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Specimen Collection Manual and Test Catalog

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CELL COUNT WITH DIFFERENTIAL, SYNOVIAL FLUID

Geisinger Epic Procedure Code:  LAB3314    Geisinger Epic ID:  69116

SPECIMEN COLLECTION
Specimen type: 

Synovial fluid, Bursa fluid. Indicate specimen source on label and requisition.


Preferred collection container: 
Alternate collection container: 
Sterile screw-cap tube
6 mL red-top (plain, non-serum separator) tube
4 mL green/green-top (sodium heparin) tube
Specimen required: 

2-3 mL (preferred), 1 mL (minimum)


Special notes: 

Non-gel or non-anticoagulated tubes are acceptable; however, clotting is more likely.

Indicate specimen source on label and requisition. Clotted and partially clotted specimens will receive a comment, "Fluid clotted cell count questionable". Fluids received in sodium heparin tubes will receive a comment, "Specimen received in heparin anticoagulant which may cause lower WBC counts." Clinical correlation is essential and if there is a concern for specimen viability, recommend resubmitting a fresh sample in EDTA for analysis.



SPECIMEN PROCESSING
Processing instructions: 

Do not centrifuge or freeze.


Transport temperature: 

Refrigerated.


Specimen stability: 

Refrigerated: 24 hours.


Rejection criteria: 

Specimen sent with needle. Frozen specimens.



TEST DETAILS
Interpretation guide: 

Red cells are increased in trauma and hemorrhage.
White blood cells are increased in inflammatory and infectious processes:
- neutrophils predominate in bacterial infections
- lymphocytes predominate in viral infection 
- macrophages may be increased in inflammatory and infectious processes
- eosinophils may be increased in parasitic or fungal infections.


CPT code(s): 
Note: The billing party has sole responsibility for CPT coding.  Any questions regarding coding should be directed to the payer being billed.
The CPT codes provided by GML are based on AMA guidelines and are for informational purposes only.

Test includes: 

Color, Clarity, Total cells count (TCC) (Note: This includes WBC count and other nucleated cells including epithelial cells, histiocytes, macrophages, mesothelial cells etc.) , RBC, TNC differential = % of each cell type in 100 total nucleated cells


Methodology: 
Electronic resistance detection enhanced by hydrodynamic focusing and flow cytometry
Hemocytometer
Microscopic Examination
Synonyms: 

BFC, cell count, fluid cell count


Clinical significance: 

Quantitative determination of cells including WBCs, RBCs, and synovial lining cells in various synovial fluid, which aids in the diagnoses of joint disease, systemic disease, inflammation, malignancy, infection, and trauma.


Doctoral Director(s): 
Mary Dhesi MD
Review Date:  01/08/2025

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