CEREBROSPINAL FLUID & AMNIOTIC FLUID Flashcards
viscous CSF
- Metastatic mucin-producing adenocarcinoma
- Cryptococcal meningitis
- Liquid Nucleus Pulposus
(MCL)
Routinely performed on CSF
wbc count
to correct for wbc count and total protein concentration, subtract ______ for every 700 RBCs seen
1 wbc
to correct for wbc count and total protein concentration, subtract ______ in total protein concentration for every 10,000 RBCs/uL
8mg/dL
in CSF differential count, specimen should be ______ first before preparing a smear
concentrated
4 types of csf differential count
- routine centrifugation
- cytocentrifugation
- sedimentation
- filtration
in cytocentrifugation, addition of _________ will increase cell yield or recovery and decreases cellular distortion
30% albumin
Viral, Tubercular, & Fungal Meningitis
Multiple Sclerosis
a. neutro
b. lympho, mono
c. macro
b
Bacterial meningitis
Early case of viral, tubercular & fungal meningitis
Cerebral hemorrhage
a. neutro
b. lympho, mono
c. macro
a
Intracranial hemorrhage
a. neutro
b. lympho, mono
c. macro
c
BLAST FORMS
a. acute leukemia
b. disseminated lymphoma
c. multiple sclerosis, lymphocyte reactions
d. diagnostic procedures, neurosurgery, pneumoencephalography
e. Metastatic carcinoma, primary CNS carcinoma
a
Lymphoma cells
a. acute leukemia
b. disseminated lymphoma
c. multiple sclerosis, lymphocyte reactions
d. diagnostic procedures, neurosurgery, pneumoencephalography
e. Metastatic carcinoma, primary CNS carcinoma
b
plasma cells
a. acute leukemia
b. disseminated lymphoma
c. multiple sclerosis, lymphocyte reactions
d. diagnostic procedures, neurosurgery, pneumoencephalography
e. Metastatic carcinoma, primary CNS carcinoma
c
EPENDYMAL, CHOROIDAL,
& SPINDLE-SHAPED CELLS
a. acute leukemia
b. disseminated lymphoma
c. multiple sclerosis, lymphocyte reactions
d. diagnostic procedures, neurosurgery, pneumoencephalography
e. Metastatic carcinoma, primary CNS carcinoma
d
MALIGNANT CELLS
a. acute leukemia
b. disseminated lymphoma
c. multiple sclerosis, lymphocyte reactions
d. diagnostic procedures, neurosurgery, pneumoencephalography
e. Metastatic carcinoma, primary CNS carcinoma
e
MALIGNANT CELLS
a. acute leukemia
b. disseminated lymphoma
c. multiple sclerosis, lymphocyte reactions
d. diagnostic procedures, neurosurgery, pneumoencephalography
e. Metastatic carcinoma, primary CNS carcinoma
e
normal value of CSF protein in adults
15-45 mg/dL
normal value of CSF protein in infants
150 mg/dL
normal value of CSF protein in immature
500 mg/dL
MAJOR CSF PROTEIN
albumin
2ND MOST PREVALENT
pre-albumin
ALPHA GLOBULINS
haptoglobin, ceruloplasmin
BETA GLOBULINS
b2- transferrin,
“tau”
GAMMA-GLOBULINS
IgG and IgA
clinical significance of pellicle
tubercular meningitis
NOT FOUND in CSF
- IgM
- fibrinogen
- lipoprotein
CSF protein decreased results
- CSF leakage/trauma
- recent puncture
- rapid CSF production
- water intoxication
2 methods in CSF protein determination (TOTAL PROTEIN)
turbidimetric
dye-binding
2 methods in turbidimetric
trichloroacetic acid
sulfosalicylic acid
which of the following is the preferred method
a. Sulfosalicylic acid
b. Trichloroacetic acid
b
which of the following precipitates both albumin and globulin
a. Sulfosalicylic acid
b. Trichloroacetic acid
b
which of the following precipitates albumin only
a. Sulfosalicylic acid
b. Trichloroacetic acid
a
in sulfosalicylic acid, adding _______ will precipitate globulins
Na2SO4
in total protein - dye binding, we use
coomasie brilliant blue
2 methods in CSF protein determination
total protein and protein fractions
2 methods in protein fractions
CSF/serum albumin index
IgG index
normal value in CSF/serum albumin index
<9
normal value in CSF/serum albumin index
<9
abnormal value in CSF/serum albumin index
> 9
CSF/SERUM ALBUMIN
INDEX
9-14
a. Slight impairment
b. Moderate impairment
c. Severe impairment
d. Complete damage to BBB
a
CSF/SERUM ALBUMIN
INDEX
9-14
a. Slight impairment
b. Moderate impairment
c. Severe impairment
d. Complete damage to BBB
a
CSF/SERUM ALBUMIN
INDEX
15-30
a. Slight impairment
b. Moderate impairment
c. Severe impairment
d. Complete damage to BBB
b
CSF/SERUM ALBUMIN
INDEX
>30
a. Slight impairment
b. Moderate impairment
c. Severe impairment
d. Complete damage to BBB
c
CSF/SERUM ALBUMIN
INDEX
100
a. Slight impairment
b. Moderate impairment
c. Severe impairment
d. Complete damage to BBB
d
IgG index normal value
<0.70
IgG index abnormal value
> 0.70
detection of oligoclonal bands in gamma region, indicates immunoglobulin production
CSF electrophoresis
Presence of 2 oligoclonal bands in CSF but not in serum can be seen in
MS. NENG
- multiple sclerosis
- neurosyphilis
- encephalitis
- neoplastic disorder
- guillain-barre syndrome
demyelinating disorder, Abs against myelin sheath
MS
- (+) Anti-myelin sheath autoantibody
- (+) oligoclonal band in CSF but not in serum
- (+) Myelin Basic Protein (MBP)
- Inc. IgG Index
MS
CSF GLUCOSE is collected ___ hrs before ____________
2
spinal tap
CSF glucose normal values
60-70% (2/3)
or
50-80 mg/dL of blood glucose
CSF glucose is normal in
viral meningitis
waste product of glucose metabolism
CSF LACTATE
glucose is _______________ to lactate
inversely proportional
CSF lactate normal values
10-24 mg/dL
product of ammonia and alpha-ketoglutarate in brain cells
CSF GLUTAMATE
indirect test for presence of excess NH3 in CSF
CSF GLUTAMATE
CSF GLUTAMATE normal values
8-18 mg/dL
CSF lactate is increased in
- bacterial meningitis
- tubercular and fungal meningitis
- hypoxia
CSF lactate is normal in
viral meningitis = <25 mg/dL
CSF glutamate increased in
- disturbance of consciousness
- reye’s syndrome
ISOENZYMES IN CSF
LDH
brain tissues
a. LD 2 & 3
b. LD 1 & 2
c. LD 4 & 5
b
lymphocytes
a. LD 2 & 3
b. LD 1 & 2
c. LD 4 & 5
a
neutrophils
a. LD 2 & 3
b. LD 1 & 2
c. LD 4 & 5
c
Normal distribution LD isoenzymes IN SERUM
2>1>3>4>5
Normal distribution LD isoenzymes IN CSF
1>2>3>4>5
CSF pattern seen in serum (flipped pattern)
AMI/hemolytic anemia
If serum pattern seen in CSF this indicates
neurologic abnormalities
In CSF pattern: 5>4>3>2>1- indicates
BACTERIAL meningitis
Creatine kinase is increased in
Stroke
MS
Degenerative disorder
Brain tumor
Bacterial and viral meningitis
Epileptic seizure
Aspartate aminotransferase is increased in
intracerebral and subarachnoid hemorrhage
bacterial meningitis
BACTERIAL MENINGITIS COMMON AGENTS
- Group B strep- neonates
- E. coli and gram neg bacilli- NB to 1 y.o
- N. meningitidis- 3 mos. older
- S. pneumoniae- 3 mos. older
- H. influenzae- 3 mos. to 18 y.o
- L. monocytogenes-
TUBERCULAR MENINGITIS common agent
mycobacterium tuberculosis
(+) Gram Stain
(+) Culture
(+) Limulus Lysate Test
bacterial meningitis
(+) AFB Stain
(+) Pellicle/weblike clot formation after
tubercular meningitis
TUBERCULAR MENINGITIS common agent
Mycobacterium tb
(+) Gram Stain
(+) India Ink
(+) Latex Agglutination Test
FUNGAL MENINGITIS
AMOEBIC MENINGOENCEPHALITIS COMMON AGENTS
- Naegleria fowleri
- Acanthamoeba spp.
- Balamuthia mandrillaris
(+) RBCs
(+) Acridine Orange Stain
AMOEBIC MENINGOENCEPHALITIS
VIRAL MENINGITIS common agents
- enteroviruses (coxsackie, echo, polio)
- arboviruses
RT-PCR can detect
VIRAL MENINGITIS
2 types of SPIROCHETAL MENINGITIS
- Neurosyphilis
- Neuroborreliosis
diagnosis for SPIROCHETAL MENINGITIS
- nontreponemal tests- VDRL, FTA-Abs
- ELISA
- Western blot
function of amniotic fluid
- cushion
- allows fetal movement
- stabilize temp
- lung maturity
The _____________ is the ultimate source of
amniotic fluid water and solutes
placenta
normal volume of amniotic fluid during third trimester
800-1200 mL
Decrease fetal swallowing of urine
POLYHYDRAMNIOS
>1200 mL
Neural tube defects
Increased fetal swallowing of urine
OLIGOHYDRAMNIOS
<800 mL
Membrane leakage
Urinary tract deformities
amniocentesis is safe to perform on
14th week of gestation
Maximum amount in amniocentesis
30 mL, first 2-3 mL is discarded
16th week, chromosomal studies (Trisomy 21/DS)
a. 2ND TRIMESTER AMNIOCENTESIS
b. 1st TRIMESTER AMNIOCENTESIS
c. 3RD TRIMESTER AMNIOCENTESIS
a
fetal lung maturity, fetal hemolytic disease
a. 2ND TRIMESTER AMNIOCENTESIS
b. 1st TRIMESTER AMNIOCENTESIS
c. 3RD TRIMESTER AMNIOCENTESIS
c
TEST FOR FETAL LUNG MATURITY
(FLM)
a. kept at RT or body temp (37degC)
b. placed on ice during delivery, kept refrigerated
c. protect from light; use amber-colored bottle, foil, black plastic cover
b
TEST FOR CYTOGENETICS STUDIES/
MICROBIAL STUDIES
a. kept at RT or body temp (37degC)
b. placed on ice during delivery, kept refrigerated
c. protect from light; use amber-colored bottle, foil, black plastic cover
a
TEST FOR HEMOLYTIC DISEASE OF
THE NEWBORN (HDN)
a. kept at RT or body temp (37degC)
b. placed on ice during delivery, kept refrigerated
c. protect from light; use amber-colored bottle, foil, black plastic cover
c
AMNIOTIC FLUID vs MATERNAL URINE
Amniotic fluid
Protein: +
Glucose: +
Urea: <30 mg/dL
Creatinine: <3.5 mg/dL
Maternal urine
Protein: -
Glucose: -
Urea: >30 mg/dL
Creatinine: >10 mg/dL
Detects ruptured amniotic membranes
FERN TEST
specimen in FERN TEST
vaginal fluid
(+) result in fern test
fern-like crystals (protein and NaCl)
normal color of amniotic fluid
a. DARK GREEN
b. BLOOD-STREAKED
c. colorless to pale yellow
d. YELLOW
e. DARK RED-BROWN
c
Traumatic tap, abdominal trauma, intra-amniotic hemorrhage
a. DARK GREEN
b. BLOOD-STREAKED
c. colorless to pale yellow
d. YELLOW
e. DARK RED-BROWN
b
bilirubin- HDN
a. DARK GREEN
b. BLOOD-STREAKED
c. colorless to pale yellow
d. YELLOW
e. DARK RED-BROWN
d
meconium (first fetal bowel movement)
a. DARK GREEN
b. BLOOD-STREAKED
c. colorless to pale yellow
d. YELLOW
e. DARK RED-BROWN
a
fetal death/demise
a. DARK GREEN
b. BLOOD-STREAKED
c. colorless to pale yellow
d. YELLOW
e. DARK RED-BROWN
e
TEST FOR HEMOLYTIC DISEASE OF THE NEWBORN (HDN) aka _________________
Optical density 450 (OD450)
normal absorbance of amniotic fluid
increased at 365 nm
decreased at 550 nm
abnormal absorbance of amniotic fluid
increased at 450 nm (max. bilirubin absorbance)
in OD450 results are plotted in a
liley graph
OD450- Zone I
a. moderately affected fetus
b. nonaffected/mildly affected fetus
c. severely affected fetus
b
OD450- Zone II
a. moderately affected fetus
b. nonaffected/mildly affected fetus
c. severely affected fetus
a
OD450- Zone III
a. moderately affected fetus
b. nonaffected/mildly affected fetus
c. severely affected fetus
c
Interferences in OD450
cells, meconium, debris, Hgb (peak abs 410 nm)
birth defect where there is incomplete closing of the backbone and
membranes around the spinal cord
Spina bifida/split spine
absence of major portion of the brain and scalp
Anencephaly
AFP is _____________ in spina bifida and Anencephaly
increased
AFP is _____________ in down syndrome
decreased
confirmatory test for neural tube defect
acetylcholinesterase (AChE)
do not perform AChE if bloody, could lead to _________
false increase
Most frequent complication of early delivery
RESPIRATORY DISTRESS SYNDROME
7th most common cause of morbidity and mortality among premature infants
RESPIRATORY DISTRESS SYNDROME
RESPIRATORY DISTRESS SYNDROME is caused by
lack of lung surfactants (phospholipids)
reference method for FETAL LUNG MATURITY (FLM)
LECITHIN/SPHINGOMYELIN (L/S) RATIO
<1.6 L/S Ratio
a. mature fetal lungs - > preterm delivery is safe
b. <35 wk
b
≥2.0 L/S Ratio
a. mature fetal lungs - > preterm delivery is safe
b. <35 wk
a
L/S Ratio false increase
blood and meconium
AMNIOSTAT-FLM
immunologic test for phosphatidylglycerol
phosphatidylglycerol’s production is ___________ to lecithin
parallel
microviscosity is _________________ to phospholipid
inversely proportional
MICROVISCOSITY measured by
fluorescence polarization
Surfactant-to-albumin (S/A) ratio is measured
MICROVISCOSITY
Dye bound to Surfactant
a. decreased fluorescence, high polarization
b. longer fluorescence, low polarization
b
Dye bound to Albumin
a. decreased fluorescence, high polarization
b. longer fluorescence, low polarization
a
stored form of phospholipid in fetus
LAMELLAR BODY COUNT
_________________ produce lung surfactants stored in the form of ___________________
Type II pneumocyte,
lamellar bodies
Methods in lamellar body count
impedance and optical scatter method
amount of adequate fetal lung maturity based on lamellar body count
> 32,000 / uL
Increased lamellar bodies = _______________ O.D.
increased
OD of __________ is equivalent to
- L/S Ratio of ______________
- Presence of _______________
≥ 0.150
≥2.0 - fetal lung is matured
phosphatidylglycerol not affected by blood and myconium
TEST FOR FETAL AGE
AMNIOTIC FLUID CREATININE
AMNIOTIC FLUID CREATININE
<36 weeks gestation
1.5 - 2.0 mg/dL
AMNIOTIC FLUID CREATININE
36 weeks gestation
> 2.0 mg/dL
in urine specimen preparation, warming @37 degC may
dissolve some crystals