CSF ANALYSIS 2

Normal Values of glucose in the CSF: Adults =

60 to 70% of plasma glucose

Normal Values of glucose in the CSF: Neonates =

80% of plasma glucose

Plasma Sample for glucose should be drawn

2 hours prior to spinal tap

Should be tested immediately to prevent significant loss due to glycolysis

Glucose

Aids in the diagnosis and management of meningitis

Lactate

Used to evaluate effectiveness of antibiotic therapy

Lactate

Used to monitor severe head injuries

Lactate

Lactate value in bacterial meningitis

(>35mg/dl),

Lactate value in tubercular meningitis

(>25mg/dl),

Lactate value in fungal meningitis

(>25mg/dl),

Demonstrable in Gram staining

Gram Neg: (+)

Limulus Lysate Test

Bacterial meningitis

Marked ↑ protein

Bacterial meningitis

↑Neutrophils

Bacterial meningitis

Pellicle formation

(+) Acid fast staining

Tubercular meningitis

(+) India Ink Staining

Fungal meningitis

Frequently assayed in CSF but not in blood

Glutamine

Metabolic product from the removal of ammonia (toxic waste product)

Glutamine

Glutamine is Assayed to indirectly measure

ammonia

Glutamine normal value in CSF

8 to 18 mg/dL

Glutamine value if there is a disturbance in consciousness

>35mg/dl

results from ↑ usage of α-ketoglutarate

Coma of unknown origin

75% of diagnosed children of this disease has elevated glutamine

Reye’s syndrome

Aids in the diagnosis of meningitis

Lactate Dehydrogenase Isoenzymes

brain tissue destruction

LD1 and LD2:

viral meningitis

LD2 and LD3

bacterial meningitis

LD4 and LD5

Value in post-cardiac arrest that indicates poor prognosis

>17mg/dL

Value that indicates recovery from cardiac arrest after resuscitation

<17mg/dL

Should be performed immediately to prevent significant loss of cells

CELL COUNTING

WBCs in CSF

up to 200/uL

RBCs in CSF

up to 400/uL

WBCs and RBCs disintegrate within

one hour

________ disintegrate after two hours

40% of WBCs

Normal WBCs:

Normal WBCs: predominant in adults

lymphocytes:

Normal WBCs: predominant in children

monocytes:

Normal WBCs: rare normal cell component

neutrophils:

lymphocyte to monocyte ratio

70:30

: ↑numbers of normal cells (abnormal finding)

Pleocytosis

Abnormal CSF Cells:

immature WBCs, eosinophils, plasma cells, macrophages, increased tissue cells and malignant cells

Normal

Viral, tubercular and fungal meningitis

Multiple sclerosis

Lymphocytes

Bacterial meningitis

Early cases of viral, tubercular, fungal meningitis

Cerebral hemorrhage

Neutrophils

Granules may be less prominent than in blood

Cells disintegrate rapidly

Neutrophils

Found mixed with lymphocytes

Monocytes

Normal

Viral, tubercular and fungal meningitis

Multiple sclerosis

Monocytes

RBCs in spinal fluid

Contrast media

Macrophages

May contain phagocytized RBCs appearing as empty vacuoles or ghost cells, hemosiderin granules and hematoidin crystals

Macrophages

Acute leukemia

Blast forms

Lymphoblasts, myeloblasts or monoblasts

Blast forms

Resemble lymphocytes with cleft nuclei

Lymphoma cells

Disseminated lymphomas

Lymphoma cells

Traditional and classic forms see

Plasma cells

Multiple sclerosis

Lymphocyte reactions

Plasma cells

Diagnostic procedures

Ependymal, choroidal and spindle-shaped cells

Seen in clusters with distinct nuclei and distinct cell walls

Ependymal, choroidal and spindle-shaped cells

Metastatic carcinomas

Primary CNS carcinoma

Malignant cells

Seen in clusters with fusing of cell borders and nuclei

Malignant cells