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Functions of CSF
Removal of metabolic wastes, Supplying nutrients to the CNS, Protection of the brain and spinal cord
NOT a function of CSF
Producing an ultrafiltrate of plasma
CSF flow location
Subarachnoid space
Control of substances in CSF
By blood-brain barrier
CSF tube labeled 3
Sent to Hematology department
CSF tube that should be refrigerated
Tube 3
Traumatic tap
Concentration of blood in tube 1>2>3, Specimen contains clots, Clear supernatant
Intracranial hemorrhage
Even distribution of blood in all tubes, No clot formation (CSF no fibrinogen), Xanthochromic supernatant
Xanthochromia causes
Presence of RBC degradation products, Elevated serum bilirubin, Presence of the pigment carotene
Xanthochromia EXCEPT
TRAUMATIC TAP, RECENT hemorrhage (clear)
Web-like pellicle in CSF
Tubercular meningitis
WBC count calculation
CSF WBC count: 800 WBCs/μL, WBC=WBCxDIL=80x10=800 WBCs/μL
CSF TOOTAL cell count dilution
Diluted with Normal saline
Total CSF cell count on CLEAR fluid
Should be counted undiluted (CLEAR SPECIMEN), Increases cell yield
Adding albumin to CSF before cytocentrifugation
Decreases cellular distortion
Primary concern with increased neutrophils and lymphocytes in CSF
Meningitis
Neutrophils with pyknotic nuclei
Indicate degenerating cells, Resemble nucleated RBCs
Increased eosinophils
When a CNS shunt malfunctions
Macrophages in CSF
Appear following HEMORRHAGE, Repeated spinal taps, Diagnostic procedures
Nucleated RBCs in CSF
Seen as a result of Bone marrow contamination
Cells seen after CNS diagnostic procedure
Choroidal cells, Ependymal cells, Spindle-shaped cells
Hemosiderin granules and hematoidin crystals
Seen in macrophages
Myeloblasts in CSF
Complication of acute leukemia
Lymphoma cells
Cells resembling large and small lymphocytes with cleaved nuclei
Normal value of CSF protein
15 to 45 mg/dL
Differentiation of CSF from plasma
By the presence of Tau transferrin and Prealbumin (transthyretin)
Second most prevalent protein in CSF
lgG
Elevated CSF protein causes
Damage to the blood-brain barrier, Ig production within the CNS, Decreased normal protein clearance from the fluid, Neural tissue degeneration
Conditions causing elevated CSF protein
Meningitis and hemorrhage conditions that damage the blood-brain barrier are the most common causes
Integrity of the blood-brain barrier measurement
Using the CSF/serum albumin index
lgG index calculation
lgG index=CSF IgG (mg/dL)/serum lgG (g/dL) / CSF albumin (mg/dL)/ serum albumin (g/dL)
lgG index values greater than 0.70
Indicates IgG production within the CNS
Finding of oligoclonal bands in CSF
Seen with MULTIPLE SCLEROSIS and other conditions: encephalitis, neurosyphilis, Guillain-Barré syndrome and neoplastic disorders
CSF glucose and WBC count indicative of bacterial meningitis
CSF glucose of 15 mg/dL, WBC count of 5,000 with 90% neutrophils, and protein of 80 mg/dL
Normal CSF glucose
Range of 72 to 84 mg/dL
CSF glucose
60 to 70% of blood glucose
CSF lactate
Consistently decreased (NORMAL) in viral meningitis
CSF glutamine analysis
Measurement that can replace ammonia in children with Reye syndrome
Gram stain on CSF
Specimen must be centrifuged prior to staining
Cryptococcal meningitis
India ink preparation is positive; starburst pattern is seen on Gram stain
WBC count in cryptococcal meningitis
Over 2,000
Test of choice to detect neurosyphilis
VDRL (RECOMMENDED BY CDC, page 197)
Spermatogenesis location
Takes place in seminiferous tubules of testes
Maturation of spermatozoa
Takes place in epididymis
Enzymes for coagulation and liquefaction
Produced by the prostate gland
Major component of seminal fluid
Fructose
First portion of a semen specimen not collected
Semen analysis will have abnormal sperm concentration
Failure to document semen sample time
Primarily affects the interpretation of semen viscosity
Liquefaction of a semen specimen
Within 30 to 60 minutes after collection
Increased semen pH causes
Prostatic infection, decreased prostatic secretions, increased bulbourethral gland secretions
Normal sperm concentration
Above 20 million per milliliter
Sperm concentration calculation
83x20x1,000=83 Millions/mL
Primary reason to dilute a semen specimen
Immobilize the sperm
Sperm motility evaluations timing
Well mixed, liquefied semen within 1 hour of specimen collection
Normal sperm motility percentage
50%
Grading criteria for sperm motility
EXCEPT lateral movement
Purpose of the acrosomal cap
Ovum penetration
Morphologic shape of a normal sperm head
Oval
Normal sperm morphology criteria
>30% normal forms (routine criteria)
Synovial fluid functions
Lubrication for the joints, cushioning joints during jogging, providing nutrients for cartilage
Primary function of synoviocytes
Secrete hyaluronic acid
Procedure for collection of synovial fluid
Arthrocentesis
Normal synovial fluid appearance
Resembles egg white
Most frequently performed chemical test on synovial fluid
Glucose
Primary purpose of serous fluid
Lubrication of serous membranes
Membrane covering organs within a cavity
Visceral membrane
Increase in the amount of serous fluid
Effusion
Mesothelial cells
Normal cells seen in pleural fluid.
Neutrophils
A type of white blood cell involved in the body's response to infection.
Lymphocytes
A type of white blood cell that is part of the immune system.
Mesothelioma cells
Abnormal cells associated with mesothelioma, a type of cancer.
Differential observation of pleural fluid
Involves assessing the types and quantities of cells in pleural fluid.
Presence of plasma cells
Associated with tuberculosis.
Cytoplasmic molding
A characteristic of malignant cells.
Mucin-containing vacuoles
A characteristic of malignant cells.
Increased nucleus: cytoplasm ratio
A characteristic of malignant cells.
Absence of nucleoli
Characteristic of malignant cells except.
Pleural fluid pH of 6.0
Indicates esophageal rupture.
Mesothelioma cell
Seen in pleural fluid and indicates primary malignancy.
Ascites
Another name for a peritoneal effusion.
RBC count
Test performed on peritoneal lavage fluid.
Peritoneal lavage RBCs>100,000/μL
Indicate blunt trauma injury.
Serum ascites albumin gradient
Recommended test for determining if peritoneal fluid is a transudate or an exudate.
Serum albumin, 2.2 g/dL
Fluid albumin, 1.6 g/dL; indicates peritoneal fluid is exudate.
SAAG≥1.1
Indicates transudate; SAAG <1.1 indicates exudate.
Absolute neutrophil count
Used to differentiate between bacterial peritonitis and cirrhosis.
Normal WBC counts
Less than 350 cells/μL; increases with bacterial peritonitis and cirrhosis.
CA 125 tumor marker
Detection in peritoneal fluid is indicative of ovarian cancer.
Glucose↓
Indicates bacterial, tubercular peritonitis, malignancy.
ALP↑
Indicates gastrointestinal perforations.
Amylase ↑
Indicates pancreatitis, gastrointestinal perforations.
Lactose dehydrogenase
Not a chemical test primarily performed on peritoneal fluid.
Amniotic fluid
Provides a protective cushion for the fetus.
Fetal urine
Primary cause of the normal increase in amniotic fluid as pregnancy progresses.
Oligohydramnios
Decreased amount of amniotic fluid.
Creatinine level
Requested on amniotic fluid to differentiate amniotic fluid from maternal urine.
Bilirubin
Destruction is prevented by placing amniotic fluid specimens in amber-colored tubes.
FLM testing specimens
Delivered on ice and refrigerated or frozen.
Cytogenetic analysis
Amniotic specimens incubated at 37 °C prior to analysis.
Phospholipids
Filtration of amniotic fluid is required to avoid decreased values in test results.