AUBF - OTHER BODY FLUIDS

Cerebrospinal Fluid

third major body fluids

Cerebrospinal Fluid

Most notable among other body fluids

choroid plexus

site of production by Cerebrospinal Fluid

70%

Cerebrospinal Fluid is characterized as an imperfect ultrafiltrate of plasma because of what percentage of the total volume comes from plasma ultrafiltration?

30%

Cerebrospinal Fluid is characterized as an imperfect ultrafiltrate of plasma because of what percentage of the total volume is contributed by the lining cells or the cells that form a part of choroid plexus?

Lumbar or Spinal Tap

method of collection for CSF?

between L3 & L4 or L4 & L5

the needle is inserted in what portion of the vertebrae in a spinal tap?

lateral decubitus

The patient assumes what position in a lumbar tap?

20 mL in 3-4 tubes

number of tubes and volume collected in a spinal tap

1 hour

CSF must be analyzed within __________ of collection

Chemistry and Immunology

Microbiology

Hematology

Additional tests

CSF ORDER OF DRAW: Tube 1-4

Frozen

Room temperature

Refrigerated

Depends on test to be performed

CSF STORAGE: Tube 1-4

Appearance and Viscosity

Gross examination of CSF includes?

colorless and crystal clear

CSF: Normal Appearance

non-viscous (similar to water)

CSF: Normal Viscosity

cryptococcal meningitis

mucin-producing adenocarcinoma

Abnormal Viscosity of cerebrospinal fluid is associated with what diseases?

encapsulated yeast

causative agent of cryptococcal meningitis

WBCs and microorganisms

Protein

cerebrospinal fluid viscosity of Hazy, cloudy, turbid, milky means high presence of what?

Hazy, cloudy, turbid or milky

CSF that is high in WBCs, microorganisms and protein appears?

Damage to Blood Brain Barrier

Multiple Sclerosis

What conditions may cause CSF to be high in proteins?

Inappropriate increased production of IgG

What is the cause of multiple sclerosis manifestation?

radiographic contrast media

CSF: Oil Viscosity seen through?

Tuberculosis Meningitis

CSF: Pellicle formation - (web-like) Viscosity is indicative of?

traumatic tap or subarachnoid hemorrhage

CSF: Bloody Viscosity

Uneven

Distribution of blood in a Traumatic tap

Even

Distribution of blood in a Hemorrhage (subarachnoid/intercranial)

Clear and colorless

Supernatant in a Traumatic tap

Xanthochromic

Supernatant in a Hemorrhage (subarachnoid/intercranial)

Present

Clot formation in a Traumatic tap

Absent

Clot formation in a Hemorrhage (subarachnoid/intercranial)

Fibrin Degradation Products

Fibrin Split Products

D-Dimer tests for what?

Negative

D-Dimer in a Traumatic tap

Positive

D-Dimer in a Hemorrhage (subarachnoid/intercranial)

Absent

Erythophagocytosis in a Traumatic tap

Present

Erythophagocytosis in a Hemorrhage (subarachnoid/intercranial)

Traumatic Tap

blood is introduced in the CSF during sample collection

Hemorrhage

blood is already mixed with CSF even before sample

collection occurs

Erythrophage

a macrophage that has ingested red blood cells, usually due to hemorrhage from trauma or a bleeding disorder

2-4 hours

It takes ______________ for macrophages to be seen in CSF. The longer the contact time, the more likely erythrophages are demonstrated.

hemosiderin and hematoidin cystals

The engulfed RBC inside the macrophage eventually disintegrates and gives rise to?

Xanthochromic

indicates presence of RBC degradation products, bilirubin, carotene, ↑ protein, melanin

Pink

Supernatant Color associated with RBC lysis/hemoglobin breakdown products

Yellow

Supernatant Color associated with RBC lysis/hemoglobin breakdown products

- Hyperbilirubinemia

- CSF protein > 150 mg/dL (1.5 g/L)

Hyperbilirubinemia

CSF protein of greater than 150 mg/dL or 1.5 g/L

If the supernatant color is yellow, it may be indicative of?

Orange

Supernatant Color associated with RBC lysis/hemoglobin breakdown products

- Hypervitaminosis A (carotenoids)

Hypervitaminosis A (carotenoids)

If the supernatant color is Orange, it may be indicative of?

Yellow-green

Supernatant Color associated with Hyperbilirubinemia (biliverdin)

Hyperbilirubinemia

If the supernatant color is Yellow-green, it may be indicative of?

Brown

Supernatant Color associated with Meningeal metastatic melanoma

15-45 mg/dL

Normal Values of Total Protein

CSF Protein Electrophoresis

Protein fractions: prealbumin, albumin, α-globulins, transferrin, tau

protein (carbohydrate-deficient transferrin fraction), gamma globulins

(IgG, IgA)

Tau protein

______________ unique in CSF. Used as landmark for identifying an unknown fluid as CSF.

Albumin

most abundant CSF protein?

fibrinogen, IgM, B-lipoprotein

CSF Protein Electrophoresis is used in the detection of oligoclonal bands in the gamma region for proteins that are not present in significant amounts in CSF but

present in plasma such as?

fibrinogen, IgM, B-lipoprotein

3 major plasma proteins which are absent in CSF

Immunofixation electrophoresis

method of detection of oligoclonal bands in the gamma region to detect 3 major plasma proteins absent in CSF

Immunofixation electrophoresis

specific technique for detecting

oligoclonal bands

Neurosyphilis

Encephalitis

Guillain-Barre syndrome

CNS neoplasm

4 conditions that must be ruled out when diagnosing multiple sclerosis since they can also show oligoclonal bands in the gamma region

< 9

CSF/Serum albumin index

Clinical Significance: ↑ damage to blood-brain barrier

NV?

CSF/Serum albumin index

Normal Value: < 9

Clinical Significance: ↑ damage to blood-brain barrier

CSF IgG index

Normal Value: < 0.7

Clinical Significance: ↑ multiple sclerosis

< 0.7

CSF IgG index

Clinical Significance: ↑ multiple sclerosis

NV?

Glucose Test

Normal Value: 50 - 80 mg/dL

(65% of plasma glucose)

Clinical Significance: ↓ bacterial meningitis

50 - 80 mg/dL

(65% of plasma glucose)

Glucose Test

Clinical Significance: ↓ bacterial meningitis

NV?

MBP (Myelin Basic Protein)

Normal Value: < 4 ng/mL

Clinical Significance: ↑ multiple sclerosis (> 8 ng/mL)

< 4 ng/mL

MBP (Myelin Basic Protein)

Clinical Significance: ↑ multiple sclerosis (> 8 ng/mL)

NV?

< 25 mg/dL

Lactate Tests

Clinical Significance: ↑ bacterial meningitis, intracranial hemorrhage

NV?

Lactate Tests

Normal Value: < 25 mg/dL

Clinical Significance: ↑ bacterial meningitis, intracranial hemorrhage

Glutamine Tests

Normal Value: 8-18 mg/dL

Clinical Significance: ↑ liver disorders e.g. Reye's syndrome, coma, Reye's syndrome, disturbance of consciousness

8-18 mg/dL

Glutamine Tests

Clinical Significance: ↑ liver disorders e.g. Reye's syndrome, coma, Reye's syndrome, disturbance of consciousness

NV?

CSF/Serum albumin index

reflects the integrity or permeability of the BBB

Lactate

product of glycolysis

2 hours

CSF is drawn after __________ of collection of plasma glucose

hyperammonemia

High CSF Glutamine is consistent with _____________________

glutamine

When ammonia reaches the CNS, the body's mechanism of rendering

ammonia into a non-toxic form is by converting it into ____________________?

> 35 mg/dL

_____________________ level of Glutamine is associated with coma and disturbance

of consciousness

coma and disturbance of consciousness

> 35 mg/dL level of Glutamine is associated with _______________________________

<5/μL

WBC Count Normal Values for Adult

<30/μL

WBC Count Normal Values for Neonates

Clarity and Recommended Dilutions:

Slightly Hazy

Hazy

Slightly Cloudy

Slightly Bloody

Cloudy, Bloody, Turbid

Clarity and Recommended Dilutions:

1:10

1:20

1:100

1:200

1:10,000

Hemocytometry

The diluted samples is then subjected to cell count or?

3% Acetic Acid

The diluent in WBC count for CSF is?

3% Acetic Acid

lyses the RBC and improved the visualization of the nuclei

1 drop of 30% albumin per 0.1 mL

Differential Cell Count: Cytocentrifugation requires the addition of _________________________ to minimize cell distortion and increase the yield

0.2 mL of Saline + 2 drops of 30% albumin

A daily control slide for bacteria should also be prepared using?

Lymphocytes and Monocytes

Clinical Significance: Normal ratio in adults 70:30; in children 30:70

Neutrophils

Clinical Significance: Bacterial meningitis, cerebral hemorrhage

Erythrophages

Clinical Significance: Intracranial hemorrhage

Blast forms

Clinical Significance: Leukemias and lymphomas

Plasma cells

Clinical Significance: Multiple sclerosis, lymphocyte reactions

Ependymal and choroidal cells

Clinical Significance: Diagnostic procedures

Malignant cells

Clinical Significance: Metastatic carcinomas, primary CNS carcinoma

Eosinophils

Clinical Significance: Intracranial shunt malfunctions

nRBCs

Clinical Significance: Bone marrow contamination during spinal tap

70:30

Lymphocyte/Monocyte Ratio in Adults

30:70

Lymphocyte/Monocyte Ratio in Children

- Gram stain and Culture

- Bacterial Antigen Test using Latex

- Limulus Lysate Test

Tests for Bacterial Meningitis

- AFB and culture

- PCR

Tests for Tubercular Meningitis

- India ink/Nigrosin

- Cryptococcal Antigen Test

Tests for Fungal Meningitis

- Immunoassay

- PCR

Tests for Viral Meningitis