CSF Flashcards
a major fluid of the body associated to CNS
Cerebrospinal fluid
Csf is produced in the ________ of the two lumbar ventricles and the______ and ____ ventricles
Choroid plexus
3rd and 4th
Approx ________ is produced every hour in adults
20mL
Maintain the volume of ______ to _______ ml in adults
90-150 ml
Volume of csf in neonates
10-60 ml
The circulating fluid is reabsorbed back into the blood capillaries in ____________/ at rate to equal to its production
Arachnoid granulations
Are capillary networks that form the csf from plasma mechanisms of selective filtration under __________ and _________
hydrostatic pressure and active trans port secretion
Are capillary networks that form the csf from plasma mechanisms of selective filtration under hydrostatic pressure and active transport secretion
Choroid plexus
Csf specimen is collected by the ___________ between third,fourth or fifth lumbar vetebrate
lumbar puncture/ tap
The opening pressure of the CSF taken when the needle first enters the?
Subarachnoid space
More preferred site of collection
More Relax
Lying position
Less fluid is collected in this position
Higher opening pressure
Sitting position
method of puncturing the sub occipital area
Cysternal Technique
performed among neonates, FONTANEL is the site of collection
Ventricular technique
Tube 1 is for?
Chemistry and serology test
Freezing temp
- these tests are least affected by blood or bacteria introduced as a result of the tap procedure
Tube 1
possible contaminants are flushed already in Tube 1
Tube 2
Tube 2 is for
Microbiology
Room temp
it is least likely to contain cells introduced by the spinal tap procedure
Tube 3
Tube 3 is for?
Hematology
Refrigrated
A fourth tube may be drawn for the___________ laboratory to provide better exclusion of skin contamination or for additional serologic tests
Microbiology lab
Excess fluid should not be discarded and should be _______ until there is no further use for it
Frozen
Supernatant fluid that is left over after each section has performed its tests may also be used for additional
Chemical or serologic tests
Lateral position in adult
90-180 mmHg
Opening pressure space to infants and children
10-100 mmHg
“If the opening pressure is greater than________ for a relaxed patient, NO more than should be collected
200 mmHg
No more than 2 mL
Avoid_________ because cell adhesion to the glass affects cell count and differentiation
Glasstubes
Processing time should be cellular degradation begins _______ after collection
quick/ 1hour
Refrigeration is contraindicated for culture specimens (Tube # 2) because fastidious organisms such as ?what organism cannot survived
Hemophilus influenza and Neisseria meningitides will not survive
Normally crystal clear. Standard is
h20 or distilled water
Cloudy or Turbid CSF
a. Presence of microorganisms
b. Increased protein
c. Increased WBC, RBC
a. Increased carotene
b. Intake of rifampin -ANTU-TB DRUG
c. Increased protein (>150mg/dL)
Xanthochromic CSF
a. Presence of microorganisms
b. Increased protein
c. Increased WBC, RBC
Cloudy or Turbid CSF
non-pathologic
Traumatic tap
Internal bleeding, pathologic
Intracranial hemorrhage
a. 6,000 RBC/uL
b. Traumatic tap – non-pathologic
c. Intracranial hemorrhage – Internal bleeding, pathologic
Grossly Bloody CSF
term used to describe CSF supernatant that is pink, orange, or yellow. Brought about by hemolysis
XANTHOCHROMIA
Very slight amount of oxyhemoglobin
Color?
Pink
Heavy hemolysis
Orange
conversion of oxyhemoglobin to unconjugated bilirubin
Yellow
*RBC à Lyse à releasing Hgb causing?
xanthochromic hemolysis
is caused by bilirubin due to immature liver function is also commonly seen in infants, particularly in those who are premature
Xanthochromia
Disorders affecting bloodbrain barrier Tubular meningitis
Pellicle
Disorders affecting bloodbrain barrier Traumatic tap
Clotted
Old hemorrhage Lysed cells RBC degradation Elevated bilirubin Increased serum level Disorders affecting bloodbrain barrier Meningeal melanosarcoma
Xanthochromic
Turbidity and Cloudiness begins to appear with:
- CSF WBC count Turbidity and Cloudiness begins to appear with:
- CSF WBC counts >200 cells/uL or
- CSF RBC counts >400 cells/uL
> 200 cells/uL or >400 cells/uL
CSF with cell counts of <50 cells/uL when direct sunlight is directed to the tube at 90 degree angle from the observer appear __________
Sparkling or snowy
CSF with cell counts of <50 cells/uL when direct sunlight is directed to the tube at 90 degree angle from the observer appear “sparkling” or “snowy”
TYNDALL EFFECF
when CSF clots without presence of blood, there is damage in blood brain barrier
Froin syndrome
Grossly bloody CSF can be an indication of intracranial hemorrhage, but it may also be due to the puncture of a blood vessel during the spinal tap procedure
Traumatic tap
Uneven distribution of blood?
Traumatic tap
Equal redness
Intracranial hemorrhage
1 st tube is much red and color diminish
Traumatic tap
Introduction of plasma fibrinogen into the specimen
Clot formation
Bloody CSF caused by ________does not contain enough fibrinogen to clot
Intracranial hemorrhage
RBC contains fibrinogen which is a clotting factor, fresh blood introduced due to
Traumatic tap
Diseases in which damage to the blood-brain barrier allows increased filtration of protein and coagulation factors also cause clot formation but do not usually produce a bloody fluid
Meningitis
Froin syndrome
Blockage of csf
A classic web-like pellicle is associated with
Tubular meningitis
RBCs must usually remain in the CSF for approximately 2 hours before noticeable hemolysis begins
Xanthochromic supernatant
RBCs concentrated at the bottom
Traumatic tap
Bloody all throughout
Intracranial hemorrhage
1>2>3
Positive (plasma fibrinogen)
Clear supernatant
Negative to erythrophages
Traumatic tap
1=2=3
Negative (fibrinogen is absent
Xanthochromic
Positive to erythrophages
Intracranial hemorrhage
- Subtract ___WBC for every 700 RBC
- Subtract___ mg/dL Protein for every 10,000 RBC/uL
1 WBC
8 mg/dl
The microscopic finding of macrophages containing ingested RBCs or hemosiderin granules is indicative of
Intracranial hemorrhage
are usually determined only when a traumatic tap has occurred and a correction for leukocytes or protein is desired
Rbc count
Routinely done
Wbc count
Diluent in wbc count
3% acetic acid + Methylene blue
increased number of normal cells in csf
Pleocytosis
•70% Lymphocytes is for?
•80% Monocytes is for?
Adult
Neonate
Normal in CSF
- If increased – seen in viral, fungal and tubercular metastasis
Lymphocyte
Normal in CSF
- If increased – seen in fungal and tubercular meningitis
Monocyte
- Not normal
- Indicative of bacterial meningitis
- Found in early cases of viral, fungal, and tubercular meningitis
Neutrophil
- Macrophages with ingested RBC
- Seen in intracranial hemorrhage
Erythrophages
Seen in multiple sclerosis – can lead to paralysis
Plasma cells
Seen in leukemia
Blast cells
RBC in spinal fluid Contrast media
Macrophages
Normal Viral, tubercular, and fungal meningitis Multiple sclerosis
Monocytes
May contain phagocytized RBCs appearing as empty vacuoles or ghost cells, hemosiderin granules and hematoidin crystals
Macrophages
Disseminated lymphomas
Resemble lymphocytes with cleft nuclei
Lymphoma cells
Diagnostic procedures
Seen in clusters with distinct nuclei and distinct cell walls
Ependymal, choroidal, spindleshaped cells
Metastatic carcinomas Primary CNS carcinoma
Seen in clusters with fusing of cell borders and nuclei
Malignant cells
The most frequently performed chemical test on CSF
Csf proteins
Primary protein fraction (same as serum)
Albumin
Second most prevalent (distinctive to CSF)
Pre albumin
- Haptoglobin
- Ceruloplasmin
Alpha globulins
- Transferrin (Major)
- Tau – carbohydrate deficient variant of transferrin (unique to CSF)
Beta Globulin
- IgG (primarily)
- IgA (small amount)
Gamma globulin
True or false
“IgM, Fibrinogen, and Beta lipoprotein are normally found in CSF”
False because it is NOT SEEN IN CSF
- CSF leakage/trauma
- Recent puncture
- Rapid CSF production
- Water intoxication
Decreased Results
- Meningitis
- Hemorrhage
- Primary CNS tumors
- Multiple sclerosis
- Guillain-Barré syndrome
- Neurosyphilis
- Polyneuritis
- Cushing disease
- Polyneuritis
- Diabetes
- Uremia
- Connective tissue disease
- Myxedema
Elevated Results in
• Proteins that were artificially introduced into the CSF by traumatic tap
Artificially induced proteins
more preferred, it can precipitate both albumin and globulin
. TCA (Trichloroacetic acid)
precipitates only albumin
SSA (Sulfosalicylic acid
Method whereas TCA AND SSA IS UNDER
Turbidimetry
Red + Protein = Blue (read photometrically
DYE BINDING
a. CBB (Coomasie Brilliant Blue
for Globulin Rgt: Ammonium sulfate (+) turbidity or grayish white ring
Rose jones test
for Globulin Rgt: Ammonium sulfate (+) turbidity
Nonne apelt
for Globulin Rgt: Saturated phenol solution (+) turbidity or bluish white cloudiness
Pandy’s
Albumin-Globulin ratio (increased Globulin = infection)
Lange’s colloidal gold test
Reagent use for rose jones method
Ammonium sulfate
Reagent use for nonne apelt method
Ammonium sulfate
Reagent used in pandy’s method
Saturated phenol solution