ua week 7

CSF fluid

subarachnoid CNS space, formed by selective filtration of plasma and active transport secretion by epi membranes

csf physiology

floes through subarachnoid space between arachnoid and pia mater, reabsorbed into blood, formed by selective filtration

csf total vol

adult 80-150, baby 10-60

meninges

lines brain and spinal cord, dura mater (outer), arachnoid (middle), pia mater (surfaces of brain and spinal cord)

csf functions

provide nutrients to nervous tissue, remove metabolic wastes, maintain intracranial pressure, mechanical barrier to cushion brain and spinal cord

csf fluid production

choroid plexuses of the 4 ventricles, 20 mL/min produced in adults

csf collection

3-5 lumbar puncture, aliquoted into 3+ sterile tubes- 1 chem freeze, 2 micro rt count in 1hr, 3 hem cell count 4 hr fridge, 4 other, if only 1 tube do micro first

CSF milky vs cloudy/turbid

protein, lipid, vs wbc (meningitis) infec, poteins lipids

csf pink-red

intracranial bleed (consistent color/cell count, no clot), traumatic tap (gradual decrease color/count from 1st to last tubes, clots- web like= TB)

csf xanthrochromia

yellow/amber/orange, hgb degradation products due to older intracranial bleed, elevated serum bili and protein, if bloody centrifuge & observe supernatent, jaundice

csf cell count range

0-5 wbc adults, <30 newborn, 0 rbc, manual hemocytometer (neubauer counting chamber), hematology analyzer body fluid mode

granulocytes

lyse within 1 hr stat count

csf diff

cytospin concentrated slide, adult primary lymphs:monos 70:30, kids 30:70

neutrophils

bacterial meningitis, phagocytize bacteria, increase early virla, fungal, tubercular, parasitic, may have vacuoles, bm contamination, can pyknotic

csf diff abnormals

high neutrophil- bacterial meningitis, high lymph/monos- viral meningitis, macrophages- previous hemorrhage, malignant cells- hematologic origin, metastatic carcinomas, CNS tumors

abnorm csf values due to

alteration in permeability of blood-brain barrier, increased metabolism by neural cells in response to pathological condition

multiple sclerosis

<50 lymphs norm and reactive, no bands in serum only in csf, compare to IgG index

eosinophils

coccidioides immitis, med and shunts into CNS

csf protein

15-45 method dependent, increased in infants and over 40, low= leak, high= meningitis or hemorrhage damaging blood brain barrier

IgG index

csf IgG / serum IgG / csf alb / serum alb, >0.7 = IgG production within CNS

detection of oligoclonal bands

cns inflammation, located in the gamma region or protein electrophoresis, simultaneous serum electrophoresis must be done

csf glucose

60-80% plasma glucose if low sig, compared to blood (drawn 2 hrs before spinal tap), selective transport across blood brain barrier

low csf glucose

with high wbc neutrophils= bacterial meningitis, high lymphs= TB meningitis, w/o high wbc= alteration of transport across blood brain barrier or increased glu metabolis by brain cells

high csf glucose

due to increase plasma glucose

additional csf testing

lactate, GS and culture, molecular, serology

csf lactate

dx and manage meningitis (>25= bact TB fungal, <25= viral), elevated until effective treatment falling rapidly, due to low O2 flow to tissue condition (severe head injury)

csf glutamine

by brain cells from ammonia and a-ketoglutarate to remove toxic ammonia, Indirect detects ammonia in csf, 8-18, better than direct csf

elevated csf glutamine

liver disease, kids with reye syndrome, disturbance of consciousness when glutamine >35

CSF glutamine staining

acid fast or fluor ab only it Tb meningitis, india ink for cryptococcus neoformans, starburst pattern= cryptococcus

immunologic assays- latec agglu

more sensitive for C. neoformans than india ink, confirm with culture dye to false pos frequency (rheumatoid factor), can also use enzyme linked immunosorbent

GS csf

on sediment of centrif at 1500g for 15 min, cytocentrif helps, draw blood culture, few orgs and debris = difficult, best for detection

csf GS and immunologic assays for

S. pneumo, H. influ, E. coli, N. meningitis, L. monocytogenes, S. agalactiae, (MTB, C immitis immuno only)

naegleria fowleri

in ponds/lakes/pools, enters nasal passage migrated to brain, motile amoeba in wet prep, nonmotile in cytospin prep, elongated with tapers posterior

PCR

nuc acid amp detect cause of meningitis with pathogen dna, high sens and spec, rna detects and diff path of meningitis

serologic testing

for neurpsyphilis, uncommon due to early penicillin treatment, detection of AB is dx, VDRL specific with pos FTA-ABS

serous fluid

ultrafiltrate of plasma constantly produced and reabsorbed, pleural, pericardial, peritoneal, lubricant between membranes surrounding organs and organ cavities

effusion

excess fluid between membranes, transudate (CHF or hypoproteinemia) or exudate (direct damage)

transudate effusion congestive heart failure

imbalance of filtration & reabsorption, bad heart pumping> excess blood in bv= increased hydrostatic pressure> push fluid into serous space)

transudate effusion hypoproteinemia

imbalance of filtration & reabsorption, low protein in plasma due to nephrotic syndrome> osmotic pressure change> fluid flow into serous spaces to even out concentrations

exudate effusion

direct damage to membranes by infection or malignancy

transudate lab values

protein <0.5 fluid:serum, LDH < 0.6 fluid:serum, low wbc and rbc

exudate lab values

protein >0.5 fluid:serum, LDH >0.6 fluid:serum, high wbc and rbc

collection of serous fluids

pleural- thoracentesis, pericardial- pericardiocentesis, peritoneal- paracentesis, large vol, sterile for micro/cytology, EDTA for cell count/diff, ice for pH

hematology serous fluid tests

cell count- wbc, total nucleated cells, rbc; nucleated cell diff- wbc, mesothelial, malignant

chemistry serous fluid tests

pH, protein, LDH, amylase, tumor markers

pleural

transudate, exudate (pneumonia, malignancy, PE), low pH= pneumonia not responding to abx, pH6= esophageal rupture

mesothelial cells

line serous membranes, norm or reactive

malignant cells

high nucleus:cytoplasm, irregular chromatin, nuclear and cytoplasmic molding (no windows between cells)

pericardial

cardiac tampnade by effusions, transudate, exudate (malignancy, trauma, pericarditis or endocarditis), high neutrophils & >1000 wbc= bacterial endocarditis

peritoneal

ascites, transudative (hepatic disorder- cirrhosis), exudate (bac infec= peritonitis, appendicitis, intestinal perforaton; malignancy)

peritoneal green

bile, high amylase= pancreatitis and GI perforation, high CEA= GI malignancy, high CA125= ovarian malignancy

synovial fluid

lubricate joints (diarthroses), shock absorbing in activity, nutrients for cartilage, ultrafiltrate of plasma containing hyaluronic acid

joint disorders

noninflam- degenerative (osteoarthritis), septic- infect, inflam- immunologic (RA) or crystal inducted (gout, pseudogout), hemorrhagic- traumatic injury/ tumor

synovial collection

arthrocentesis, EDTA (anticoag if disease fluid has fibrinogen)- cell count/ diff/ crystal ID, hyaluronidase- decreases viscosity

synovial fluid appearance

norm= clear-pale yellow, turbid= cells crystals fat droplets fibrin, deep yellow= effusion, bloody, green= bacterial infec

synovial cell count

norm= 200 wbc, abnormal highest in inflam and septic

synovial diff

norm= mono/macro/lining cells, septic= high neutrophils, inflam= high lymphs

synovial crystal analysis

monosodium urate MSU= uric acid gout, calcium pyrophosphate dihydrate CPPD= pseudogout birefringence, polarizing microscope

synovial fluid other tests

GS and culture, glu, protein, uric acid, lactate, enzymes

ammniotic fluid collection

amniocentesis, genetic disease- neural tube disorder, fetis distress- bili for HDFN, fetal maturity- resp distress (common in preme) and lung maturity by surfactant level

fetal lung maturity- surfactant level

phospholipid lowers surface tension in alveoli (stays open), analyizes L/S ratio, phosphatidyl glycerol, foam stability, lamellar bodies

L/S ratio

TLC, labor intensive

phosphatidyl glycerol

immunologic agglutination test

foam test

amniotic fluid added to 95% EtOH (antifoam), shake for 15 sec, stable bubble ring after 15 min= adequate surfactant

lamellar body count

phospholipid storage granule, same size as plt, measured on hem analyzer using plt channel

fecal occult blood

colorectal cancer screening, anemia investigation, guaiac method, immunochemical method

fecal leukocytes

ulcerative colitis, infec diarrhea, wright stain

fecal fats and elastase

pancreatic insufficiency, quantitative

fecal occult blood- guaiac method vs immunochemical method

pseudoperoxidase activity of hgb= color change vs ab specific for human hgb

fecal occult blood false neg

testing before stool has dried on card, collected in closed container can heat and break down hgb, too much hgb= prozone

vaginal secretion wet prep

wbc, yeast, clue cells, trich

vag secretions rupture membranes testing

fetal fibronectin- preterm labor, AmniSure, actin PROM, ROM plus, fern test

semen analysis

infertility, assisted reproductive tech, postvasectomy, forensic analyses, sperm count/motility/morph

neubauer calc formula

cells counted x dilution/ cells counted x col of 1 square

cytocentrifugation

makes monolayer, 30% alb increases yield and decreases distortion, positive slide attracts cells

leukemias

lymphoblasts, myeloblasts, monoblasts, nucleoli more prominent than in blood, bands in serum and csf

lymphomas

dissemination from lymph organs, cleaved nucleii and prominent nucleoli, bands in serum and csf

HIV bands

in serum and csf

electrophoresis and immunophoretic- elevated CSF total protein but a normal cell count and a clear, colorless specimen

encephalitis, neurosyphilis, guillain-barre, and neoplasms, ref symptoms

myelin basic protein

presence in csf indicated demyelination of myelin sheath around axons of neurons, monitors MS treatment, immunoassay

A fluid specimen submitted as "CSF" is of questionable origin. Which finding would help confirm that the fluid is truly CSF?

Presence of the tau transferrin (carbohydrate-deficient transferrin) fraction, which is unique to CSF

csf/serum alb

>9 blood brain barrier damage

A control slide for the detection of monosodium urate crystals is prepared with which material?

Betamethasone acetate

A MLS counts 63 cells in all nine large squares of a Neubauer chamber using a 1:2 dilution with saline. What is the WBC count (cells/uL)?

140