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Is this a case of sbp?
Reading File
Finding Sources
Finding Sources
I have everything I need. Here is the analysis:
Is This a Case of SBP? - No, this does not meet the diagnostic criteria for SBP.
What the Report Shows
This is an ascitic fluid cytology report from a 67-year-old female with chronic liver disorder (likely cirrhosis), from KIMS, Bhubaneswar.
| Parameter | Result |
|---|---|
| Total Cell Count | 400 cells/cumm |
| Differential | Lymphocytes 95%, Neutrophils 5% |
| Appearance | Hazy, deep yellow |
| Malignant cells | Not seen |
The SBP Diagnostic Criterion
According to multiple authoritative sources (Harrison's, Washington Manual, Rosen's EM, Sabiston Surgery):
SBP is diagnosed when the ascitic fluid PMN (polymorphonuclear/neutrophil) count is ≥ 250 cells/µL.
Applying This to the Case
- Total cell count = 400 cells/cumm
- Neutrophils = 5% of 400 = 20 cells/cumm
The absolute neutrophil (PMN) count is only ~20 cells/cumm, which is far below the diagnostic threshold of 250 cells/cumm.
What the Differential Pattern Suggests Instead
A lymphocyte-predominant ascitic fluid (95% lymphocytes) is not typical of SBP. This pattern raises concern for:
- Tuberculous peritonitis - classically lymphocyte-predominant exudative ascites
- Malignant ascites (ruled out here by cytology - no malignant cells seen)
- Chylous ascites (less likely given findings)
The cytology report itself confirms: IAC Category 2A - No malignant cells seen, with predominantly lymphocytes and reactive mesothelial cells.
Summary
This ascitic fluid does not represent SBP. The absolute PMN count (~20/cumm) is well below the diagnostic threshold of 250/cumm. The lymphocyte-predominant pattern should prompt evaluation for tuberculous peritonitis (ADA levels, TB-PCR of ascitic fluid, or CBNAAT) alongside the known chronic liver disease context.
Summarise this report
Here is a concise summary of the report:
Ascitic Fluid Cytology Report - Summary
Patient: Mrs. Gedala Annapurna, 67.6 years, Female
Hospital: KIMS, Bhubaneswar | Department: Medical Gastroenterology
Reported On: 19 July 2026
Clinical Context
- Known case of chronic liver disorder
- Specimen: Ascitic fluid (15 mL, deep yellow, hazy appearance)
Key Results
| Parameter | Finding |
|---|---|
| Total Cell Count | 400 cells/cumm |
| Differential | Lymphocytes 95%, Neutrophils 5% |
| Cellularity | Moderate |
| Microscopy | Predominantly lymphocytes, neutrophils, and scattered reactive mesothelial cells |
| Malignant Cells | Not seen |
Diagnosis
IAC Category 2A - No malignant cells identified. The fluid shows a benign reactive picture, consistent with the background of chronic liver disease/cirrhosis-related ascites.
Key Clinical Points
- No malignancy detected - rules out peritoneal carcinomatosis at this time
- Not SBP - absolute neutrophil count (~20 cells/cumm) is far below the diagnostic threshold of 250 cells/cumm
- Lymphocyte-predominant pattern - warrants consideration of tuberculous peritonitis (ADA, TB-PCR advisable if clinically suspected)
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