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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]
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.
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 vs. exudate. Transudate: Exudate: Main causes ↑ hydrostatic pressure, ↓ colloid osmotic pressure: Inflammation-Increased vascular permeability:
Physicians with a Doctor of Medicine (MD) degree are required to pass the USMLE for medical licensure. However, those with a Doctor of Osteopathic Medicine degree (DO) are required to take the COMLEX-USA (COMLEX) exams but may also sit for the USMLE as well. [10] [11] States may enact additional testing and/or licensing requirements. [12]