Bay Biosciences provides high-quality, frozen pleural effusion samples, matched fresh frozen sera (serum), plasma, and peripheral blood mononuclear cells (PBMC) bio-fluids from patients diagnosed with lung disease.
The pleural effusion and the matched sera (serum), plasma and PBMC biofluid specimens are processed from lung disease patient’s peripheral whole-blood using customized collection and processing protocols.
Pleural effusion and matched biofluid samples are collected from unique patients diagnosed with lung disease.
Bio-samples are provided to a valued pharmaceutical customer for research, diagnostics, discovery and drug development.
Pleural Effusion Overview
A pleural effusion is an unusual amount of fluid around the lungs, it can resemble a respiratory infection. Symptoms of pleural effusion may include a cough, chest pain, and difficulty breathing.
Pleural effusion is also called water on the lung. It happens when fluid builds up abnormally, between the lungs and chest cavity, usually resulting from excess fluid production and/or decreased lymphatic absorption.
The development of a pleural effusion occurs from fluid seeping into the pleural space, a thin area between the visceral and pleural membranes in the chest cavity, which normally contains a small amount of fluid to facilitate smooth lung movement.
Fluid under pressure, malignant cells cells, and infectious agents can occasionally enter the pleural cavity and cause it to expand with abnormal amounts of fluid and other compounds.
Many diseases can cause pleural effusion, so even though your pleural effusion may have to be drained, your doctor likely will target the treatment at whatever caused it.
The pleura is a thin membrane that lines the surface of your lungs and the inside of your chest wall. When you have a pleural effusion, fluid builds up in the space between the layers of your pleura.
It is the most common manifestation of pleural disease, and its etiologies range in spectrum from cardiopulmonary disorders and/or systemic inflammatory conditions to malignancy. Approximately 1.5 million patients develop pleural effusions are diagnosed in the United States each year.
Types of Pleural Effusion
Following are the two types of pleural effusion:
Transudative Pleural Effusions
This type is caused by fluid leaking into the pleural space due to increased pressure in the blood vessels.
It can happen if you have the following conditions:
- Congestive heart failure
- Cirrhosis
- Kidney Disease
- Have just started peritoneal dialysis
- Mutation due to low albumin levels in the blood
Exudative Effusions
This happens when a buildup of fluid occurs as the result of:
- A lung injury
- Inflammation
- Infection
- Tumors
Conditions that could result in this type of pleural infusion include:
- Cancer
- Inflammatory conditions, such as pancreatitis, lupus, or rheumatoid arthritis
- Complications from heart surgery
- Chylothorax, which results from an obstruction in the lymph vessels
- Pneumonia
- Hemothorax, when blood collects in the pleural cavity
- Tuberculosis
Some conditions, such as pulmonary embolism, can lead to either transudate or exudate pleural effusion.
Signs and Symptoms of Pleural Effusion
Some patients do not experience any symptoms of pleural effusion. If symptoms do occur, they typically start to appear as fluid fills the chest cavity.
A pleural effusion can cause uncomfortable side effects. You may experience the following symptoms:
- Chest Pain
- Fever
- Flu like symptoms
- Dry Cough
- Feeling of chest heaviness or tightness
- General feeling of being unwell
- Inability to lie flat
- Persistent hiccups
- Sharp, severe pain when taking deep breaths
- Shortness of breath
- Unable to exercise
Some patients only find out they have pleural effusion when they undergo a test for another condition.
Also, it is important to note that the symptoms of pleural effusion can resemble those of other lung conditions. A person needs prompt medical help if they experience any of these symptoms.
Causes of Pleural Effusion
Pleural effusion always results from another condition. Many conditions can cause it. Here are some of the most common causes:
- Asbestos exposure and Mesothelioma
- Any type of cancer that affects or spreads to the lungs or pleura
- Congestive heart failure
- Infections, such as tuberculosis or Pneumonia
- Liver or kidney disease, such as cirrhosis
- Ruptured esophagus
- Autoimmune conditions, such as lupus or rheumatoid arthritis
- Pancreatitis
- Pulmonary embolism, which occurs when a blood clot blocks the arteries of the lung
Some of the following medical treatments can also trigger pleural effusion:
- Open heart surgery or other surgery involving the chest
- Certain medications, including methotrexate, amiodarone, and phenytoin
- Ovarian hyperstimulation
- Radiation therapy
Cancer and Pleural Effusion
There are several different causes of pleural effusion. For patients with cancer pleural effusion is often malignant. This means that there are cancer cells in the pleural space causing fluid to build up.
Sometimes, a pleural effusion can occur as a result of inflammation, lung obstruction, trauma, or another medical condition that may not be due to cancer.
Certain types of cancer: Some types of cancer are more likely to cause a pleural effusion. For example, around 40% of people with lung cancer develop a pleural effusion at some point during the course of their cancer.
Pleural effusion can also be a sign that cancer has spread to the lymph nodes.
Cancer treatments: Radiation therapy, chemotherapy, abdominal surgery, and certain medications can cause pleural effusion. Pleural effusions may also occur after lung surgery.
Other health conditions. Pleural effusion can also be caused by other conditions that are not cancer. These conditions include:
- Blood clots in the lungs, also called pulmonary embolism
- COVID-19
- Heart disease or heart failure
- Kidney Disease
- Liver disease
- Pneumonia
- Airway obstruction or lung collapse
- Ovarian hyperstimulation syndrome
- Poor nutrition, causing low protein levels
Diagnosis of Pleural Effusion
I can be challenging to diagnose pleural effusion as the symptoms may overlap with those of many other conditions. Your doctor will perform a physical examination and listen to your lungs with a stethoscope. They may also order a chest X-ray to help diagnose pleural effusion.
Following are some of the tests performed to diagnose pleural effusion:
- CT scan
- Bronchoscopy
- Pleural biopsy
- Thoracentesis where the doctor removes some pleural fluid for analysis
- Ultrasound of the chest
Thoracentesis involves removing fluid from the pleural membrane area by inserting a needle into the chest cavity and suctioning the fluid into a syringe. The doctor will use ultrasound to guide the needle. At the same time, they may drain the excess fluid from the chest cavity. The fluid will then be tested to determine the cause.
Your doctor may also choose to perform a pleural biopsy, which involves taking a tissue sample from the pleura. They do this by inserting a small needle from outside the chest wall into the chest cavity.
If they discover you have a pleural effusion but are unable to diagnose which type, your doctor may schedule a thoracoscopy. This is a surgical procedure that lets the doctor see inside the chest cavity using a fiber-optic camera.
For this procedure, your doctor will make a few small incisions in the chest area while you’re under general anesthesia. Then they’ll insert the camera through one incision and the surgical tool through the other to extract a small amount of fluid or tissue for analysis.
The healthcare professional will also need to determine whether the effusion is transudate or exudate. This is important because the results of the fluid analysis may provide a diagnosis and determine the course of treatment.
Thoracentesis which is a procedure to remove the fluid from the pleural space, followed by laboratory analysis of the fluid can differentiate between transudate and exudate.
The results from the fluid obtained from the thoracentesis are compared to certain blood tests, for example LDH, glucose, pH, cholesterol and others.
Additional testing of the pleural fluid may also include a cell count, cytology, and cultures. Criteria are then used to differentiate exudate from transudate.
Exudative effusions have the following characteristics:
- Pleural fluid LDH > 0.45 of the upper limits of normal blood values
- Pleural fluid protein level > 2.9g/dL
- Pleural fluid cholesterol level > 45mg/dL
Other healthcare professionals may use different criteria to determine the presence of exudate, such as the ratio of pleural fluid to serum protein levels . 0.5, LDH ratio > 0.6 and LDH ratio >2/3 the upper limits of normal.
Other pleural fluid analysis test results, cytology or amylase, for examples may also reveal the source of the effusion.
Risks and Complications of Pleural Effusion
Pleural effusions can be complicated or uncomplicated. Uncomplicated pleural effusions contain fluid without signs of infection or inflammation. Theses are less likely to cause permanent lung problems.
Complicated pleural effusions, however, contain fluid with significant infection or inflammation. They require prompt treatment that frequently includes chest drainage.
Pleural effusion can be a sign of severe symptoms with some diseases. Recently, some researchers found that patients with COVID-19 who developed pleural effusion were more likely to have severe inflammation and complications, which could affect their chances of recovery.
Treatment can also lead to complications.
Minor complications from more invasive treatments can include slight pain and discomfort, which often go away with time. More serious complications will depend on the severity of the condition, the cause, and the treatment used.
Following are some of the serious complications:
- Bleeding
- Empyema, when there is pus in the pleural space
- Infection
- pulmonary edema or fluid in the lungs, which can result from draining fluid too quickly during thoracentesis
- partial collapsed lung
- Trapped lung or inability of the lung to expand
These complications, while serious, are rare. Your doctor will help determine the most effective treatment option and discuss the benefits and risks of each procedure.
Treatment of Pleural Effusion
Your doctor may need to treat only the medical condition that caused the pleural effusion. The treatment and outcome will depend on the cause of the pleural effusion.
Usually conditions like pneumonia are treated with antibiotics and congestive heart failure is treated with diuretics. Large infected, or Inflamed pleural effusions often need to get drained to help you feel better and prevent more problems.
Draining Fluid
One of the ways to treat pleural effusion is by draining the fluid from the chest cavity, either with a needle or by inserting a small tube into the chest.
The patient receives a local anesthetic before this procedure, which will make the treatment more comfortable. You may feel some pain or discomfort at the incision site after the anesthetic wears off. Usually doctors will prescribe medication to help relieve pain.
You may need this treatment more than once if fluid builds up again.
Other treatments may be necessary to manage fluid buildup if cancer is the cause of the pleural effusion.
Thoracentesis
If the effusion is large, your doctor may take more fluid than they need for testing, just to ease your symptoms.
Antibiotics
If you have a bacterial infection, the doctor will likely prescribe antibiotics or administer them intravenously. They will usually do this alongside drainage.
Pleurodesis
Pleurodesis is a treatment that creates mild inflammation between the lung and chest cavity pleura. After drawing the excess fluid out of the chest cavity, a doctor injects a drug into the area. This drug causes the two layers of the pleura to stick together, which prevents the future buildup of fluid between them.
A doctor may decide to do this if pleural effusion is due to cancer. It reduces the need for frequent drainage.
Surgery
If symptoms don’t improve with drainage and antibiotics, the doctor may recommend thoracoscopic decortication or thorascopic debridement. They will insert a thoracoscope into the pleural space then either remove any tissue that is causing a problem (decortication) or surgically clean a wound to enable it heal (debridement). This is also known as a medical thoracoscopy or a pleuroscopy.
In some cases, a doctor surgically inserts a shunt, or small tube, into the chest cavity. This helps redirect the fluid from the chest into the abdomen, where it can be more easily removed by the body. This may be an option for those who don’t respond to other treatments.
Pleurectomy, in which the surgeon removes part of the pleural lining, may also be an option in certain cases.
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Samples available are cancer (tumor) tissue, cancer serum, cancer plasma cancer PBMC and human tissue samples from most other therapeutic areas and diseases.
Bay Biosciences maintains and manages its own bio-repository, human tissue bank (biobank) consisting of thousands of diseased samples (specimens) and from normal healthy donors available in all formats and types.
Our biobank procures and stores fully consented, deidentified and institutional review boards (IRB) approved human tissue samples and matched controls.
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This critical patient’s clinical data includes information relating to their past and current disease, treatment history, lifestyle choices, biomarkers and genetic information.
Patient’s data is extremely valuable for researchers and is used to help identify new effective treatments (drug discovery & development) in oncology, other therapeutic areas and diseases.
Bay Biosciences banks wide variety of human tissue samples and biological samples including cryogenically preserved at – 80°C.
Including fresh frozen tissue samples, tumor tissue samples, FFPE’s, tissue slides, with matching human bio-fluids, whole blood and blood derived products such as serum, plasma and PBMC’s.
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Bay Biosciences provides human tissue samples (human specimens) from diseased and normal healthy donors which includes:
- Peripheral whole-blood,
- Amniotic fluid
- Bronchoalveolar lavage fluid (BAL)
- Sputum
- Pleural effusion
- Cerebrospinal fluid (CSF)
- Serum (sera)
- Plasma
- Peripheral blood mononuclear cells (PBMC’s)
- Saliva
- Buffy coat
- Urine
- Stool samples
- Aqueous humor
- Vitreous humor
- Kidney stones (renal calculi)
- Other bodily fluids from most diseases including cancer.
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