BF

what fluids are studied

what fluids are studied

• cerebrospinal (brain + spine)

• synovial (surrounds joints)

• serous

what does serous fluid consist of

• pleural (chest cavity and lungs)

• peritoneal (fluid between abdomen and organs)

• pericardial (around heart)

routine analysis of BF

• gross examination

• total cell count

• differential count

• microbiologic examination

• chemical analysis

• cytology examination

function CSF

• cushion

• waste collection

• nutrient circulation

• lubrication

• regulate volume of intracranial pressure

• chemical environment

where does CSF circulate between

pia and arcahnoid layer

what processes if CSF involved in

• active secretion

• transport

• ultrafiltration from plasma

csf three membranes and meanings

• dura matter = outer

• arachnoid = middle

• pia = inner

normal CSF volume in adults

90-150 mL

normal CSF volume neonate

10-60 mL

turnover of CSF per day and hour

500-600 mL/day

20 mL/hour

what is increased CSF called

hydrocephalus

when does hydrocephalus occur

circulation is blocked or reabsorption is impaired

how is CSF collected , and where

how much can be safely removed

lumbar puncture

• L3 and L4 lumbar space

• L4 and L5 for neonates

• 10-20 mL of fluid

what would you record for CSF collection

total volume of the tap in all tubes

how many tubes of CSF is collected, where do they go

3

• chemistry

• micro

• hematology

w

what would a 4th tube of CSF be used for

observation of a pellicle

when is CSF stable

within an hour , no clots

do you refrigerate CSF

NO

what does it mean when CSF exhibits xanthochromia

contains bilirubin

what is xanthochromia

yellow discoloration

what is cell count performed on

hemacytometer

what can CSf indicate

• infection of meninges

• subarachnoid hemorrhage

• CNS malignancies

• demyelinating disorders

example of menginges infection

bacterial meningitis

example of CNS malignancy

acute leukemia

example of demyelinating disorder

multiple sclerosis

what does CSF lab analysis involve

• gross examination

• microscopic examination

• chemical analysis

whats involved in CSF gross examination

color, clarity, clotting ← bleed or poorly drawn

whats involved in CSF microscopic examination

RBC, WBC counts, differentials

what is involved in CSF chemical analysis

glucose and protein

what do you do to distinguish a traumatic tap from an intracranial hemorrhage

observe clearing from tube to tube

what indicates a traumatic puncture

first tube contains blood , but remaining are clear

what does it mean for CSF if all tubes are uniformly bloody

subarachnoid hemorrhage present

what does it mean if CSF (supernatant?) is clear

traumatic tap

• blood at bottom

what does it mean if CSF (supernatant?)is yellow or pink- what does each color mean

hemorrhage

• yellow = bilirubin broken down, OLD BLOOD

• pink = fresh NEW blood

what does it mean if CSF after centrifugation is clear

bacteria

what should you observe for in CSF after centrifugation

xanthochromia

what does subarachnoid hemorrhage sample look like in 1-4 hours , what does it contain

pale pink ← oxyhemoglobin

• erythrocyte

• neutrophils

• lymphocytes

what does subarachnoid hemorrhage sample look like in 12 hours , what does it contain

yellow xanthochromia (bilirubin)

• peaks 2-4 weeks

• macrophages englufed with RBCs OR stored iron (hemosiderin)

• 1-8 weeks siderophages

should CSF clot? why?

no, CSF does not contain fibrinogen

characteristics of traumatic tap

• blood decreasing amounts

• clot formation

• colorless supernatant

• negative D dimer

characteristics of subarachnoid hemorrhage

• blood is in equal amounts

• does not clot

• xanthrochromic

• positive D dimer

• hemosiderin

what is normal for CSF gross examination

CSf should be clear

what is normal cell count for CSF

adult 0-5 uL

neonate 0-30 uL

what is CSF normal differential

lymphocytes and monocytes normal

lymph 60%, mono 30%, poly 2%

what is CSF normal chemical examination

glucose : 50-80 mg/dL

protein 15-45 mg/dL

where is cell counts performed

chamber with undiluted fluid

equation for cell count

(#of cells counted ) x (dilution)

__________________________________

(#of squares counted) x (volume of 1 sq)

when is protein count in CSF higher

• neonates have higher count that adults

• after the age of 40 it increases as well

what does increased CSF protein indicate

• traumatic tap

• increased permeability of blood CSF barrier

• infections

• subarachnoid hemorrhage

• increased synthesis of IgG, neurosyphilis, MS

what do CSF glucose values need to be compared to

serum glucose values

what is the normal adult CSF glucose levels

60-70% of plasma levels

what is an increased CSF glucose related to

plasma elevations w

what is a decreased CSF glucose value related to

• impaired glucose transport

• increased glycolytic activity

• increased glucose utilization by bacteria

what in CSF aids in diagnosing and managing meningitis

CSF lactacte

what are the causes of an incease in CSF lactate levels, and what are their values

• bacteria : <35 mg/dL

• viral 25 mg/dL

w

what can CSF lactate also be used to monitor

head injuries , tissue destruction

what is pleocytosis

increased amount of WBCs in body fluid

• type of WBC correlates with condition or disorder

what do neutrophils indicate

bacterial infection

what do lymphs indicate

• viral

• Guillain Barre (own immune system attacks nerves)

what do plasmacytes indicate

multiple sclerosis

what do eosinophils indicate

allergic reactions

• rare

• example: shunt

what do monocytes/macrophages indicate

phagocytized

what can b seen in CSF

• WBC, RBC

• ependymal

• macrophage

• malignant cells

what do WBCs indicate in CSF

inflammatory or infectious process in CNS

• meningitis → increase in WBC

what do RBCs indicate in CSF

• subarachnoid hemorrhage

• intracranial bleeding

what produces CSF into brain ventricles

the choroid plexus

what do germinal matrix cells have to do with CSF

give rise to various cell types in CNS

what do macrophages indicate in CSF

inflammatory response or immune reaction in CNS

what is this cell

lymphocyte

what is seen in the picture

segs, monos, and nRBCs

what is pictured

the choroid plexus

• eccentric nucleus

• lining cells

• waxy cytoplasm

• clustered together

signet ring

• monocyte phagocytizing vacuole

what is pictured

subarachnoid hemorrhage

what are WBC levels / findings in Bacterial Meningitis

• >50k WBC/uL

• 90% neutrophils

• INC protein

• DEC glucose

what can cause bacterial meningitis

• H influenzae

• S pneumonia

• N meningitis

• GBS

what is seen in viral meningitis

mild - severe leukocytosis

• predomiately lymphs → large and reactive

what causes viral meningitis

enteroviruses

what are the types of acute leukemia

• lymphoblastic

• myeloblastic

what causes fungal meningitis

• cryptococcus neoformans (india ink)

• low or normal glucose

• elevated protein

what is seen with intracranial shunts for hydrocephalus

• increased monocytes

• iINC macrophages

  • INC eos

where are malignant cells more common

• lung

• breast

• GI

neutrophils with bacteria

bacteria and yeast

acute leukemia

intracranial hemorrhage

what is synovial fluid? where is it found

• supplied nutrients to cartilage

• lubricant to surface joints

• removes debris

  • found in joint cavities

what is general normal chemical composition of synovial fluid like? why

• same as plasma

  • it is ultra-filtrate of plasma

what are some properties of synovial fluid

• straw color

• viscous

  • essential to proper lubrication

• hyaluronic acid

  • hyaluronate = mucopolysaccharide for viscosity

what is the normal volume for synovial fluid,where is it found

1-4 mL

• knee, hip, elbow

what does a large amount of synovial fluid volume mean

disease process

what are normal WBC value for synovial fluid ? what composes that

<200 uL

• lymphs are majority (mononuclear)

• <25% neutrophils

what is normal for synovial fluid in terms of RBCs and crystals

there should be none seen

how is synovial fluid collected? how many tubes?

arthrocentesis with a heparinized needle

• three tubes

should there be clots in synovial fluid? why?

NO

• does not contain fibrinogen

what should the patient do before synovial fluid collection

fasting for 6 hours

what are the tubes used for in synovial fluid

1: sterile for micro

2: heparin/EDTA for microscopy

3: plain tube for clot formation, gross examination, chemical examination

what is preferred for the 2nd tube in synovial fluid

heparin

what is involved in routine examination of synovial fluid

• physical appearance

• cell count

• differential

• crystal exam

• chemical

physical appearance for synovial fluid

color viscosity, clarity

cell count for synovial

RBC and WBC