Clotted Knee Fluid Cell Counts

From Susan Lemire: We received a solidly clotted knee fluid, with minimal non clotted blood. How do others handle these as far as reporting cell count and differential?

From George: I’m not certain this approach would resolve your situation, but we treat synovial fluid with hyaluronidase to liquify the clot-forming hyaluronic acid before counting. I invite comments from our participants, who are likely to have additional suggestions.

Here is a reference, sorry, it is restricted so I can’t provide the actual article.

Jayadev C, Rout R, Price A, Hulley P, Mahoney D. Hyaluronidase treatment of synovial fluid to improve assay precision for biomarker research using multiplex immunoassay platforms. J Immunol Methods. 2012;386:22–30.