Cirrhosis Lab Report

Previously drawn laboratory tests have been released into the patient’s chart and show a blood glucose of 110 mg/dL, serum total protein of 6.0 g/dL and lactate dehydrogenase (LDH) of 300 U/L. A diagnostic thoracentesis is performed, removing 50mL of pleural fluid. The pleural fluid will be sent for cell count, gram stain, culture, pH, glucose, protein and LDH. Gram stain and culture of a sputum specimen is negative for tuberculosis.

If the effusion is due to the patient’s history of cirrhosis, which of the following would be most consistent with this patient’s condition?

A. Pleural pH of 7.2
B. Pleural glucose of 110 mg/dL
C. Pleural amylase of 200 IU/L
D. Pleural protein level of 2.9 g/dL
E. Pleural LDH of 150 U/L

Answer

Choice "B"
This can be confirmed with pleural fluid analysis obtained from a thoracentesis. It is important to remember that according to Light’s Criteria, to diagnose a transudate, none of the criteria can be met. Answer choices “D” and “E” demonstrate the inability to meet criteria to be classified as an exudate.
Pleural protein 3.0 g/dL / Serum protein 6.0 g/dL= x < .5
Pleural LDH 150 U/L / Serum LDH 300 U/L = x < .6
It is important to note that the amount of glucose in pleural fluid is similar to the level of glucose in the serum. A relatively stable glucose level in the pleural fluid is more indicative of a transudative process. A very low glucose x > 50 mg/dL is consistent with an infectious or malignant etiology
*Remember, you need at least one of Light’s Criteria to diagnose that the pleural fluid is an exudate. In patients where it is highly suggestive that they have a transudative process but meet Light’s Critera: serum albumin – pleural albumin= x < 1.2 mg/dL to confirm