Ascitic Fluid Analysis - Normal Values, Uses & Test Results

Ascites refers to fluid accumulated within the abdominal cavity (the area between the abdominal wall and the spine). The ascitic fluid analysis is a diagnostic test that examines this fluid buildup.

Ascites can be categorised into two types: 

1. Exudates: These are fluids or cells in the inflamed tissue that get slowly discharged from the blood vessels. It may result from conditions like:

1. Infection
2. Malignancies (cancerous growths)
3. Rheumatoid disease (inflammatory or autoimmune diseases affecting the whole body)
4. Systemic lupus erythematosus (autoimmune disease, immune system mistakenly attacks healthy tissue) 

2. Transudates: Thin fluids pass through membranes, seep through tissues, or enter extracellular spaces. They contain few protein cells. The most common causes of transudate fluid accumulation include:

1. Cirrhosis (severe scarring of the liver)
2. Congestive heart failure (heart does not pump blood efficiently)

Ascites generally have an unfavourable prognosis. According to a research article by Lin-Lin Huang et al. in 2014, cirrhotic patients have a mortality of 15% one year after the development of ascites and 44% five years after ascites. However, it is important to remember that progression depends on the underlying cause.

The ascitic fluid test is used to check the abdominal fluid for characteristics like colour, clarity, and the presence of blood. It is performed to diagnose the cause of ascites. The doctor orders the test when they suspect a disease that causes ascites. It is needed when the patient has the following: 

1. Prolonged abdominal pain and tenderness 
2. Ascites of unknown origin with symptoms like pain below the ribs in the upper abdomen area, unintentional weight loss, bright red blood in the stool
3. Intestinal perforation (a hole in the intestine causing content leakage in the abdomen)
4. Suspected-intra abdominal malignancy (unusual growths originating in the abdominal cavity like ovarian and pancreatic cancer)

The ascitic fluid examination is important in diagnosing conditions that cause ascites, like liver disease, cancer, infection, etc. It offers significant benefits, including: 

1. Quick Procedure: Ascitic fluid analysis typically takes 20 to 30 minutes, depending on the sample needed. This reduced time of the test minimises the discomfort for the patient. 
2. Low Risks and Complications: It carries a low-risk profile. The procedure causes minimal discomfort and has a low incidence of complications. 
3. Detects Peritonitis: The test can help identify peritonitis (tissue inflammation lining the abdominal inner wall). Ascites fluid analysis enables early diagnosis and prompt treatment, preventing life-threatening infections.
4. Checks Internal Bleeding: Ascitic fluid test also helps doctors evaluate abdominal injuries. Blood in the ascitic fluid can indicate internal bleeding due to injuries. 
5. Guides Treatment Approach: Doctors use ascitic fluid test results to determine the best treatment course. Antibiotics may be prescribed for infections, while chemotherapy or radiation may be recommended for cancer.

Before the ascitic fluid analysis, the doctor will provide instructions that patients must follow. The preparation usually requires changes in diet and medicine. Patients can expect the following before the test: 

Preliminary Assessment

The medical specialist may perform some tests before the procedure. These may include blood tests and an ultrasound to find fluid in the abdomen. 

Discussion

The doctor will briefly explain the procedure of sample collection. They may ask patients to stop taking medications like blood thinners before the test. Before the procedure, patients must inform their doctor if they:

1. Are allergic to anaesthetics or other medicines
2. Have a bleeding disorder.
3. Are pregnant or planning the same soon

Fasting

Patients may need to stop eating or drinking for at least six hours before the procedure. 

Bladder Emptying

Healthcare professionals recommend emptying the patient’s bladder before the sample collection procedure. 

Ascitic fluid analysis can be performed in the clinic or hospital. The fluid collection is performed through paracentesis or abdominal tap. The general steps involved in an ascitic fluid examination are as follows:

1. Patient Position: The patient will be positioned comfortably on the procedure table or reclining chair in the lateral decubitus position. This position involves lying on either the left or right side with the operative side up. Pillows or foam padding will be used to flex the legs.
2. Local Anaesthesia: Someone from the nursing team will shave the abdominal area and clean it with an antiseptic solution. The doctor will administer local anaesthetic to numb the area. 
3. Physical Evaluation: The doctor will check the patient’s blood pressure, temperature, breathing, and heart rate throughout the procedure. 
4. Needle Insertion: The doctor will insert a thin, sterile needle 1-2 inches deep in the abdominal cavity. They may need to make a small incision if inserting the needle becomes difficult. 
5. Fluid Collection: The fluid will be collected into a sterile syringe. The amount of fluid collected will depend on the specific diagnostic goals. 
6. Needle Removal: Once enough fluid has been collected, the needle is gently removed.
7. Bandage: The doctor will apply a small bandage on the puncture site to reduce the risk of bleeding. 
8. Sending to the Laboratory: The collected ascitic fluid will be sent to a laboratory for analysis. 

If a lot of fluid is removed during the procedure, the patient may feel dizziness or lightheadedness. After undergoing an ascitic fluid analysis, patients must follow specific aftercare instructions to ensure a smooth recovery. Here are some general aftercare guidelines: 

1. Rest and Observation: Patients will be asked to rest in a recovery area after the procedure. Doctors will monitor for immediate complications, such as bleeding or infection. When the patient is ready, the nurse will help them get up slowly. 
2. Medications: It is expected to experience pain and discomfort after the test. The doctor may prescribe medications to manage pain. 
3. Wound Care: Patients should keep the bandage on for 24 hours after the procedure. They can then shower and remove the bandage to wash the puncture site with soap and water.
4. Activities: Individuals can resume normal activities after the procedure unless the doctor says otherwise. 

The results of diagnostic tests performed on ascitic fluid are available in one or two days. Understanding the ascites fluid normal values involves assessing several factors. These factors include:

1. Gross Appearance: The physical appearance of the fluid offers helpful information in the differential diagnosis. Usually, the ascites fluid is clear to pale yellow. 
2. Protein Levels: The ascitic total protein concentration may help determine whether the ascitic fluid is exudate or transudate. The normal protein level in ascitic fluid is less than 4.1 g/dl. 
3. Serum-Ascites Albumin Gradient (SAAG): It can be used to determine if ascites are caused by portal hypertension (increased pressure in the portal vein and the smaller veins branching from it). SAAG is calculated as a difference between ascitic fluid albumin and serum albumin. 
4. Glucose: Ascitic fluid glucose normal range is similar to that in serum. It ranges between 70 to 100 mg/dl. 
5. Lactate Dehydrogenase (LDH): A blood test measures LDH levels, an enzyme in many body tissues. Elevated LDH levels may indicate cell damage or tissue breakdown. 
6. WBC Differential Count: The total white blood cell count helps look for infection or malignancy. The normal WBC count is below 300/mm3. 
7. Microscopic Examination: These tests may be performed on an ascitic fluid sample if infection or cancer is suspected. Normally, microscopic examination shows no malignant cells, bacteria, and fungal bodies. 
8. Gram Stain and Bacterial Culture: It is done to observe bacteria or fungi under a microscope. Usually, no microbes should be present in the peritoneal fluid. The presence of microbes may indicate bacterial peritonitis. 
9. Amylase: It is an enzyme produced by the pancreas and salivary glands. The test is done to diagnose pancreatic conditions like pancreatitis (swelling of the pancreas). The normal range of amylase is 138 to 404 units/L. 
10. Adenosine Deaminase (ADA): The test is rarely ordered to detect tuberculosis in ascites fluid. Ascitic fluid ADA normal value is less than 40 units/l. 

Interpretation of the Ascitic Fluid Analysis 

While interpreting the results of ascitic fluid analysis, it is important to consider all the factors mentioned above. A higher or lower range of these parameters may indicate problems. 

While interpreting the results of ascitic fluid analysis, it is important to consider all the factors mentioned above. A higher or lower range of these parameters may indicate problems. 

Treatment Plan After Ascitic Fluid Analysis

After the patient receives their ascitic fluid test results, the doctor will schedule an appointment to discuss the next steps. The ascites treatment can help reduce symptoms and complications. Sometimes, the doctor may recommend a low-sodium diet and diuretics (water pills) to manage complexities. 

Patients may also need other treatments like: 

Paracentesis

The procedure performed for diagnosis can also be used as a treatment. The medical specialist inserts a needle into the abdomen to remove a large amount of excess fluid. 

Liver Transplant

The patient may need a liver transplant in severe cases of cirrhosis when their liver is failing. 

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

The doctor inserts a stent (wire mesh) into a vein in the patient’s liver. The stent is inflated to form a channel (shunt) that bypasses the liver. This treatment option is recommended in the following cases: 

1. Home remedies (dietary modifications) and non-surgical treatments (diuretics) don’t work.
2. The patient needs several paracentesis every month.
3. They are not a candidate for a liver transplant.

Cancer Treatments

Doctors may recommend chemotherapy or hormone therapy for malignancies. The treatment helps shrink the tumour and stop fluid buildup.

The risks after an ascitic fluid test are generally low. Usually, the benefits of obtaining diagnostic information outweigh the risks. However, patients must understand the risks they can expect after the test. These risks include: 

1. Damage to Nearby Structures: When inserting the needle for ascitic fluid analysis, there is a small risk of puncturing the bowel or bladder. 
2. Bleeding: The procedure can also cause damage to the blood vessels. Puncture of blood vessels can result in bleeding. 
3. Infection: Penetrating the skin risks introducing bacteria into the body. Infection can occur at the puncture site or within the abdominal cavity.
4. Low Blood Pressure: Removing a significant amount of ascitic fluid rapidly reduces intra-abdominal pressure. As a result, right atrial pressure decreases, leading to reduced blood circulation and potential drops in blood pressure. This may cause dizziness, lightheadedness, or fainting.

When to Call a Doctor?

After undergoing an ascitic fluid analysis, monitoring unusual or concerning symptoms is important. Patients should call a doctor or seek medical attention immediately if they experience the following:

1. Fever (above 104 F for more than 5-6 hours)
2. Swelling or redness around the puncture site 
3. Bleeding
4. Increased pain
5. Shortness of breath
6. Chest pain
7. Fainting
8. Cough
9. Fluid leakage 
10. Increased abdominal swelling

Before undergoing the ascitic fluid analysis test, it is important to understand its cost. The price of ascitic fluid analysis in India starts from ₹ 15,000. The average price is ₹ 20,000. The cost can reach up to ₹ 25,000. 

The cost of ascitic fluid analysis can vary depending on several factors. These factors include:

1. Type of Hospital: Private and big hospitals may charge more than government-run hospitals. 
2. City or Location: The cost tends to be higher in metropolitan and urban areas than in smaller towns and rural areas. This is due to the difference in the cost of living. 
3. Doctor’s Fee: The fees charged by the doctor performing the procedure can significantly influence the overall cost.
4. Diagnostic Laboratory Costs: The fees for analysing the ascitic fluid in a laboratory can vary. It depends on the facility’s location, reputation, and equipment.
5. Patient’s Medical Condition: Patients with underlying health conditions like liver disease or heart problems may require more extensive evaluation. This leads to additional costs.

Ascitic fluid analysis is a crucial diagnostic test. Comparing the results helps doctors understand the condition that causes fluid buildup. This enables them to make informed decisions, guide treatment, and improve patient outcomes. 

The expert team at HexaHealth will help interpret the ascitic fluid analysis normal values complexities. We can also connect you with top doctors for treatment. Contact HexaHealth today to know more about the conditions that can cause a fluid buildup in the abdominal cavity. 

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