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Other Body Fluids > CSF Overview and Collection > Flashcards

CSF Overview and Collection Flashcards

1
Q

CSF provides a physiologic system to supply nutrients to the nervous tissue, _____ metabolic waste, and provides a ________ ______ to cushion the brain and spinal chord.

A
  • removes metabolic waste
  • mechanical barrier
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2
Q

What lines the brain and spinal chord?

A

Meninges

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3
Q

Name the three layers of the meninges?

A
  1. Dura mater (outside)
  2. Arachnoid (middle)
  3. Pia mater (inner)
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4
Q

Describe the three layers of the meniges?

A
  1. Dura mater - lines skull and verterbral canal
  2. Arachnoid - filamentous inner memebrane
  3. Pia mater - thin memebrane lining surfaces of the brain and spinal chord.
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5
Q

Where is CSF produced?

A

Choroid plexuses of the two lumbar ventricles and 3rd and 4th ventricles.

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6
Q

What are the choriod plexuses?

A

Capillary networks that form the CSF from plasma by selective filtration under hydrostatic pressure and active transport seceretion.

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7
Q

How much CSF is produced hourly in adults?

A

20 mL

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8
Q

CSF flows through the _________ ________ located between the arachnoid and pia mater.

A

subarachnoid space

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9
Q

To maintain a volume of _______ in adults and _______ in neonates, the circulating fluid is reacbsorbed back into the blood capilaries in the arachniod granulations/villae at a rate equal to its production.

A
  • 90 - 150 mL
  • 10 - 60 mL
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10
Q

The cells of the arachnoid granualtions act as one-way valves that respond to and prevent what?

A
  • pressure in CNS
  • prevent reflex of fluid
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11
Q

The choriod plexuses endothelial cells have very tight fitting junctures that prevent?

A

prevents the passage of many molecules

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12
Q

What is the tight fitting structure of endothilial cells in the choriod plexus called?

A

Blood-brain barrier

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13
Q

Give an example of two diseases that can disrupt the blood brain barrier?

A
  • Meningitis
  • Multiple sclerosis
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14
Q

How is CSF collected?

Which vertebrae?

A
  • Lumbar puncture
  • Between the 3rd, 4th or 5th vertebrae
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15
Q

What precaustions are taken prior to a lumbar puncture? (2)

A
  • Measurement of intracranial pressure
  • careful technique to prevent introduction of infection or damage of neural tissue
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16
Q

The volume of CSF that can be removed is based on? (2)

A
  • volume avaiable in a patient (adult vs. neonate)
  • opening pressure of CSF when needle first enters the subarachnoid space.
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17
Q

Specimens are collected on three sterile tubes. What tests is each tube used for and how is each preserved temperature wise?

A
  • Tube 1 - chemical and serological tests; least affected by blood/bacteria introduced as a result of tap. FROZEN
  • Tube 2 - Microbiology, ROOM TEMP
  • Tube 3 - Cell count (hematology), FRIDGE
  • Tube 4 - microbiology for additional testing and better exclusion of contamination.
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18
Q

Describe the appearance of CSF?

A

Crystal clear

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19
Q

A cloudy, turbid, or milky CSF specimen can be the result of?

A
  • Increased protien / lipid concentration
  • Infection (WBCs cause turbidity)
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20
Q

Xanthochromia is used to describe CSF that is?

A
  • Pink
  • Orange
  • Yellow
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21
Q

What is the most common cause of xanthochromia?

Describe varying color changes?

A

RBC degredation products

  • Pink - very slight oxyhemoglobin
  • Orange - heavy hemolysis
  • Yellow - oxyhemoglobin converted to unconjugated bilirubin
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22
Q

Apart from RBC degredation, what are other causes for xanthochomia in CSF? (4)

A
  • Elevated serum bilirubin
  • the presence of pigment carotene
  • markedly increased [protein]
  • melanoma pigment
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23
Q

Grossly Bloody CSF is indicative of?

A
  • Intracranial hemorrhage
  • blood vessel puncture from spinal tap
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24
Q

How do you differentiate between intracranial hemorrhage and a traumatic tap?

A

Three visual examinations of the collected specimens can usually determine this:

  • Blood from cerebral hemorrhage is evenly ditributed
  • Traumatic tap - blood heaviest conc. in forst tube, with decreasing amounts in tubes 2 and 3
25
Q

Why might CSF from a truamatic tap form clots?

Does it clot from intracranial hemorrhage?

A
  • Due to introduction of fibrinogen into specimen
  • Bloody CSF from intracranial hemorrhage does not contain enough fibrinogen to clot.
26
Q

What conditions damage the blood-brain barrier, allowing the filtration of protien and coagulation factors causing clot formation, but not bloody CSF? (3)

A
  • Meningitis
  • Froin syndrome
  • Blockage of CSF circulation
27
Q

How long can RBCs remain in CSF before noticable hemolysis?

A

2 hours

28
Q

A classic web-like pellicle that can be seen in CSF after overnight refridgeration is associated with?

A

Tubercular meningitis

29
Q

What is another way of differentiating intracranial hemmorage from traumatic tap? (2)

A
  • D-Dimer test
    • By latex agglutination immuno assay indicated formation of fibrin at hemorrhage site.
  • microscopic finding of marophages w/ ingested RBCs or hemosiderin granules indicates intracranial hemorrhage
30
Q

What cell count is routiely done on CSF?

When is an RBC cell count done?

A
  • WBC count
  • determined only when traumatic tap occured and need to correct leukocytes or protiens.
31
Q

Why should a cell count be performed immediately?

A

WBCs (esp. granulocytes) and RBCs begin to lyse w/i 1 hour anf 40% WBCs disintegrate after 2 hours

32
Q

Normal CSF range for WBCs?

A

0 - 5 WBCs uL (number is higher in children as manay as 30 mononuclear cells/ uL in neonates)

33
Q

Calculation of CSF Cell counts?

Can this be used on diluted and undiluted specimens?

A
  • Nebauer calculation
    • # cells counted x dilution factor / # of sqs. counted (5) x vol. of sq. (0.1) = cells /uL
  • Yes
34
Q

What is used for the lysis of RBC cells prior to performing the WBC count?

A

Glacial acetic acid

35
Q

Correction for contamination calculation?

A
  • WBC (added) = WBC (blood) x RBC (CSF) / RBC (Blood)
  • Calculate artificially added WBCs by comparing WBC to RBC ratio in periperal blood and compare with ratio of contaminating RBCs.
36
Q

QC: How often should all diluents be checked?

How often is centrifuge checked?

How are non-disposable counting chambers cleanned?

A
  • Bi-weekly, under microcopic examination for contaminants
  • monthly using a tachometer for speed and w/ a timer for timing
  • bactericidal solution soak for 15 minutes then rise w/ water and isopropyl alcohol
37
Q

Differential: to ensure that the maximum number of cells are available for examination, what should be done with the specimen prior to smear prep?

A

Concentrated prior to prep of smear.

38
Q

How many cells are counted for the CSF differential?

A

100

39
Q

Why is albumin added for the cytocentrifugation?

A

The addition of albumin increases cell yield and decreases cellular distortion

40
Q

What cells arefound in normal CSF and their ratios in adults and children?

A
  • Lymphocytes and monocytes
  • Adults have predminance of lymp. to mono at 70:30
  • Children have predominance of lymp to mono at 70:30
41
Q

What is Pleocytosis?

A

The presence of increased #s of normal cells and is considered abnormal, as is finding immature leukocytes, eos, plasma cells, marcrophages, increased tissue, and malignant cells.

42
Q

A high WBC count, with the majority of cells being neutrophils is indicative of?

A

Bacterial menigitis

43
Q

A moderately elevated CSF WBC count with a high percentage of lyphocytes and monocytes suggests?

A

Menigitis of viral, tubercular, fungal or parasitic origin

44
Q

These cells are from the epitelial lining of the choroid plexus?

A

Choroidal cells

45
Q

These cells are from the lining of the ventricles and neral canal?

A

Ependymal cells

46
Q

These cells represent the lining from the arachnoid. They are usually seen in clusters with systemic malignancies.

A

Spindle-shaped cells

47
Q

Lymphoblasts, myeloblasts, and monoblasts in the CSF are frequently seen in the case of?

A

Acute leukemia

48
Q

What is the most frequenly performed test on CSF?

A

Protien determination

49
Q

What are the normal values for total CSF protien?

A

15 - 45 mg/dL

50
Q

What protein makes up the majority of SF protien?

A

Albumin

51
Q

Abnormally values of protien are indicative of?

A

fluid leaking from the CNS

52
Q

What conditions damage the blood brain barrier?

A
  • Menigitis
  • Hemorrhage
53
Q

What test is used to determin whether IgG is elevated due to its prodution in the CNS or defect in the blood-brain barrier?

It evaluates the integrity of the blood brain barrier

A

Serum/albumin index

CSF/serum albumin index = CSF albumin (mg/dL) / Serum albumin (g/dL)

54
Q

Serum/albumin index: What value represents an intact blood brain barrier?

A

index value <9

Index increases relative to the damage to the blood-brain barrier

55
Q

What values are indicative of IgG production within the CNS?

A

>0.7

56
Q

The presence of what in CSF that are not present in serum is indicative of multiple sclerosis?

A
  • Oligoclonal bands (CSF Protein Electrophroesis)
    • Bands appear in gamma region
57
Q

Myelin Basic Protein (MBP) in the CSF is indicative of?

A

Recent destruction of the myelin sheath that protets the axons of neurons.

58
Q

Measurement of what in CSF can be used to monitor the progression of Multiple Sclerosis?

This also measures the effectiveness of current and future treatments.

A

MBP

59
Q

How does glucose enter the CSF?

What is the normal value CSF glucose compared to plasma glucose?

What is run for comparison?

A
  • Seletive transport across the BB barrier.
  • 60 - 70% of plasma glucos (e.g. if plasma glucose is 100 mg/dL, CSF glucose wuld approx. be 65 mg/dL)
  • Blood glucose test

Other Body Fluids (6 decks)

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