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Hemothorax diagnosis based on pleural fluid

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hemothorax pleural fluid hematocrit definition 50 percent peripheral blood guideline

Hemothorax is diagnosed when:
[ \frac{\text{Pleural fluid hematocrit}}{\text{Peripheral blood hematocrit}} > 0.50 ]
That is, pleural-fluid hematocrit is more than 50% of the simultaneous peripheral-blood hematocrit. Fishman's Pulmonary Diseases and Disorders, p. 16-95.
  • A bloody-looking effusion alone is not diagnostic. Pleural fluid can look like blood at a hematocrit as low as about 5%.
  • A pleural fluid hematocrit below 50% of blood hematocrit is a hemorrhagic pleural effusion, rather than a true hemothorax.
  • With dilution over time, some sources consider a ratio of 25% to 50% strongly suggestive of hemothorax in the right clinical setting.
This is also consistent with the thoracic pleural-effusion workup reference.
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