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MLS 415 Urinalysis & B.F. > Cerebrospinal Fluid > Flashcards

Cerebrospinal Fluid Flashcards

1
Q

What is cerebrospinal fluid?

A

Clear, colorless fluid between the arachnoid and the pia mater in the brain and spinal cord. It is contained within the subarachnoid space.

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2
Q

What are the two components where CSF is made?

A

(1) Production by choroid plexus cells and ependymal lining cells (30%)
(2) Selective secretion from plasma into the ventricles and choroid plexus (70%)

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3
Q

(T/F) CSF is an ultrafiltrate of plasma.

A

False, CSF is NOT an ultrafiltrate of plasma

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4
Q

How much (volume) total CSF is contained within adults?

A

85-150 mL

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5
Q

How much (volume) total CSF is contained within neonates?

A

10-60 mL

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6
Q

Where does CSF circulate?

A

Circulates to brainstem and spinal cord

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7
Q

What are the functions of CSF?

A

(1) Protects the brain and spinal cord: acts as a mechanical buffer to prevent trauma; regulates volume of fluid present; helps with intercranial pressure
(2) Transports and exchange nutrients and waste: blood brain barrier (regulates the flow of particles between the blood and nervous system)
(3) Stable chemical environment: homostatic functions

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8
Q

What are some reasons why CSF may be collected?

A

(1) Infection
(2) Hemorrhage
(3) Neurologic disease
(4) Malignancy
(5) Tumor
(6) Treatments

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9
Q

Where in the spine is CSF collected in adults?

A

3rd or 4th lumbar interspace

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10
Q

Where in the spine is CSF collected in children?

A

4th or 5th lumbar interspace

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11
Q

What is the pressure reading that should be obtained prior to collecting CSF?

A

50 to 180 mmHg

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12
Q

If the pressure of CSF collection is between 50 and 180 mmHg, how much CSF can be collected?

A

About 20 mL

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13
Q

If the pressure of CSF collection is less than/greater than between 50 and 180 mmHg, how much CSF can be collected?

A

1 to 2 mL

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14
Q

What will happen if CSF remains at room temperature?

A

40% of WBCs in CSF will lyse in 2 hours

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15
Q

What storage temperature of CSF will yield the best recovery of viable organisms?

A

Room temperature

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16
Q

What will happen if CSF is refrigerated?

A

15% of WBCs in CSF will lyse

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17
Q

What are some other special considerations when testing CSF?

A

(1) Clotted specimens

(2) Low volume specimens

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18
Q

When testing CSF, what is tube 1 primarily used for?

A

Chemical, immunology, and serology

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19
Q

When testing CSF, what is tube 2 primarily used for?

A

Microbiological studies

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20
Q

When testing CSF, what is tube 3 primarily used for?

A

Cell counts and cytology studies

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21
Q

When testing CSF, what is tube 4 primarily used for?

A

Miscellanous testing

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22
Q

What is the color or normal CSF?

A

Colorless

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23
Q

Define xanthachromia

A

Yellow, orange, or pink discoloration

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24
Q

What is xanthachromia indicative of?

A

Bilirubin i.e. lysed blood cells present

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25
Q

Xanthachromia is neonates is indicative of what?

A

Increased bilirubin and increased protein due to immaturity of blood-brain barrier.

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26
Q

Define pleocytosis

A

An increase in the number of cells in CSF

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27
Q

What is the grading system used to determine the clarity of CSF?

A

Graded 0 (clear) to 4+ (cannot see through fluid)

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28
Q

What are some characteristics of a traumatic tap?

A

(1) Amount of blood decreases/clears progressively from first to last tube
(2) Streaking of blood in CSF during collection
(3) CSF may clot
(4) Usually no xanthrochromia
(5) No hemosiderin present

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29
Q

What are some characteristics of a hemorrhage CSF collection?

A

(1) Amount of blood is the same in all collection tubes
(2) Blood is evenly dispersed during collection
(3) CSF does not clot
(4) Xanthochromia present
(5) Present of hemosiderin-laden macrophages AKA siderophages

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30
Q

What is the reference range for total protein in CSF?

A

15-45 mg/dL

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31
Q

At what age do infants and adults generally often have higher protein concentration?

A

> 40 years old

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32
Q

What is total protein in CSF assessing?

A

Assesses the integrity of blood brain barrier

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33
Q

Increased total protein may indicate what?

A

(1) Contaminated specimen (blood)
(2) Altered capillary endothelial exchange
(3) Decreased reabsorption into the venous blood
(4) Increased synthesis in the central nervous system (CNS)

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34
Q

Decreased total protein may indicate what?

A

(1) Increased reabsorption through the arachnoid villi because of increased intracranial pressure
(2) Loss of fluid due to trauma or invasive procedures

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35
Q

What is the reference protein for permeability of blood brain barrier?

A

Albumin

36
Q

(T/F) No albumin is synthesized in the CNS

A

True

37
Q

What is the calculation for CSF/serum albumin index?

A

Albumin[CSF] (mg/dL)/Albumin[serum] (g/dL)

38
Q

An CSF/serum albumin index of <9

A

Considered normal

39
Q

CSF/serum albumin index of 9-14

A

Minimal impairment of blood brain barrier

40
Q

CSF/serum albumin index of 15-100

A

Moderate to severe impairment

41
Q

CSF/serum albumin index >100

A

Complete breakdown of barrier

42
Q

(T/F) Immunoglobin G (IgG) is normally present in CSF in very large amounts

A

FALSE, IgG is present in very small amounts (~1 mg/dL)

43
Q

What is the calculation for CSF IgG index?

A
44
Q

What is the normal index range for CSF IgG?

A

0.30 to 0.70

45
Q

What does an increase CSF IgG index represent?

A

Increased intrathecal production, multiple sclerosis, and/or inflammatory neurological disorders

46
Q

What does a decreased CSF IgG index represent?

A

Compromised blood-brain barrier

47
Q

What are the four predominate bands in normal CSF pattern for protein electrophoresis?

A

(1) Transthyretin (TTR)
(2) Albumin
(3) Two distinct transferrin bands (T-transferrin only present in CSF)

48
Q

What is the primary purpose for protein electrophoresis in CSF?

A

Detect oligoclonal bands

49
Q

When oligoclonal bands are present in CSF and absent in serum, what condition is that indicative of?

A

Multiple sclerosis

50
Q

What is the reference range for CSF glucose?

A

50-80 mg/dL

51
Q

How does glucose enter CSF?

A

(1) Active transport by endothelial cells

(2) Simple diffusion along concentration gradient

52
Q

What is the normal value for CSF/plasma glucose ratio?

A

~6

53
Q

What is increase glucose indicative of?

A

Hyperglycemia, traumatic tap (blood contamination)

54
Q

What is decreased glucose indicative of?

A

(1) Decreased/defective transport across blood-brain barrier and increased glycolysis within CNS
(2) Hypoglycemia
(3) Meningitis
(4) Tumor

55
Q

What is the reference range for lactate in CSF?

A

10-22 mg/dL

56
Q

Increased lactate in CSF is indicative of what?

A

Anaerobic metabolism within CNS due to tissue hypoxia/decreased oxygenation

57
Q

What is the range for lactate in CSF for someone who may have viral meningitis?

A

~25 - 30 mg/dL

58
Q

What is the range for lactate in CSF for someone who may have bacteria/fungal meningitis?

A

> 35 mg/dL

59
Q

What is a normal CSF WBC count in adults?

A

0-5 WBCs/uL

60
Q

What is a normal CSF WBC count in children?

A

0-10 WBCs/uL

61
Q

What is a normal CSF WBC count in neonates?

A

0-30 WBCs/uL

62
Q

What is a normal CSF RBC count?

A

None (0)

63
Q

What is the WBC differential procedure for CSF?

A

(1) Scan slide on 10x; helps in detecting abnormalities - plasma cells, malignant cells, cell clumps, etc.
(2) Perform differential on 100x; may not be about to count 100 cells depending on total cell count

64
Q

What are some infectious causes of seeing neutrophils in CSF?

A

Meningitis, cerebral abscess

65
Q

What are some non-infectious causes of seeing neutrophils in CSF?

A

Hemorrhage, tumor, intrathecal treatment (drug administration in spinal cord)

66
Q

What is the most common cell found in CSF?

A

Lymphocytes

67
Q

What are some infectious causes of seeing lymphocytes in CSF?

A

Meningitis (viral, tuberculosis, fungal, syphilitic), HIV/AIDS

68
Q

What are some non-infectious causes of seeing lymphocytes in CSF?

A

Multiple Sclerosis, Guillain-Barre syndrome, lymphoma, drug abuse

69
Q

What are some infectious causes of seeing monocytes in CSF?

A

Meningitis

70
Q

What are some non-infectious causes of seeing monocytes in CSF?

A

Tumor

71
Q

What are some characteristics of lymphocytes within a microscopic examination of CSF?

A

(1) High N:C ratio
(2) Oval/round nuclear shape
(3) Smaller in overall size
(4) Dense chromatin pattern

72
Q

What are some characteristics of monocytes within a microscopic examination of CSF?

A

(1) Low N:C ratio
(2) Irregular nuclear shape
(3) Larger in overall size
(4) Less dense chromatin pattern

73
Q

Identify the following indicated CSF cell

A

Plasma Cell

74
Q

(T/F) Plasma cells are not normally in CSF

A

True

75
Q

What are some infectious causes of seeing plasma cells in CSF?

A

Tuberculous and Syphilitic Meningitis

76
Q

What are some non-infectious causes of seeing plasma cells in CSF?

A

Multiple Sclerosis, Guillain-Barre syndrome

77
Q

What are some infectious causes of seeing eosinophils in CSF?

A

Parasitic infections, fungal infections, Idiopathic eosinophilic meningitis

78
Q

What are some non-infectious causes of seeing eosinophils in CSF?

A

Allergic reaction, lymphoma, leukemia

79
Q

What are some infectious causes of seeing macrophages in CSF?

A

Tubercular meningitis, fungal meningitis

80
Q

What are some non-infectious causes of seeing macrophages in CSF?

A

Response to RBCs and lipids in CSF, treatments

81
Q

What are some results of seeing malignant cells within CSF?

A

CNS tumor, metastasis (melanoma, lung, breast, GI, leukemia, lymphoma

82
Q

Microscopically, what is the difference between choroid plexus/ependymal cells and malignant cells?

A

(1) Distinct borders
(2) Chromatin evenly dispersed
(3) “Window” between cells

83
Q

What common staining technique is used for microbial testing?

A

Cytospin slide with gram stain

84
Q

(T/F) It is okay to start a patient on antibiotics prior to CSF collection

A

FALSE, you should always collect the CSF specimen prior to starting antibiotics

85
Q

What is the gold standard for testing CSF for bacterial and fungal meningitis?

A

CSF gram stain and culture

MLS 415 Urinalysis & B.F. (37 decks)

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