AUBF PART 2 Flashcards
CSF production in adults
20mL of fluid per hour
CSF is produced in?
Choroid plexus of the two lumbar ventricles and the third and fourth ventricles
CSF flows through the?
Subarachnoid space
Subarachnoid is located between
Arachnoid and pia mater
CSF volume in adults
90 to 150 mL
CSF volume in neonates
10-60 mL
The circulating fluid is reabsorbed back into the blood capillaries in
the?
Arachnoid granulations
Acts as a one way valve to prevent reflux of the csf
Cells of the arachnoid granulation
It is the capillary networks that form the
CSF from plasma by mechanisms of selective filtration under
hydrostatic pressure and active transport secretion
Choroid plexuses
Is CSF an ultrafiltrate of the plasma? Y/N?
No because of the mechanisms of selective filtration under hydrostatic pressure and active transport secretions
A very tight-fitting junctures that prevent the passage of many molecules.
Blood-brain barrier
CSF tubes
Tube 1 - ____
Tube 2 - ____
Tube 3 - ____
Tube 1 - Clinical Chemistry and Serology
Tube 2 - Microbiology
Tube 3 - Hematology
Fourth tube may be drawn for the microbiology laboratory to better exclude skin contamination or for additional serologic test
If only one tube is collected - Microbiology first
CSF tubes temperature
Hematology - ____
Chemistry and Serology - ____
Microbiology - ____
Hematology - Refrigerated
Microbiology - Room temp
Chem and sero - Frozen
Term used to describe CSF supernatant that is pink, orange, or yellow
Xanthochromia
Three visual examinations of the collected specimen to determine if it is a TRAUMATIC TAP
- Uneven blood distribution (More rbc and bloody in Tube 1)
- Clot formation (Because of the introduction of plasma fibrinogen into the specimen)
- Xanthochromic Supernatant (RBC hemolyze in approx. 2hrs. to become noticeable in the CSF)
Normal WBC csf
0-5 WBC/uL
Higher in children with as many as 30 mononuclear cells/uL
Neubauer calculation formula
Number of cells counted × dilution/ Number of cells counted × volume of 1 square = Cells/uL
Where cells are counted in Neubauer
Four corner squares
Used to lyse RBC
3% glacial acetic acid
Used to stain the WBC
Methylene blue
Cells found in normal CSF are composed of
Lymphocytes and Monocytes
70:30 - Lymphocytes: Monocytes (Adult)
70:30 - Monocytes: Lymphocytes (Children)
Presence of increased number of WBC in CSF is called?
Pleocytosis
High neutrophils in WBC count of CSF
Bacterial Meningitis
High lymphocytes and monocytes in WBC count of CSF
Viral, tubercular, fungal, or parasitic meningitis
Major Clinical Significance:
Normal
Viral, tubercular, and fungal meningitis
Multiple sclerosis
Microscopic Findings:
All stages of development may be found
Lymphocytes
Major Clinical Significance:
Bacterial Meningitis
Early case of viral, tubercular, and fungal meningitis
Cerebral hemorrhage
Microscopic Findings:
Granules may be less prominent than in blood
Cells disintegrate rapidly
Neutrophil
Major Clinical Significance:
Normal
Viral, tubercular, and fungal meningitis
Multiple sclerosis
Microscopic Findings:
Found mixed with lymphocytes
Monocytes
Major Clinical Significance:
RBCs in spinal fluid
Microscopic Findings:
May contain phagocytized RBCs appearing as empty
vacuoles or ghost cells, hemosiderin granules, and hematoidin crystals
Macrophages
Major Clinical Significance:
Acute leukemia
Microscopic Findings:
Lymphoblasts, myeloblasts, or monoblasts
Blast forms
Major Clinical Significance:
Disseminated lymphomas
Microscopic Findings:
Resemble lymphocytes with cleft nuclei
Lymphoma cells
Major Clinical Significance:
Multiple sclerosis
Lymphocyte reactions
Microscopic Findings:
Traditional and Classic forms seen
Reactive lymps
Plasma Cells
Major Clinical Significance:
Diagnostic procedures
Microscopic Findings:
Seen in clusters with distinct nuclei and distinct cell
walls
Ependymal, choroidal,
and spindle-shaped
cells
Major Clinical Significance:
Metastatic carcinomas
Primary central nervous system carcinoma
Microscopic Findings:
Seen in clusters with fusing of cell borders and nuclei
Malignant cells
Neutrophils associated with bacterial meningitis may contain?
Phagocytized bacteria
Neutrophils with ____ indicates degenerating cells
Pyknotic nuclei
Neutrophils can resemble NRBCs but Neutrophils have multiple nuclei. NRBCs are seen as a result of a?
Bone marrow contamination during spinal tap
Increased lymphocytes can be seen in cases of both asymptomatic ______?
HIV infection and AIDS
Moderately elevated WBC count (<50 WBC/uL) with increased normal and reactive lymphocytes and plasma cells may indicate what?
Multiple sclerosis or other degenerative neurologic disorders
Seen in the CSF in association with parasitic infections, fungal infections (Coccidioides immitis), and foreign material including medications and shunts
Eosinophil
The purpose of this in the CSF is to remove cellular debris and foreign objects such as RBCs
Macrophages
Macrophages appear within how many hours after RBCs enter the csf?
2-4 hours
Indicates a previous hemorrhage
Macrophages in CSF
Degradation of the phagocytized RBCs results in the appearance of
dark blue or black iron containing hemosiderin granules
Yellow hematoidin crystals represents what?
Further degradation of RBC
Nonpathologically significant cells are most frequently seen
after diagnostic procedures such as
Pneumoencephalography and in fluid obtained from ventricular taps or during neurosurgery
From the epithelial lining of the choroid plexus
Choroidal cells
From the lining of the ventricles and neural canal
Ependymal cells
From the lining cells of the arachnoid
Spindle-shaped cells
Frequently seen as a serious complication
of acute leukemias.
Lymphoblasts, myeloblasts, and monoblasts
Indicates dissemination from the lymphoid tissue
Lymphoma cells
Cells from CNS tumors includes
Astrocytomas, retinoblastomas, and medulloblastomas
Normal CSF protein
15 to 45 mg/dL
higher values are found in infants and people over age 40
Most of CSF protein
Albumin (Same as serum)
Prealbumin
The second most prevalent fraction in CSF
Major beta globulin present
Transferrin
Carbohydrate-deficient transferrin fraction that can only be SEEN in CSF
TAU
Primary CSF gamma globulin
IgG
Only small amount of IgA
___, _____, and _________are not found in the CSF
IgM, fibrinogen, and beta lipoprotein
Most common cause of elevated CSF protein
Meningitis and hemorrhage conditions that damage the Blood-brain barrier
Principles of measuring total CSF protein
Turbidity (Nephelometry) production or dye-binding ability
- Myxedema
- Cushing disease
- Connective tissue
disease - Polyneuritis
- Diabetes
- Uremia
- Meningitis
- Hemorrhage
- Primary CNS tumors
- Multiple sclerosis
- Guillain-Barré syndrome
- Neurosyphilis
- Polyneuritis
Elevated CSF protein
- CSF leakage/trauma
- Recent puncture
- Rapid CSF production
- Water intoxication
Decreased CSF protein
CSF/serum albumin index formula
From the name itself
CSF albumin (mg/dL) / Serum albumin (g/dL)
What index value level represent an intact blood-brain barrer
Index value less than 9
IgG index
(CSF IgG/Serum IgG)/
(CSF albumin/Serum Albumin)
Normal IgG index values
0.70
Represents inflammation within the CNS (electrophoresis)
Oligoclonal bands
What presence that are not present in serum can be a valuable tool in diagnosing multiple sclerosis
Two or more oligoclonal band
Indicates recent destruction of the myelin sheath
Myelin basic protein
Approximate value of CSF glucose to Plasma glucose
60-70%
Glutamine is produced from?
Ammonia and alpha-ketoglutarate
This removes the toxic metabolic waste product ammonia from the CNS
Glutamine
Normal glutamine concentration in the CSF
8 to 18 mg/dL
The concentration of ammonia in the CSF increase, the supply of _____ depletes
Alpha-ketoglutarate
Disturbance in consciousness is seen when glutamine levels are?
more than 35mg/dL
Lactate reference range
10 - 24 mg/dL
Lactate with >35mg/dL
Bacterial meningitis
Decreased CSF glucose is due to
Bacterial, tubercular, and fungal meningitis
Decreased CSF protein is due to
CSF leakage
Increased CSF protein is due to
Meningitis, hemorrhage, MS
Elevated WBC count
Neutrophils present
Marked protein elevation
Markedly decreased
glucose level
Lactate level >35 mg/dL
Positive Gram stain and
bacterial antigen tests
Bacterial Meningitis
Elevated WBC count
Lymphocytes present
Moderate protein
elevation
Normal glucose level
Normal lactate level
Viral Meningitis
Elevated WBC count
Lymphocytes and monocytes
present
Moderate to marked protein
elevation
Decreased glucose level
Lactate level >25 mg/dL
Pellicle formation
Tubercular Meningitis
Elevated WBC count
Lymphocytes and monocytes
present
Moderate to marked protein
elevation
Normal to decreased glucose level
Lactate level >25 mg/dL
Positive India ink with Cryptococcus
neoformans
Positive immunologic test for
C. neoformans
Fungal Meningitis
Organisms most frequently encountered in the CSF
S. pneumoniae, H. influenza, E. coli, N. meningitidis
Organisms that can be encountered in the CSF of the newborn
L. monocytogenes, S. agalactiae
Most sensitive test for syphilis
FTA-ABS
Recommended by the CDC/ Routine
VDRL
Seminiferous tubules of testes
Spermatogenesis (Sperm Production)
Epididymis
Sperm Maturation
Ductus Deferens (vas deferens)
Propel sperm to ejaculation ducts
Seminal Vesicles
Provide nutrients for sperm and fluid
Prostate glands
Provide enzymes and proteins for coagulation and liquefaction
Bulbourethral glands
Add alkaline mucus to neutralize prostatic acid and vaginal acidity
Spermatozoa (Concentration)
5%
Seminal Fluid (Concentration)
60-70%
Prostate Fluid (Concentration)
20%-30%
Bulbourethral glands (Concentration)
5%
Responsible for the gray color of semen
Flavin
When a part of the first portion of the ejaculate is
missing,
The sperm count will be decreased, the pH falsely
increased, and the specimen will not liquefy
When part of the last portion of ejaculate is missing
the semen volume is decreased, the sperm count is falsely increased, the pH is falsely decreased, and the specimen will not clot
Volume (semen)
2-5 mL
Viscosity (semen)
Pours in droplets
pH (semen)
7.2 - 8.0
Sperm concentration (semen)
> 20 million/mL
Sperm count (semen)
> 40 million/ Ejaculate
Motility (semen)
> 50% within 1h
Quality (semen)
> 2.0 or a, b, c
Morphology (semen)
> 14% normal forms (strict criteria)
30% normal forms (routine criteria)
