5 - CSF, Semen, Serous Fluid

LUMBAR PUNCTURE:

• Adult =

• Children =

LUMBAR PUNCTURE:

• Adult = L4 & L5

• Children = L3 & L4

Maximum CSF collection capacity for adults

20 mL

CSF order of draw

• TUBE 1 - Chem / Serology (Frozen Temp)

• TUBE 2 - Microbiology (Room Temp)

• TUBE 3 - Hematology (Ref Temp)

• IF ONLY 1 TUBE AVAILABLE = Micro → Hema → Chem

IF 4th tube is collected in CSF, what is done?

For microbiology or cytology exam → excess is frozen for storage

• TUBE 1 - Chem / Serology (Frozen Temp)

• TUBE 2 - Microbiology (Room Temp)

• TUBE 3 - Hematology (Ref Temp)

  • IF ONLY 1 TUBE AVAILABLE = Micro → Hema → Chem

What blood cell is routinely counted in CSF

• White Blood Cells (WBCs)

  • RBC → done only in traumatic tap or for leukocyte correction

CSF WBCs count:

• Normal WBC in adult → _________

• Normal WBC in children → _________

  • Diluting fluid → ____________

CSF WBCs count:

• Normal WBC in adult → 0-5 WBCs/uL

• Normal WBC in children → 0-30 WBCs/uL

  • Diluting fluid → 3% Glacial Acetic Acid

What is the dilution of CSF if it appears CLEAR?

0 or undiluted

Predominant Cells in CSF

LYMPHOCYTES and MONOCYTES:

• Adult → 70% lymp + 30% mono

• Neonates → 70-80% mono + 20-30 lymp

Given that Lymphocytes and Monocytes are predominant in CSF, which has higher concentration in Neonates?

• Neonates → 70-80% mono + 20-30% lymp
  
  

• Adult → 70% lymp + 30% mono

Most common Chemical Test done for CSF

Protein

• Albumin

• Pre-albumin

What are the Major CSF Proteins

• 1 - Albumin

• 2 - Prealbumin or Transthyretin

  • Alpha globulin → Haptoglobin & Ceruloplasmin

  • Beta globulin → Tau protein

What are the turbidity test for CSF Protein

• Trichloroacetic Acid → preferred (both albumin and globulin)

• Slufosalicylic Acid → (Albumin only) + add Sodium Sulfate to ppt globulin

Dye Binding test for CSF Protein

Coomassie Brilliant Blue Dye

What CSF test is used to assess the integrity of Blood-Brain-Barrier

• CSF Serum Albumin Index

  • Normal - less 9

  • Abnormal - 9.9-14 (minimal impairment)

  • Abnormal - 100 (complete damage)

What CSF test is used to assess condition like Multiple Sclerosis

• IgG index:

  • Normal - less 0.77

  • Abnormal: - more 0.77

For Electrophoresis, what is the findings for MS. NEnG + What does this mnemonic stand for?

• 2 or more oligobands + increased IgG index in CSF but not in serum

  • Multiple Sclerosis

  • Neurosyphilis

  • Encephalitis

  • Guillian-Barre Syndrome

CSF Glucose is tested together with BLOOD glucose level. What is collected 1st?

• Blood Glucose → done first

• CSF Glucose (spinal tap) → 2hrs after blood collection

A normal Glucose + Lactate level may be an indication of?

• Viral meningitis

  • Glucose → 50-80 mg/dL

  • Lactate → 10-24 mg/dL

Viral meningitis = normal glucose and lactate. What are their levels for other disease (Bacterial, Tubercular, Fungal)

• Glucose → decreased

• Lactate → increased
  
  

INVERSE RELATIONSHIP

Positive for india ink in CSF may indicate

Fungal Infection

SPERMANALYSIS:

• Abstinence for ___________

• Prolonged may lead to _________ and _________

• FERTILITY TEST:

  • _______________

  • _______________

SPERMANALYSIS:

• Abstinence for 2-7 days

• Prolonged may lead to high volume and decreased motility

• FERTILITY TEST:

  • 2-3 samples ( not less 7 days and 3 weeks apart)

  • 2 abnormal samples are significant

• SPERMANALYSIS:

  • Liquifaction duration → ____________

  • Add liquifaction agent if → __________

    • ____________

    • ____________

    • ____________

SPERMANALYSIS:

• Liquifaction duration → 30-60 mins

• Add liquifaction agent if → not liquified after 2hrs

  • Dulbecco’s Phosphate Buffered Saline

  • a-Chymotrypsin

  • Bromelain

SPERMANALYSIS:

• Transport temp (within 1hr) → _________

• Awaiting for analysis → _______

SPERMANALYSIS:

• Transport temp (within 1hr) → room temperature

• Awaiting for analysis → body temp

SPERMANALYSIS:

• Viscosity →

• pH →

• Sperm CONC. →

• Sperm COUNT →

• Sperm MOTILITY →

• Sperm MORPHOLOGY →

SPERMANALYSIS:

• Viscosity → in droplets

• pH → 7.2 - 8.0

• Sperm CONC. → 20-250 M sperm / mL

• Sperm COUNT → >40 M sperms / ejaculate

• Sperm MOTILITY → 50% w/ 2.0 rating

• Sperm MORPHOLOGY → more 30%

SPERMANALYSIS:

• High prostatic fluid

• Ejaculatory duct obstruction

• Poorly developed seminal vesicles

DECREASED pH

(increase = STD or Infection)

SPERMANALYSIS:

• STD

• Infection

INCREASED pH

(decrease = high prostate fluid, ejac duct obstruction, undeveloped seminal visicles)

SPERMANALYSIS:

• How many sperms are analyzed for Sperm Morphology

200 sperms

SPERMANALYSIS:

• Stains for Sperm Morphology

• Wright’s stain

• Giemsa stain

• Papanicolao stain → preferred

What is the test used for Sperm Vitality

• Modified Bloom’s Test or Eosin-Negrosin Test

  • Living Sperm = unstained or bluish white

  • Dead Sperm = red aginst purple background

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