Effect of storage on the detection and identification of crystals in synovial fluid using polarized light

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  • 関節液中結晶の検出・同定に対する保存影響の検討
  • カンセツエキ チュウ ケッショウ ノ ケンシュツ ・ ドウテイ ニ タイスル ホゾン エイキョウ ノ ケントウ

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Abstract

<p>Gout caused by monosodium urate (MSU) crystals and pseudogout caused by calcium pyrophosphate (CPPD) crystals can be confirmed by the microscopic examination of crystals in synovial fluid. There is a report outside of Japan showing that “synovial fluid for observing crystals can be refrigerated for several days,” but as far as we investigated, there are no reports on this in Japan. We investigated the change of crystals over time by preserving synovial fluid. Of the synovial fluid specimens submitted to our inspection room from May 2020 to October 2022, 76 specimens with heparin added and 55 specimens with no anticoagulant, which could be examined, were used. The specimens were observed under a polarizing microscope, and the effects of storage were examined using a proprietary visual quantitative standard. The specimens were kept refrigerated at 4°C, and the change in crystals over time was observed after 24 hours, 48 hours, 72 hours, 96 hours, and 1 week. The concordance rates between visual quantification values before and after refrigerated storage were as follows: heparin addition: CPPD crystals, 96.0% (168/175); MSU crystals, 100% (40/40); no crystals, 100% (165/165); with no anticoagulant: CPPD crystals, 94.3% (99/105); MSU crystals, 100% (35/35); no crystals, 100% (135/135). Both types of specimen showed a good concordance rate before and after storage, and there was no particular difference due to the anticoagulant. Some CPPD crystals showed changes in visual quantitation during storage, but the crystals were sufficiently detectable. From the above, we believe that for crystal observation, refrigerated storage of synovial fluid for about one week is possible.</p>

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