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An accurate diagnosis of the cause of the effusion, transudate versus exudate, relies on a comparison of the chemistries in the pleural fluid to those in the blood, using Light's criteria. According to Light's criteria (Light, et al. 1972), a pleural effusion is likely exudative if at least one of the following exists: [31]
The SAAG may be a better discriminant than the older method of classifying ascites fluid as a transudate versus exudate. [2] The formula is as follows: SAAG = (serum albumin) − (albumin level of ascitic fluid). Ideally, the two values should be measured at the same time.
Transudate is extravascular fluid with low protein content and a low specific gravity (< 1.012). It has low nucleated cell counts (less than 500 to 1000 per microliter) and the primary cell types are mononuclear cells: macrophages, lymphocytes and mesothelial cells. For instance, an ultrafiltrate of blood plasma is transudate.
The Rivalta Test is a simple, inexpensive method that can be used in resource-limited settings to differentiate a transudate from an exudate. [1] It is a simple, inexpensive method that does not require special laboratory equipment and can be easily performed in private practice.
Serous exudate (sometimes classified as serous transudate) is usually seen in mild inflammation, with relatively low protein. [10] Its consistency resembles that of serum, and can usually be seen in certain disease states like tuberculosis. (See below for difference between transudate and exudate)
Transudate vs. exudate. Transudate: Exudate: Main causes ↑ hydrostatic pressure, ↓ colloid osmotic pressure: Inflammation-Increased vascular permeability:
The serum-ascites albumin gradient (SAAG) is probably a better discriminant than older measures (transudate versus exudate) for the causes of ascites. [12] A high gradient (> 1.1 g/dL) indicates the ascites is due to portal hypertension. A low gradient (< 1.1 g/dL) indicates ascites of non-portal hypertensive as a cause. [13]
The usual criterion (included in Light's criteria) is that a ratio of pleural LDH to serum LDH greater than 0.6 [33] or 2 ⁄ 3 the upper limit of the normal laboratory value for serum LDH [34] indicates an exudate, while a ratio of less indicates a transudate.