ASCITIC FLUID ANALYSIS

Ascitic Fluid Analyzer

Serum Albumin (g/dL)

Ascitic Albumin (g/dL)

Fluid Total Protein (g/dL)

Fluid ANC (PMNs/mm³)

Fluid ADA (U/L)

Fluid Glucose (mg/dL)

Differentiating the etiology of ascites is a cornerstone of clinical diagnostics. SAAG = Serum Albumin - Ascitic Fluid . The SAAG accurately reflects the presence or absence of portal hypertension in 97% of cases.

High Gradient (> 1.1 g/dL): Indicates that portal hypertension is present Low Gradient (< 1.1 g/dL): Indicates that portal hypertension is absent. If Glucose < 50 mg/dL and High LDH, suspect Malignancy or Secondary Peritonitis

Ascitic Fluid Analysis (SAAG Logic)

SAAG Level	Fluid Protein	Etiology
High (≥ 1.1)	Low (< 2.5)	Cirrhosis
High (≥ 1.1)	High (≥ 2.5)	Cardiac Ascites / Early BCS
Low (< 1.1)	High (≥ 2.5)	TB, Malignancy, Pancreatitis
Low (< 1.1)	Low (< 2.5)	Nephrotic Syndrome

Amylase : If Fluid Amylase > Serum Amylase, it’s Pancreatic Ascites.Elevated in pancreatic ascites.Value > 2000 U/L suggests Pancreatic ascites .

ADA (Adenosine Deaminase) : Frequently used in TB-endemic regions; high levels of ADA suggest Tuberculous etiology

Cell Count (WBC): An absolute neutrophil count (ANC) > 250 cells/mm³ is diagnostic of Spontaneous Bacterial Peritonitis (SBP).