CM LEC - CSF up to CSF Protein Flashcards
CSF produced by
choroid plexus
choroid plexus produces how many percent of CSF
70%
where does the 30% CSF come from
plasma filtration
provides nutrients to CNS
CSF
channel for removal of waste products
CSF
mechanical buffer
CSF
protects brain and spinal cord from sudden pressure changes
CSF
CSF is also called __
fluid under pressure
volume regulator
CSF
normal CSF volume baby
10-60 ml
normal CSF volume adult
140 - 170 ml
rate of formation
20 ml CSF/hour
gold std for diagnosis of meningitis
CSF analysis
3 layers of meninges
dura
arachnoid
pia mater
types of inflammation
septic
aseptic
type of inflammation
viral, bacterial cause or other infectious agents
septic
types of inflammation
due to trauma
aseptic
methods of CSF collection
lumbar, cisternal, ventricular puncture
methods of CSF collection
w/in 3rd, 4th, 5th lumbar vertebrae
lumbar puncture
spinal puncture
lumbar tap
methods of CSF collection
most common
lumbar puncture
spinal puncture
lumbar tap
methods of CSF collection
used among infants only
done while baby’s fontanelle is open
ventricular puncture
methods of CSF collection
at base of the skull, not popular
cisternal
too much sx can’t be collected unless the pressure is
normal
opening pressure for adult
90-180 mm H20
opening pressure for young
10 - 100 mm H20
2 materials mentioned, used for csf collection
L-shaped adaptor (where needle is attached)
sterile manometer tube (measures pressure)
when can doctor aspirate?
when pressure is constant
closing pressure
45 -90 mm H20
when pressure suddenly drops
subarachnoid blockage
when pressure suddenly drops, do not ___
aspirate
determines the subarachnoid block which lowers the opening pressure
Queckenstendt test
CSF is always considered a STAT specimen except for vial # ?
2
vial # 1 is for what section
Chemistry/Serology
vial # 2 is for what section
Bacteriology
vial # 3 is for what section
Hematology
at what temp should vial # 1 be kept
freezing temp/freezer
at what temp should vial # 2 be kept
RT/incubator
at what temp should vial # 3 be kept
refrigerator temp
routine tests done on csf in chem section
CSF glucose
CSF protein
special tests done on csf in chem section
CSF CK - MB CSF CK -MT CSF LDH Glutamine Lactate
tests done on csf in serology section
vDRL
FTA - ABS
CSF C-RP
vDRL meaning
veneral disease research laboratory
FTA-ABS meaning
Fluorescent Treponemal Antibody Absorption Test
tests done on csf in bacte section
G/S
C/S
AFB
India Ink
tests done on csf in hema section
WBC Count
WBC Differential Count
RBC in CSF indication of
traumatic puncture
physical analysis is done on w/c section
hema
chemical analysis is done on w/c section
cc
microscopic analysis is done on w/c section
bacte
possible appearance of CSF (5)
crystal clear cloudy, milky, turbid xanthochromic clotted pellicle
normal appearance of csf
colorless and clear
CSF comparable to _
water
blank used for CSF analysis
distilled water
appearance of CSF
indicates no cell count
clear
appearance of CSF
indicates moderate cell count
cloudy/hazy
appearance of CSF
indicates high cell count
turbid
purpose of dilution of sx prior to counting
so cells are not overlapping
appearance of CSF
pale orange/ reddish/ yellowish discoloration
xanthochromic
xanthochromic sx has the presence of (4)
bilirubin, carotene, Hgb, protein
appearance of CSF
indicates traumatic puncture
clotted
appearance of CSF
tiny white aggregates on sample surface
pellicle
pellicle also described as __
cobweb or tigerweb
appearance of CSF
correlated with TB meningitis
pellicle
specimen suspected with __ and __ should not be kept in fridge
H. influenzae and N. meningitis
specimen suspected with H. influenzae and N. meningitis
because these are __
labile, killed at certain temp
Bloody specimen can have 2 causes
Traumatic aspiration
True intracranial bleeding
distribution of RBCs in Traumatic aspiration
uneven
distribution of RBCs in True intracranial bleeding
even
Presence of clot in TA
+ due to plasma contamination
Presence of clot in TIB
-
Xanthochromia in TA
clear
Xanthochromia in TIB
xanthochromic
CSF CK-BB in TA
not mentioned
CSF CK-BB in TIB
higher
Isoenzymes of CK
CK - MM
CK - BB
CK - MB
CSF Lactate in TA
not mentioned
CSF Lactate in TIB
increased
when does lactate increase
during tissue destruction
transparency of csf
clear
sp gr of csf
1.006 - 1.008
pH of csf
7.30 - 7.35
WBC Count Normal Values for adult
0-5WBC/ ul
WBC Count Normal Values for infants
0-30 WBC/ ul
increased WBC in CSF
pleocytosis
if sx is clear
what is the dilution
manner of counting
where to count/ what formula to use
no dilution
direct counting
count in 9 large squares
if sx is hazy
what is the dilution
manner of counting
where to count/ what formula to use
1:10 dilution
count in 5 large squares
use std formula for actual wbc count
if sx is turbid
what is the dilution
manner of counting
where to count/ what formula to use
1:20
count in 4 large squares
use std formula for actual wbc count
diluting fluid for CSF WBC count
Tuerk’s
3% Acetic Acid
what tube is used in charging for CSF WBC count
plain blue capillary tube
manner of mixing for CSF WBC count
inversion
for CSF WBC count, may be counted as a wbc
nucleated red cell
methods of obtaining sediment for diff count
sedimentation
filtration
cytocentrifugation
centrifugation
most common, most backward method of obtaining sediment for diff count
sedimentation
what to d with supernatant after sedimentation
give to chem section
stain used in CSF diff count
wright stain
advanced method of obtaining sediment for diff count
cytocentrifugation
in diff count, if cells counted do not reach 100, report only the ___ seen
number of cell types seen
method of obtaining sediment for diff count w/ good cell recovery
cytocentrifugation
method of obtaining sediment for diff count w/ complete cell recovery
filtration
stain for blood cells
wright
stain for cancer cells
papanicolaou
stain for parasitic cells
giemsa
CSF Cell constituents and %
70% lympho
30% mono
> 70% PMN indicates
bacteria meningitis
Early viral, fungal or tubercular meningitis demonstrates increase in what cells
PMN
Chronic viral, fungal or tubercular meningitis demonstrates increase in what cells
Lympho
parasitic meningitis demonstrates increase in what cells
eosino
bacterial meningitis demonstrates increase in what cells
PMN
Immature leukocytes indicates
leukemia
malignant cells indicates
tumor/cancer
plasma cells and reactive lympho indicates
HIV/ AIDS
macrophages in brain
microglial cells
bacteria that causes increase in lympho
Listeria monocytogenes
fungi with star burst appearance
C. neoformans
N.V. of CSF protein
15 - 45 mg/dL
Elevated CSF protein indicates
damage in BBB
why CSF protein is
CSF protein is a product of filtration, proteins cannot pass the filtering membrane
conditions of increased CSF protein
meningitis
traumatic tap
IgG synthesis
in traumatic tap, a drop of plasma causes how much increase of protein
10x
globulin produced during infection
IgG
conditions of decreased CSF protein
Elevated intracranial pressure
large sample removal
hyperthyroidism
otorrhea
CSF leaks from brain to ears
otorrhea
CSF leaks from brain to nose
rhinorrhea
protein fraction normally in csf (decreasing order)
Alb Pre-alb Ceruloplasmin Transferrin IgA IgG
Marker to differentiate CSF from other body fluids
Tau protein or T protein or carbohydrate deficient protein (?)
proteins not normally in CSF
fibrinogen
IgM
beta lipoprotein
precipitating agents (2)
SSA
TCA
SSA meaning
sulfosalicylic acid
TCA meaning
trichloroacetic acid
can ppt alb fraction better than glob fraction
SSA
can ppt alb fraction and glob fraction better
TCA
more sensitive ppt agent
TCA
Supernatant (Alb) measured using what dyes
BCG
MO
HABA
Used to visualize all protein fractions
electrophoresis
type of electrophoresis commonly used for CSF
PAGE
first choice dye
has affinity for all protein fractions
Coomassie Brilliant Blue
