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CLINICAL MICROSCOPY > Strasinger_CSF > Flashcards

Strasinger_CSF Flashcards

1
Q

CSF Functions

A
  • provides nutrients to nervous tissue
  • removes metabolic wastes
  • produces mechanical barrier to cushion the brain and spinal cord against trauma
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2
Q

lines the brain and spinal cord

A

meninges

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3
Q

3 meninges layers

A

dura mater
arachnoid
pia mater

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4
Q

Which layer of the meninges lines the skull and vertebral canal

A

dura mater

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5
Q

hard mother

A

dura mater

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6
Q

which layer of the meninges is referred to as the spider-like filamentous inner membrane

A

arachnoid

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7
Q

thin membrane lining the surfaces of brain and spinal cord

A

pia mater

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8
Q

gentle mother

A

pia mater

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9
Q

How much CSF is produced every hour

A

20 mL

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10
Q

Where CSF is produced

A

choroid plexuses (of the two lumbar ventricles and the third and fourth ventricles)

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11
Q

Where the CSF flows through

A

subarachnoid space

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12
Q

where the subarachnoid space is located

A

between arachnoid and pia mater

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13
Q

normal volume of CSF in adults

A

90-150 mL

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14
Q

normal volume of CSF in neonates

A

10-60 mL

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15
Q

how is CSF volume maintained?

A

the circulating fluid is reabsorbed back into the blood capillaries in the arachnoid granulations/villae at a rate equal to its production.

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16
Q

arachnoid granulations:

one-way or two-way valve?

A

one-way:

The cells of the arachnoid granulations act as one-way valves that respond to pressure within the central nervous system (CNS) and prevent reflux of the fluid

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17
Q

How is CSF formed?

A

Choroid plexuses form CSF from plasma by mechanisms of selective filtration under
hydrostatic pressure and active transport secretion

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18
Q

T/F:

CSF does not resemble an ultrafiltrate of plasma

A

TRUE

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19
Q

cells that line the capillary walls throughout the body

A

endothelial cells

: these are loosely connected to allow passage of soluble nutrients and wastes between the plasma and tissues

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20
Q

tight-fitting structure of the endothelial cells in the choroid plexuses

A

blood-brain barrier (BBB)

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21
Q

T/F:

Diseases such as meningitis and multiple sclerosis disrupts BBB

A

True

: this then allows leukocytes, proteins, and additional chemical to enter CSF

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22
Q

procedure used for CSF collection

A

lumbar puncture

: between the third, fourth, or fifth lumbar vertebra

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23
Q

T/F:

Lumbar puncture is a complicated procedure

A

FALSE

: Lumbar puncture is not complicated but may require certain precautions.

: requires measurement of intracranial pressure and technique to prevent infection or neural tissue damage

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24
Q

number of tubes needed for CSF collection

A

3

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25
Q

Tube 1 from CSF collection is for:

A

chemical and serological tests

: frozen
: least affected by blood or bacteria introduced as a result of tap procedure

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26
Q

Tube 2 from CSF collection is for:

A

microbiology

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27
Q

Tube 3 from CSF collection is for:

A

cell count

: least likely to contain cells introduced by the tap

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28
Q

4th tube may be drawn from the CSF collection. This is for:

A

microbiology to better exclude skin contamination or for additional
serologic tests

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29
Q

T/F:

Excess CSF fluid drawn may be discarded

A

FALSE

Excess fluid should not be discarded and should be frozen until there is no further use for it.

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30
Q

Supernatant fluid left over after each section has performed its tests may be used for?

A

additional chemical or serologic tests

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31
Q

T/F:

CSF testing are ideally performed on a STAT basis

A

TRUE

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32
Q

Storage condition of CSF tube:

Hematology tubes

A

Refrigerated

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33
Q

Storage condition of CSF tube:

Microbiology tubes

A

Room temp

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34
Q

Storage condition of CSF tube:

Chemistry and serology tubes

A

Frozen

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35
Q

CSF appearance that may be a result of increased protein or lipid concentration and may be indicative of infection

A

cloudy, turbid, milky

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36
Q

If only one tube can be collected for CSF, where must it be tested first?

A

Microbiology

37
Q

T/F:

It is not unusual for cell counts requested to be performed on both Tubes 1 and 4

A

TRUE

: this is to check for cellular contamination by the puncture

38
Q

CSF supernatant is pink, orange, or yellow

A

Xanthochromia

39
Q

most common cause of xanthochromia

A

presence of RBC degradation products

40
Q

CSF color that would indicate there is a very slight amount of oxyhemoglobin

A

pink

41
Q

CSF color that would indicate heavy hemolysis

A

orange

42
Q

CSF color that would indicate conversion of oxyhemoglobin to unconjugated bilirubin

A

yellow

43
Q

Other causes of xanthochromia other than presence of RBC degradation products

A
  • elevated serum bilirubin
  • presence of pigment carotene
  • markedly increased protein concentrations
  • melanoma pigment
44
Q

T/F:
Xanthochromia that is caused by bilirubin due to immature liver function is also commonly seen in infants, particularly premature infants

A

TRUE

45
Q

appearance of a normal CSF

A

crystal clear

46
Q

causes of grossly bloody CSF

A
  • intracranial hemorrhage

* due to puncture of a blood vessel during spinal tap procedure

47
Q

visual examinations of CSF that would determine whether the blood is the result of hemorrhage or a traumatic tap

A
  • uneven blood distribution
  • clot formation
  • xanthochromic supernatant
48
Q

Blood from a cerebral hemorrhage will be (evenly/unevenly) distributed throughout the three CSF specimen tubes

A

evenly

: traumatic tap will leave the heaviest concentration of blood in tube 1, and gradually diminishing amounts in tubes 2 and 3.

49
Q

T/F:

Fluid collected from a traumatic tap may form clots owing to the introduction of plasma fibrinogen into the specimen.

A

TRUE

: Bloody CSF caused by intracranial hemorrhage does not contain enough fibrinogen to clot

50
Q

presence of web-like pellicle in CSF is associated with?

A

tubercular meningitis

: pellicles can be seen after overnight refrigeration of fluid

51
Q

RBCs must usually remain in the CSF for approx. how many hours before noticeable hemolysis begins?

A

2 hours

52
Q

T/F:
A xanthochromic supernatant would be the result of blood that has
been present longer than that introduced by the traumatic tap.

A

TRUE

: care should be taken; a recent hemorrhage would produce a clear supernatant, and introduction of serum protein from a traumatic tap could also cause the fluid to appear xanthochromic.

53
Q

color of CSF (supernatant) from a recent hemorrhage

A

clear

54
Q

how to examine a blood fluid for the presence of xanthrochromia?

A

centrifuge in a microhematocrit tube

examine against a white background

55
Q

Other tests used for differentiation of blood CSF from intracranial hemorrhage or traumatic tap?

A

Microscopic Examination
: presence of ingested RBCs (erythrophagocytosis) or hemosiderin granules = intracranial hemorrhage

D-dimer Test
: detection of fibrin degradation product D-dimer by latex agglutination immunoassay indicates fibrin formation at a hemorrhage site

56
Q

Cell count routinely performed on CSF specimens

A

leukocyte (WBC) count

57
Q

In CSF analysis, cell count must be performed immediately. WBCs (particularly granulocytes and RBCs begin to lyse within ______, and leukocytes disintegrate after ____ hours.

A

1 hr; 2 hours

58
Q

What percentage of leukocytes in the CSF begin to disintegrate after 2 hours?

A

40%

59
Q

T/F:

Specimens that cannot be
analyzed immediately should be frozen.

A

FALSE

: refrigerated

60
Q

Normal WBC count in normal adult CSF

A

0-5 WBCs/uL

61
Q

T/F:

The number of leukocytes is higher in children as compared to adults

A

TRUE

:as many as 30 mononuclear cells/µL can be considered normal in newborns.

62
Q

T/F:

Specimens that contain up to 200 WBCs or 400 RBCs/uL may appear clear

A

TRUE

: so it is necessary to examine all specimens microscopically

63
Q

this is routinely used for performing CSF cell counts

A

Improved Neubauer Counting Chamber

64
Q

This have not been used for performing CSF cell counts due to high background counts and poor reproducibility of low counts

A

Electronic cell counters

65
Q

T/F:
The standard Neubauer calculation formula used for blood cell counts is also applied to CSF cell counts to determine the number of cells per microliter

A

TRUE

66
Q

CSF Cell Count Formula

A

[(# of cells counted x dilution) / (# of cells counted x volume of 1 square)] = cells/uL

67
Q

The CSF cell count formula can be used for both diluted and undiluted specimens

A

TRUE

: it also offers flexibility in the number and size of the squares counted

68
Q

T/F:

Clear specimens may be counted undiluted, provided no overlapping of cells is seen during the microscopic examinatio

A

TRUE

69
Q

Dilutions for total cell counts are made with _________

A

normal saline

:then, mixed by inversion, and loaded into the hemocytometer with a Pasteur pipette

70
Q

What parts of the hemocytometer are cells counted for CSF analysis?

A

4 corner squares and center square on both sides of the hemocytometer

71
Q

T/F:

Lysis of RBCs must be obtained before performing the WBC count on either diluted or undiluted specimens.

A

TRUE

72
Q

reagent used to lyse RBCs

A

3% glacial acetic acid

73
Q

reagent used to stain WBCs

A

methylene blue

: added to the diluting fluid
: this provides better differentiation between neutrophils and mononuclear cells

74
Q

how often must diluents be checked for contamination?

A

biweekly

75
Q

Diluents are checked for contamination by examining them in a counting chamber under what magnification?

A

400x

76
Q

T/F:
Contaminated diluents should be discarded and
new solutions must be prepared

A

TRUE

77
Q

Speed of cytocentrifuge must be checked ______ (how often?)

A

monthly

78
Q

used to check speed of cytocentrifuge

A

tachometer

: timing is checked with a stopwatch

79
Q

If nondisposable counting chambers are used for CSF cell count, they must be soaked in a bactericidal solution for how long?

A

at least 15 minutes

: then thoroughly rinsed with water and cleaned with isopropyl alcohol after each use

80
Q

Differential count on a CSF specimen is performed:

(a) on a stained smear
(b) via counting chamber

A

a. on a stained smear

81
Q

T/F:

In differential counting on a CSF specimen, to ensure that the maximum number of cells is available for examination, the specimen should be concentrated before
preparing the smear.

A

TRUE

82
Q

Methods available for specimen concentration

prior to differential counting on CSF specimens

A
  • sedimentation
  • filtration
  • centrifugation
  • cytocentrifugation
83
Q

Specimen concentration method/s that are not routinely used in the clinical laboratory but produce/s less cellular distortion

A

sedimentation

filtration

84
Q

This is a specimen concentration method performed when there is no cytocentrifuge available

A

centrifugation

85
Q

In concentrating CSF specimens via centrifugation, how long must be the specimen centrifuged?

A

5-10 minutes

: supernatant fluid is removed and saved for additional tests

: slides made from suspended sediment are allowed to air dry

:stain slides with Wright’s stain

86
Q

In performing CSF cell count, if the cell count is low and finding 100 cells is not possible, what must be the manner of reporting?

A

report only the numbers of the cell types seen

87
Q

In cytocentrifugation, how much CSF is used to combine with 1 drop of 30% albumin?

A

0.1 mL

:already produces adequate cell yield when processed with the cytocentrifuge

88
Q

The purpose of adding albumin in cytocentrifugation

A

increases cell yield and decreases cellular distortion frequently seen on cytocentrifuged specimen

CLINICAL MICROSCOPY (6 decks)

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