AUBF-Lab-CSF Flashcards
_____ is a clear, colorless fluid formed within the cavities (ventricle of the brain).
Cerebrospinal fluid (CSF)
The _______ produces about 70% of the CSF by ultrafiltration and secretion.
choroids plexus
The _______ and ______ produce the remainder of the CSF total volume.
ependymal lining of the ventricles and cerebral subarachnoid space
Approximately _____ of CSF fluid is formed per day, although only ______ is present in the system at any one time.
500ml; 90 to 150ml
Reabsorption of CSF occurs at the ______.
arachnoid villi
The initial appearance of the normally _____ can provide valuable diagnostic information.
crystal clear CSF
CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: What are the causes of Crystal, Clear
WBCs
RBCs
Microorganisms
Protein
CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Crystal, Clear Major Significance
Traumatic tap
Disorders that affect blood-brain barrier,
Production of IgG within the CNS
CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Oily causes
Radiographic contrast media
CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Bloody causes
RBCs
CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Bloody Major Significance
Hemorrhage, Traumatic tap
CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Xanthochromic causes
Hemoglobin, Bilirubin,
Carotene, Protein, Melanin
CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Xanthochromic Major Significance
Old hemorrhage
Lysed cells from tap RBC degredation,
Elevated serum bilirubin levels,
Increased carotene blood levels
Meningeal sarcoma
CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Clotted causes
Protein, Clotting factors
CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Clotted Major Significance
Traumatic tap
CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Pellicle causes
Protein, Clotting factors
CLINICAL SIGNIFICANCE OF CEREBROSPINAL FLUID APPEARANCE: Pellicle Major Significance
Traumatic tap Disorders
The CSF normally contains very little protein because the protein in the blood does not cross the ______ easily.
blood-brain barrier
Protein concentration normally increases _____ from the ventricles to the cisterns and finally to the lumbar sac.
caudally
Protein concentration normally increases caudally from the ______ to the _____ and finally to the ______.
ventricles; cisterns; lumbar sac
The ______ is a nonspecific but reliable indication of CNS pathology such as meningitis, brain abscess, MS, and the other degenerative processes causing neoplastic disease.
CSF protein
Elevated CSF protein levels may be caused by (4)
increased permeability of the blood-brain barrier
decreased reabsorption of the arachnoid villi
mechanical obstruction of the CSF flow
increased intrathecal immunologic synthesis.
Normal value Reference (Quantitative) of Protein in CSF:
Adults: ________ (lumbar)
_______ (cisternal)
________ (ventricular)
Neonates: ______ (lumbar)
Elderly: (>60y.o) : ________
Adults: 15-45 mg/dl (lumbar)
15-25 mg/dl (cisternal)
5-15 mg/dl (ventricular)
Neonates: 15-100 mg/dl (lumbar)
Elderly: (>60y.o) : 15-60 mg/dl
What are the tests for detection of Protein in CSF
Pandy’s Test
Ross-Jones Test
Tryptophan
Principle of Pandy’s Test:
The reagent precipitates albumin and globulin
Procedure of Pandy’s test
- Place 1ml of saturated aqueous solution of
phenol in a small test tube - Add 1 large drop of spinal fluid
Positive result of Pandy’s test
A bluish white cloud immediately forms as soon as the drop mixes with the reagent
Principle of Ross-Jones Test
This is Nonne-Apelt reaction
Procedure of Ross-Jones Test
In a small test tube, 1ml of a saturated solution
of ammonium sulfate is carefully overlaid (may
use this amount when necessary) with 1ml of the
spinal fluid to be tested
Positive Result of Ross-Jones Test
1+: A thin white ring may be seen at the zone of
contact within three minutes and which
disappears on mixing
4+: A heavy cloud which does not appear on
mixing
Procedure of Tryptophan
- Place 1ml of clear spinal fluid in a test tube
- Add 5ml of concentrated HCI and drop 2%
solution of formaldehyde (freshly prepared from
a stock of 40% solution) - Mix and let stand for 5mins
- Carefully overlay with 1.2ml of 0.06% solution
of sodium nitrate (freshly prepared from a stock
of 0.6% solution) - Read after 3mins
The CSF glucose level varies with the ______.
blood glucose levels
The CSF glucose level varies with the blood
glucose levels. It is usually about _____ of the
blood glucose level.
60%
A blood glucose specimen should be obtained at least_____ before lumbar puncture for comparisons.
60 minutes
A blood glucose specimen should be obtained at least 60 minutes before ______ for comparisons.
lumbar puncture
Any changes in the blood sugar are reflected in the CSF approximately ______ because of the lag in CSF glucose equilibrium time.
1 hour later
Any changes in the blood sugar are reflected in the CSF approximately 1 hour later because of the lag in _____
CSF glucose equilibrium time.
This measurement is helpful in determining impaired transport of glucose from plasma to CSF, increased use of glucose in the CNS and glucose utilization by leukocytes and microorganisms, the finding of a markedly decreased CSF glucose level accompanied by an increased WBC count with a large percentage of neutrophils is indicative of _______
bacterial meningitis
Normal Reference Values of Glucose in CSF:
Adult: _____
Child: _____
CSF-to-plasma glucose level ratio : _____
CSF glucose level: _______
Adult: 40-70mg/dl or 2.2-3.9 mmol/L
Child: 60-80 mg/dl or 3.3-4.4 mmol/L
CSF-to-plasma glucose level ratio : <0.5
CSF glucose level: 60%-70% of blood glucose
level
Test for determining Glucose in CSF
Benedict’s Test
Benedict’s Test procedure
- Place 0.5ml of Benedict’s qualitative reagent
to a test tube - Add 4.5cc of distilled water
- Heat to boiling
- Add 1cc of spinal fluid
- Boil again for 1-2minutes
- Allow to cool
Results of Benedict’s Test:
Normal sugar in CSF: _____
Absence of sugar (pathological): ______
Excess of protein but no sugar: ______
Normal sugar in CSF: turbid greenish yellow
Absence of sugar (pathological): no change in
color
Excess of protein but no sugar: deep purplish violet or pinkish-violet color
Normal CSF contains a small number of _____ and _____ in a ratio of approximately 70:30 in adults.
lymphocytes and monocytes
Normal CSF contains a small number of lymphocytes and monocytes in a ratio of approximately _______
in adults.
70:30
A higher proportion of monocytes is present in ______
young children.
An increase in the number of white blood cells (WBCs) in CSF is termed _______.
pleocytosis
CSF is examined for the presence of _____ and ____.
RBCs and WBCs
In general, (3) cause an elevated WBC count.
inflammatory disease
hemorrhage
neoplasms
trauma
Normal Reference Values of WBCs in CSF:
** Normal CSF is essentially _____
Adults: _______
Newborns: ________
Child: _______
Normal Reference Values:
** Normal CSF is essentially free of cells
Adults: 0-5 WBCs/ul or 5 x 106 WBCs/L
Newborns: 0-30 WBCs/ul or 0-30 x 106 WBCs/L
Child: 0-15 WBCs/ul or 0-15 x 106 WBCs/L
NORMAL CELL COUNT: Lymphocytes
ADULTS:
NEWBORN:
40% - 80%
5%-35%
NORMAL CELL COUNT: Monocytes
ADULTS:
NEWBORN:
15% -45%
50%-90%
NORMAL CELL COUNT: Polys (Neutrophils)
ADULTS:
NEWBORN:
0% - 6%
0% - 8%
**Use tube _____ for counting the cells present in the CSF sample.
3
A. Total Leukocyte Count
** Mixture of fresh blood interferes with cell counts. The larger the mixture, the greater______ the error. In
almost every case, ______ are due to traumatic bleeding caused home while obtaining the fluid.
greater; “bloody taps”
Total Leukocyte Count Procedure
- Tube 3 is thoroughly shaken (replace the cotton plug with a rubber stopper) and with the aid of capillary
pipette provided with a rubber bulb - Mount a drop of fluid on an Improved Neubauer hemocytometer counting chamber
- Count the number of WBCs on the 4 large corner squares and the RBCs on the 5 smaller squares of the
central square - Compute the results. Use the same formula used to obtain WBC and RBC counts
Computation for WBC ct? RBC ct?
WBC ct = Cells counted x ACF x DCF x DF (106/L)
RBC ct = Cells counted x ACF x DCF x DF (106/L)
