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What is the normal range for WBCs in cerebrospinal fluid of an adult?
0-5
What is the normal volume of CSF in an adult?
90-150 mL
What is the normal volume of CSF in a newborn?
10-60 mL
What are the functions of CSF?
Cushions, collects waste, circulation of nutrients, lubrication of CNS
Where is the needle inserted to obtain a CSF sample?
Between the 3rd & 5th vertebrae into the pia-arachnoid space
Which CSF collection tube is used in hematology?
Tube 3
Why is the 3rd tube of CSF collection used for hematology?
It should be free of any blood from the procedure
What CSF collection tube is used in chemistry or immunology?
Tube 1
What CSF collection tube is used for a culture?
Tube 2
What is a significant cause of a bloody CSF?
Hemorrhage
What is an insignificant cause of a bloody CSF?
Traumatic tap
What are 3 possible causes of a cloudy CSF?
WBCs, bacteria, or protein/lipids
What term is used to describe a yellow CSF?
Xanthochromic
Why would there be blood in the first tube but not the third in CSF collection tubes?
Traumatic tap
Why would there be blood throughout all tubes in a CSF sample?
Hemorrhage
What may be seen 2-4 hours post hemorrhage in a microscopic CSF?
Erythrophagocytosis
What is the cause of a fresh CSF appearing xanthochromic after centrifugation?
Hemorrhage that occurred at least 2 hrs prior to collection
At what general time will macrophages arrive after the onset of bleeding?
About 2 hrs
What cells/structures may be seen in a CSF 12-48 hrs following the onset of a brain hemorrhage?
Macrophages containing hemosiderin granules
About how long does it take (after the onset of a brain bleed) for hematoidin crystals to form?
48 hours to 2 weeks
What is the predominate WBC in the CSF of a normal newborn?
Monocyte
What is the expected range of WBCs in the CSF of a normal newborn?
0-30
What WBC is predominate in the CSF of a healthy adult?
Lymphocyte
The WBC on a CSF is 500/uL. The differential shows 3% monocytes, 2% neutrophils, and 95% lymphocytes. What are 3 possible causes?
Viral meningitis, AIDS, or multiple sclerosis
A stained CSF shows clusters of bacteria. What WBC will be predominant?
Segmented neutrophil
The cell count on a CSF is 2200 WBC/uL and the differential shows 94% segs. What is the most likely condition?
Bacterial meningitis
What WBC is predominate in the CSF of a patient with a shunt?
Eosinophil
A patient with multiple sclerosis may be expected to have large numbers of what type of cell in their CSF?
Plasma cell
When can ependymal cells be seen in CSF?
Post-surgery, trauma, or infection
What is the clinical significance of choroid plexus cells in CSF?
None
What are 3 conditions where eosinophils are predominate in a CSF?
Shunt, parasitic infection, or allergic reaction to drug
Describe the white cell distribution/differential in a blood CSF due to a traumatic tap.
Similar to a peripheral blood smear
Typically, when are lactate levels increased?
Conditions involving oxygen deprivation (severe head injury)
How can a CSF glucose level be estimated?
Should be 60-70% of plasma glucose
What is the normal range for total protein in CSF?
15-45 mg/dL
What are oligoclonal bands?
Banding in the gamma region of CSF electrophoresis representing clones of IgG protein
With what primary disease are oligoclonal bands consistent?
Multiple sclerosis
What are you looking for when you stain a CSF sediment with India ink?
Yeast with a halo consistent with Crypto
A CSF has a high white count of 1000s, low glucose, high lactate and a predominance of segs. What is the probable condition?
Bacterial meningitis
A CSF has a high white count in the 100s, normal glucose, normal lactate and a predominance of lymphs. What is the probable condition?
Viral meningitis
Macrophages in CSF
Choroid plexus
Blasts in CSF
Eosinophil in CSF
Cryptococcus neoformans in CSF
India ink stain for Crypto
What are the three types of serous fluid?
Pericardial, pleural, & peritoneal
What is the normal WBC count for pleural and pericardial fluids?
<1000
What is the normal WBC count for peritoneal fluids?
<300
What does pleural fluid surround?
Lungs
What is ascitic fluid?
Fluid surrounding abdominal organs
What do you call the process of drawing out pleural fluid?
Thoracentesis
What do you call the process of drawing out pericardial fluid?
Pericardiocentesis
What do you call the process of drawing out peritoneal fluid?
Paracentesis
What is an effusion?
Increase in volume of serous fluid
What can cause the formation of an effusion?
Electrolyte imbalances, tumors, infections, circulatory disturbances, or pressure changes
Would congestive heart failure cause the formation of a transudate or exudate?
Transudate
Would a severe protein deficiency cause the formation of a transudate or exudate?
Transudate
Would a lung infection cause the formation of a transudate or exudate?
Exudate
Would nephrotic syndrome cause the formation of a transudate or exudate?
Transudate
What is the expected white count in an exudate?
>1000
Transudate
<1,000 WBCs
Lower SG (<1.015), protein (<0.5), LDH (<0.6)
No clots
Clear, pale yellow
Systemic disorders: CHF, nephrotic syndrome, liver disease
Outside the cavity
Exudate
>1,000 WBCs
Neutrophils
High SG (>1.015), protein (>0.5), LDH (>0.6)
May clot, use EDTA
Cloudy, bloody
Localized disorders: Malignancy, infection
Inside the cavity
Is a fluid-to-serum ratio of .4 more consistent with a transudate or exudate?
Transudate
Is a specific gravity of 1.030 more consistent with a transudate or exudate?
Exudate
Describe the appearance of chylous fluid, and state the primary cause.
Milky due to cancer
What type of white cells will predominate in a normal serous fluid?
Mononuclear (monos, lymphs, mesos)
What are mesothelial cells?
Lining cells of serous spaces
In what disease are mesothelial cells characteristically absent from pleural fluid?
Tuberculosis
When can increased numbers of mesothelial cells be seen?
During or following infection
What types of cells predominate in pleural fluid in someone with TB?
Plasma cells & lymphs
A high percent of segs in pleural fluid is consistent with what condition?
Bacterial pneumonia/infection
A high percent of segs in peritoneal fluid is consistent with what condition?
Peritonitis
A high percent of lymphs in pericardial fluid is consistent with what condition?
Little diagnostic value
A high percent of segs in pericardial fluid is consistent with what condition?
Endocarditis
A pleural fluid white count of 200/ul with a predominance of lymphs is consistent with what condition?
Normal
What 2 conditions are associated with a high white count in pleural fluid along with a predominance of lymphs?
Viral pneumonia & TB
Mesothelial cells
What is the normal white count for synovial fluid?
<200
What do you call the process of drawing out synovial fluid?
Arthrocentesis
What substance causes normal synovial fluid to be viscous?
Hyaluronic acid
What cells predominate synovial fluids?
Mononuclear
Why is liquid EDTA preferred over powdered EDTA when collecting synovial fluid?
Undissolved powder could mimic crystals
Type I joint disease
Non-inflammatory
Clear, yellow
<1000 WBC
<30% segs
Degenerative, osteoarthritis
Type II Immunologic joint disease
Inflammatory
Cloudy, yellow
Up to 75,000 WBC
<50% segs
RA, LE, Lyme
Type II Crystal induced joint disease
Inflammatory
Cloudy, milky
Up to 100,000 WBC
<70% segs
Gout, pseudogout
Which classification of joint disease can be immunologic or crystal induced?
Type II inflammatory
Type III joint disease
Septic
Cloudy, yellow-green
Up to 100,000 WBC
>75% segs
Microbial infection
Type IV joint disease
Hemorrhagic
Cloudy, red
WBC & segs same as blood
Trauma, tumor, coag disorder
What type of joint disease is most common in elderly patients?
Type 1 non-inflammatory
What type of joint disease is consistent with a cloudy synovial fluid, high white count, but <50% segs?
Type 2 inflammatory, probably immunologic
Into what joint disease classification do bursitis, lupus and rheumatoid arthritis fall?
Type 2 inflammatory, immunologic
Increased segmented neutrophils are seen in which classifications of joint disease?
Type II (gout/pseudogout) & type III (septic arthritis)
What type of joint disease is caused by a blunt trauma to a joint?
Type 4 hemorrhagic
What cell type predominates in the synovial fluid of someone with gout?
Seg
What causes the synovial fluid to become LESS viscous in some diseases?
Inflammatory enzymes (which break down hyaluronic acid)
How can a lab scientist reduce the viscosity of a synovial fluid for testing purposes?
Add hyaluronidase
Polarized microscopy will cause some structures to appear bright against a black background. What term is used to describe this phenomenon?
Birefringence
MSU crystals
Increased uric acid
Gout
Needle shaped
Increased segs
Strongly birefringent
Yellow when parallel
CPPD crystals
Increased calcium
Pseudogout
Needle shaped or rhombic
Increased segs
Weakly birefringent
Blue when parallel
