical condition triggered with hyper-secretion or increased levels of amylase in the body. Amylases also may be measured for purposes of certain medical diagnosis including cystic fibrosis, liver failure, poor kidney function, perforated peptic ulcer, torsion of an ovarian cyst, strangulation, ileus, mesenteric ischemia, macro-amylasemia, mumps, appendicitis, cancers of the lung, breast and ovaries etc.A blood amylase test along with lipase estimation is used to help diagnose inflammation of the pancreas - pancreatitis (acute and chronic), pancreatic cancer, blockage in the pancreatic duct, cystic fibrosis etc. higher levels of amylase are also seen in conditions like perforated peptic ulcer, torsion of an ovarian cyst, ileus, mesenteric ischemia, mumps (inflammation of salivary glands) etc. Specimen of urine amylase is used to diagnose pancreatic and salivary disorders. Causes of pancreatitis are gall stones, abdominal surgery, certain medications, cystic fibrosis, gall stones, hypercalcemia (high blood calcium levels), infections, injury to the abdomen, obesity etc. Symptoms of pancreatic disorders are upper abdominal pain that radiates to the back or feels worse after eating, fever and loss of appetite, nausea, vomiting, jaundice, and rapid pulse. Complications of pancreatitis can lead to pseudocyst (fluid and debris get collected in cysts like pockets in the pancreas that ruptures and can cause internal bleeding and infections), infection, diabetes, malnutrition (due to lack of digestive enzymes to breakdown the nutrients from food results conditions like steatorrhea – excretion of lipids, leads to weight loss), kidney failure, breathing difficulties (acute pancreatitis can cause chemical changes in the body that affects the lung function, causing a fall in oxygen level in the blood to dangerously low levels) and pancreatic cancer. Clinical manifestations of the pancreatic disorder include nausea, vomiting, severe abdominal pain, loss of appetite, fever, jaundice etc. Causes of pancreatitis include disorders of the GIT like narrowing of the duct or the sphincter, bile duct blockage and/or blockage due to gall stone, cholecystitis, pancreatic cysts, pancreatic cancers, salivary gland tumours like parotid gland tumours, appendicitis, diabetic ketoacidosis, ectopic pregnancy etc. Low amylase levels may be a sign of insulin resistance, metabolic syndrome, obesity, pre-eclampsia during pregnancy, kidney disease, liver diseases, cystic fibrosis, pancreatic cancers etc. Body fluids such as intracellular and extracellular fluids are an accurate source of potential biomarkers as they have the ability to actively exchange certain biological factors between them i.e for example the lymphatic system, tissue interstitial fluid and blood plasma etc. The purpose of body fluids are to deliver nutrients and oxygen to all the cells of the body and remove the end products or toxic substances from the cells that are produced during the metabolism, to eliminate them from the system by flushing them out of the body as urine, feces, sweat etc. Other functions of the bio-fluid/body fluids include maintenance of body temperature. When the body temperature increases, the blood circulation to the skin also instantaneously increases thus facilitating the dissipation of heat through sweating etc. The sample specimen is usually Intra-vascular fluid i.e Blood (serum/plasma) and/or body fluids. Body/Bio-Fluid Tests: Body Fluids include Peritoneal/Ascitic fluid (Ascites) – in peritonitis (inflammation of the lining of the inner abdominal wall etc), Pericardial fluid, infected pleural fluid causing pleural effusion, Bronchial Wash, Drain or aspiration Fluids - Paracentesis, Thoracocentesis, aspiration of bone marrow, aspiration of amniotic fluid, JP Drain and /or blood, urine, saliva, sweat, bile fluid, seminal fluid, vaginal fluid, synovial fluid, nasal fluid, CSF, lymph, endolymph etc can provide a vital clue in the biochemical investigation of pathologies in certain disorders or disease conditions in certain differential diagnosis to arrive at a conclusive definitive diagnosis and also for prognosis. Significance of Amylase on body/Bio-Fluids test: Salivary amylase can be estimated in urine and peritoneal fluid sample specimens as well, apart from the routine blood specimen to detect the cause of ascites, screening cystic fibrosis and moreover cancers of the lung can be detected by pleural effusion etc. Some factors that can interfere with amylase test results are aspirin, birth control pills or oral contraceptives, opiates, alcohol and diuretics etc. Additional tests on pleural fluid other than culture and sensitivity include measurement of pleural fluid, lipase test, estimation of biochemical parameters such as glucose, lactate, amylase, triglyceride, tumour markers such as CEA etc. Other supporting tests include CBC, albumin, glucose, Chest X-Rays, CT scans, MRI, ultrasound, Gram stain, fungal test, stool test for cysts in parasitic infestation, AFB test and adenosine deaminase to detect tuberculosis etc.
General Instructions:
Sample Requirement: Specimen –Pleural Fluid. Test Preparation: None.
NOTE - Sample for specimen collections may vary based on the patient’s condition/cases according to the patient’s presenting complaints/signs or symptoms:
SPECIMEN REQUIREMENT (Special or Rare Cases) - As instructed and guided by Physician / Clinician / Pathologist / as per Laboratory’s requirements, according to procedures and protocols.
This Multi-Specialty Clinical Referral Laboratory RT DIAGNOSTICS provides precise and accurate tests with an extensive range of testing services to the medical centres to help in the diagnosis and identification of pathology in the test specimens for infectious diseases and also to evaluate the function of organ systems of the patient. It prevents further complications and helps to stabilize and restore health to near normalcy at the earliest without delay.
