Neutrophils in Extravascular Body Fluids: Cytological-Energy Analysis Enables Rapid, Reliable and Inexpensive Detection of Purulent Inflammation and Tissue Damage

Abstract

The simultaneous cytological and metabolic investigation of various extravascular body fluids (EBFs) provides clinically relevant information about the type and intensity of the immune response in particular organ systems. The oxidative burst of professional phagocytes with the concomitant production of reactive oxygen species consumes a large amount of oxygen and is the cause of switch to the development of anaerobic metabolism. We assessed the relationships between percentages of neutrophils, aerobic and anaerobic metabolism, and tissue damage via the determination of aspartate aminotransferase catalytic activities (AST) in cerebrospinal fluid (CSF), pleural effusions (PE), abdominal effusions (AE), and synovial fluids (SF). EBFs with 0.0–20.0% neutrophils: 83.0% aerobic and 1.3% strongly anaerobic cases with median of AST = 13.8 IU/L in CSF; 68.0% aerobic and 9.0% strongly anaerobic cases with median of AST = 20.4 IU/L in PE; 77.5% aerobic and 10.5% strongly anaerobic cases with median of AST = 18.0 IU/L in AE; 64.1% aerobic and 7.7% strongly anaerobic cases with median of AST = 13.8 IU/L in SF. EBFs with 80.0–100.0% neutrophils: 4.2% aerobic and 73.7% strongly anaerobic cases with median of AST = 19.2 IU/L in CSF; 7.4% aerobic and 77.3% strongly anaerobic cases with median of AST = 145.2 IU/L in PE; 11.8% aerobic and 73.7% strongly anaerobic cases with median of AST = 61.8 IU/L in AE; 25.5% aerobic and 38.2% strongly anaerobic cases with median of AST = 37.2 IU/L in SF. The significant presence of neutrophils, concomitant strong anaerobic metabolism, and elevated AST in various EBFs are reliable signs of damaging purulent inflammation.

Basic Analysis of the Cerebrospinal Fluid: An Important Framework for Laboratory Diagnostics of the Impairment of the Central Nervous System

“…Activation of immunocompetent cells correlates with an increase in glucose and oxygen consumption and the development of anaerobic metabolism in CSF. The decrease in ATP production is reflected by a decrease in KEB values [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”

“…This enzyme is present in all nucleated cells. Cellular damage is characterized by release of AST with subsequent elevation of AST activity in body fluids including CSF [ 8 , 18 ].…”

“…AST catalytic activity below 18.0 IU/L is not indicating tissue destruction in the CNS. No signs of hemorrhage are detected by CSF cytology [ 8 , 10 , 12 , 14 , 18 , 19 , 20 ].…”

“…This process is revealed as decrease in KEB values. In addition, local inflammation in the CNS may be associated with tissue destruction resulting in increased AST catalytic activity in the CSF [ 8 , 10 , 12 , 14 , 15 , 18 , 19 , 20 ].…”

“…This is responsible for enhanced oxygen consumption. In sum, extensive accumulation of neutrophils and strong anaerobic metabolism in the CSF (KEB < 10.0) together with increased BCB permeability reveal purulent inflammation induced by the presence of extracellular bacteria in the CNS [ 8 , 9 , 10 , 12 , 14 , 15 , 17 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ].…”