F2: CSF (Part 2: Sample Collection) Flashcards
SAMPLE COLLECTION
Volume of CSF fluid among three test tubes
3-6 mL serially collected
SAMPLE COLLECTION
How many tubes are used?
Three
SAMPLE COLLECTION
What section of the laboratory is Tube 1 from a CSF collection used for?
Tube 1: Chemistry and Serology
SAMPLE COLLECTION
What section of the laboratory is Tube 2 from a CSF collection used for?
Culture and Sensitivity
SAMPLE COLLECTION
What section of the laboratory is Tube 3 from a CSF collection used for?
Hematological studies
SAMPLE COLLECTION
T or F
The reason why hematology is done on last sample is to ensure sample is clean
T
SAMPLE COLLECTION
What appropriate preservation method for following tube:
Tube 1
Room Temp, Refrigerate, Freeze?
IF NOT PERFORMED IMMEDIATELY
Freeze
Tube 1: chemistry and serology
SAMPLE COLLECTION
What appropriate preservation method for following tube:
Tube 2
Room Temp, Refrigerate, Freeze?
IF NOT PERFORMED IMMEDIATELY
Room temp
Tube 2: culture and sensitivity
SAMPLE COLLECTION
What appropriate preservation method for following tube:
Tube 3
Room Temp, Refrigerate, Freeze?
IF NOT PERFORMED IMMEDIATELY
Refrigerate
Tube 3: hematology
SAMPLE COLLECTION
Tube 1, 2, 3,4 ?
Tests done: Chemistry (glucose, protein)
Amount needed: 1mL
Tube 1
SAMPLE COLLECTION
Tube 1, 2, 3,4 ?
Tests done: Gram’s stain, AFB stain, India ink preparation, Bacterial culture (blood agar, chocolate agar), Fungal culture (Sabouraud agar), Culture for TB
Amount needed: 2mL
Tube 2
SAMPLE COLLECTION
Tube 1, 2, 3,4 ?
Tests done: Total cell count, Differential count
Amount needed: 1mL
Tube 3
SAMPLE COLLECTION
Tube 1, 2, 3,4 ?
Tests done: Cytology, Immunology, Additional
Amount needed: 1mL
Tube 4
SAMPLE COLLECTION
T or F
if 4 tubes are collected in CSF, tube 1 and 2 have same procedure
T
Much harder to collect than the 3 tube sampling
SAMPLE COLLECTION
T or F
If only 1 tube is collected, cystology is the first tested
F (Microbiology is first)
Unless there is a special test request
SAMPLE COLLECTION
T or F
It is common to collect only 1 sample
T
SAMPLE COLLECTION
The longer sample is exposed, the more (blank) it will contain
The longer sample is exposed, the more bacteria it will contain
SAMPLE COLLECTION
T or F
It is not unusual for cell counts requested to be performed on both test tube 2 and 4 to check for cellular contamination by the puncture
F (t is not unusual for cell counts requested to be performed on both test tube 1 and 4 to check for cellular contamination by the puncture)
SAMPLE COLLECTION
Which tests are done in order?
Cell count, Cytology, Microbiology, Serology
- Microbiology
- Cytology
- Cell count
- Serology
CSF APPEARANCE
What CSF appearance based on description?
Clear, Watery
Normal
CSF APPEARANCE
What CSF appearance based on description?
- due to an increase in Cells
(RBC > 400 cell/cmm; WBC > 200 cell/cmm) - Protein (>150 mg/dL)
- Bacteria
- Fat
- Debris
Hazy
CSF APPEARANCE
What CSF appearance based on description?
- Supernatant that is pink, orange or yellow
- Contains: hemoglobin, oxyhemoglobin, bilirubin, carotenoids, raframpin, serum bilirubin, increased protein concentration
- Can manifest brown color due to melanin
Xanthrochromia
CSF APPEARANCE
- Indicates TB
- After 24 hours of refrigeration, it floats on top of sample, indicates TB
- When placed room temperature, this ndicates TB
Pellicle
CSF APPEARANCE
What CSF appearance based on description?
* Increased fibrinogen
* Spinal block (Froin’s Syndrome), traumatic tap, TB
Clot formation
CSF APPEARANCE
What RBC count causes CSF to appear hazy?
> 400 cell/cmm
CSF APPEARANCE
What WBC count causes CSF to appear hazy?
> 200 cell/cmm
CSF APPEARANCE
What protein volume causes CSF to appear hazy?
> 150mg/dL
CSF APPEARANCE
Most common form of xanthochromia?
XANTHOCHROMIA
Hemoglobin
CSF APPEARANCE
Color indicates heavy hemolysis
XANTHOCHROMIA
Orange
CSF APPEARANCE
Color indicates slight amount of oxyhemoglobin
XANTHOCHROMIA
Pink
CSF APPEARANCE
Color indicates conversion of oxyhemoglobiin to unconjugated bilirubin
XANTHOCHROMIA
Yellow
CSF APPEARANCE
Color indicates melanin (melanoma)
XANTHOCHROMIA
Brown
CSF APPEARANCE
T or F
Pellicle formation after 24 hours of refrigeration and in room temperature both indicates TB
Pellicle
T
CLINICAL SIGNIFICANCE OF CSF APPEARANCE
What appearance based on cause and major significance
Cause: none
Major significance: Normal
TABLE
CRYSTAL CLEAR
CLINICAL SIGNIFICANCE OF CSF APPEARANCE
What appearance based on cause and major significance
Cause: WBCs
Major significance: Meningitis
HAZY/ TURBID/ MILKY/ CLOUDY
CLINICAL SIGNIFICANCE OF CSF APPEARANCE
What appearance based on cause and major significance
Cause: Microorganisms
Major significance: Meningitis
HAZY/ TURBID/ MILKY/ CLOUDY
CLINICAL SIGNIFICANCE OF CSF APPEARANCE
What appearance based on cause and major significance
Cause: Protein
Major significance: Disorders affecting BBB Production of IgG within the CNS
HAZY/ TURBID/ MILKY/ CLOUDY, XANTOCHROMIC, CLOTTED, PELLICLE
pwede siya sa 4
CLINICAL SIGNIFICANCE OF CSF APPEARANCE
What appearance based on cause and major significance
Cause: Radiographic contrast media
Major significance: None
OILY
CLINICAL SIGNIFICANCE OF CSF APPEARANCE
What appearance based on cause and major significance
Cause: RBCs
Major significance: Hemorrhage Traumatic tap
BLOODY
CLINICAL SIGNIFICANCE OF CSF APPEARANCE
What appearance based on cause and major significance
Cause: Hemoglobin
Major significance: Old hemorrhage, Lysed cells from traumatic tap
XANTOCHROMIC
CLINICAL SIGNIFICANCE OF CSF APPEARANCE
What appearance based on cause and major significance
Cause: Bilirubin
Major significance: RBC degradation, Elevated serum levels
XANTOCHROMIC
CLINICAL SIGNIFICANCE OF CSF APPEARANCE
What appearance based on cause and major significance
Cause: Carotene
Major significance: Increased serum levels
XANTOCHROMIC
CLINICAL SIGNIFICANCE OF CSF APPEARANCE
What appearance based on cause and major significance
Cause: Clotting factors
Major significance: Introduced by traumatic tap
CLOTTED
CLINICAL SIGNIFICANCE OF CSF APPEARANCE
What appearance based on cause and major significance
Cause: Clotting factors
Major significance: Tubercular meningitis
PELLICLE
CLINICAL SIGNIFICANCE OF CSF APPEARANCE
Determine if Trauma or Subarachnoid Hemorrhage
Clearing: (+)
Xanthochromia: (-)
Eryhtophagocytosis: (-)
Hemosiderin: (-)
D dimer: (-)
Trauma
Determine if Trauma or Subarachnoid Hemorrhage
Clearing: (-)
Xanthochromia: (+)
Eryhtophagocytosis: (+)
Hemosiderin: (+)
D dimer: (+)
Subarachnoid Hemorrhage
T or F
If CSF is very red viscous, it indicates SAH
F (indicates Traumatic lumbar puncture; Internal brain bleeding)
What are the (5) characteristics involved in differentiating trauma or blood (hemorrhage)
- Clearing
- Xanthochromia
- Eryhtrophagocytosis
- Hemosiderin
- D dimer
(5) characteristics involved in differentiating trauma or blood
Positive or Negative result for clearing?
- First tube will have the most blood and 4th tube having least to no blood
- Traumatic tap
Positive
(5) characteristics involved in differentiating trauma or blood
Positive or Negative result for clearing?
- First tube is same color to the rest
- SAH/Subarachnoid hemorrhage
Negative
(5) characteristics involved in differentiating trauma or blood
Characteristic that refers to breakdown of RBC releasing hemoglobin, bilirubin,….
Xanthochromia
(5) characteristics involved in differentiating trauma or blood
Characteristic that involves erythrophagia (macrophage eating RBCs)
Eryhtrophagocytosis
(5) characteristics involved in differentiating trauma or blood
- Characteristic that is involved with coagulation
- Phagocytic system
- Fibrinolytic system is activated and breaks down fibrin into different fragments, one of which is this
D dimer
This means macrophage eating rbc
Erythrophagia
