The Cytological Energy Detection of Purulent Inflammation in Synovial Fluid Is Not All Black and White
Petr Kelbich,
Eliska Vanaskova,
Karel Hrach,
Jan Krejsek,
Frantisek Smisko,
Pavla Hruskova,
Eva Hanuljakova,
Tomas Novotny
Affiliations
Petr Kelbich
Department of Biomedicine and Laboratory Diagnostics, Faculty of Health Studies, Jan Evangelista Purkinje University and Masaryk Hospital, 401 13 Usti nad Labem, Czech Republic
Eliska Vanaskova
Department of Clinical Immunology and Allergology, Faculty of Medicine and University Hospital, Charles University in Prague, 500 03 Hradec Kralove, Czech Republic
Karel Hrach
Department of Biomedicine and Laboratory Diagnostics, Faculty of Health Studies, Jan Evangelista Purkinje University and Masaryk Hospital, 401 13 Usti nad Labem, Czech Republic
Jan Krejsek
Department of Clinical Immunology and Allergology, Faculty of Medicine and University Hospital, Charles University in Prague, 500 03 Hradec Kralove, Czech Republic
Frantisek Smisko
Department of Orthopaedics, Regional Hospital, 360 01 Karlovy Vary, Czech Republic
Pavla Hruskova
Department of Clinical Immunology and Allergology, Faculty of Medicine and University Hospital, Charles University in Prague, 500 03 Hradec Kralove, Czech Republic
Eva Hanuljakova
Department of Biomedicine and Laboratory Diagnostics, Faculty of Health Studies, Jan Evangelista Purkinje University and Masaryk Hospital, 401 13 Usti nad Labem, Czech Republic
Tomas Novotny
Department of Orthopaedics, Faculty of Health Studies, Jan Evangelista Purkinje University and Masaryk Hospital, 401 13 Usti nad Labem, Czech Republic
Neutrophils are frequently found in the cytological picture of synovial fluid in several joint pathologies, and a higher proportion of them can even wrongly indicate these cases as purulent inflammation. For reliable differentiation between purulent and non-purulent cases, we use the cytological energy analysis of the synovial fluid. Using this method, we examined 350 knee joint synovial fluid samples. Overall, we found that the percentage of neutrophils ranged between 20.0% and 50.0% in 44 (12.6%) cases and was above 50.0% in 231 (66.0%) cases. In the same group, only 85 (24.3%) highly anaerobic synovial fluid samples were evaluated as purulent inflammation, and another 17 (4.9%) cases were evaluated as very likely purulent inflammation. Further, we quantified the immediate risk of purulent inflammation using the “purulent score” (PS). Of the total of 350 samples, 103 (29.4%) cases were classified as having a very high risk of purulent inflammation (PS = 4), 53 (15.1%) cases were classified as having a significant risk of purulent inflammation (PS = 3), 17 (4.9%) cases were classified as having a moderate risk of purulent inflammation (PS = 2), and 75 (21.4%) cases were classified as having no immediate risk of purulent inflammation (PS = 1). Based on our results and analyses, the cytological energy analysis of synovial fluid is an effective method that can be used to detect and specify joint inflammation and the risk of septic arthritis development.
