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AUBF > F2: CSF (Part 3: Tests - TUBE 1) > Flashcards

F2: CSF (Part 3: Tests - TUBE 1) Flashcards

1
Q

Tube 1 includes what tests?

A

Chemistry and Serology

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2
Q

What analytes are measured in chemistry?

A
  • Protein
  • Sugar
  • Lactic acid
  • Enzymes
  • Glutamine
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3
Q

Chemistry - Protein

Percentage and volume of protein in plasma

A

< 1% of plasma level
< 45 mg/dl

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4
Q

Chemistry - Protein

Protein increases with these conditions

a. Inflammation, increased permeability of BBB
b. Disintegrated cells and bacteria
c. Antibodies produced by nervous tissue
d. Obstruction of CSF flow
e. ALL
f. NOTA

A

e. ALL

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5
Q

Chemistry - Protein

What are the (4) methods of measuring protein?

A
  • Antiquated
  • Turbidimetric
  • Colorimetric
  • Immuno-chem
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6
Q

(4) methods of measuring protein

What are the 2 tests under Antiquated method of measurement of protein

A
  • Colloidal gold
  • Pandy’s
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7
Q

(4) methods of measuring protein

  • Not done anymore
  • Expensive - uses real gold
  • Qualitative test

Antiquated test

A

Colloidal gold

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8
Q

(4) methods of measuring protein

  • Only measures globulin
  • Produced in the brain → CSF
  • Does not pass brain barrier

Antiquated test

Chemistry - Protein

A

Pandy’s

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9
Q

(4) methods of measuring protein

Tests under this method is:
* TriChlorAceticacid (TCA)
* SSA

Chemistry - Protein

A

Turbidimetric

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10
Q

(4) methods of measuring protein

Tests under this method is:
* Lowry
* CBB
* Ponceau
* modified biuret

Chemistry - Protein

A

Colorimetric

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11
Q

(4) methods of measuring protein

  • This method uses the most automated analyzers

Chemistry - Protein

A

Immuno-chem

Chemistry - Protein

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12
Q

(4) methods of measuring protein

Colorimetric biuret method positive and negative results?

A

(+) Purple
(-) Blue

Blue to purple

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13
Q

Chemistry - Protein

If sample is contaminated with blood….Protein level will be too high, what action must be done

A

Protein correction

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14
Q

Chemistry - Protein

In protein correction, one must subtract (blank) for (blank)

A

subtract 1mg/dL of protein for every 1000 RBC counted

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15
Q

T or F

Protein correction formula should only be used if HCT and blood protein levels are normal

A

T

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16
Q

Other CSF Proteins

What are the other (3) CSF proteins

A
  • Alpha 2 macroglobulin (A2M)
  • Fibronectin
  • Transferrin (tau)

AFT AFT AFT AHUH AHUH

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17
Q

Other (3) CSF proteins

  • Indicates Subdural hemorrhage
  • Breakdown of BBB
  • Not done anymore
A

Alpha 2 macroglobulin (A2M)

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18
Q

Other (3) CSF proteins

Alpha 2 macroglobulin (A2M) is now replaced by what technology?

Alpha 2 macroglobulin (A2M)

A

CT scan/MRI are now used

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19
Q

Other (3) CSF proteins

  • Indicates poor prognosis in Acute Lymphoblastic Leukemia (ALL)
  • No lumbar puncture done anymore
A

Fibronectin

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20
Q

Other (3) CSF proteins

  • Unique to CSF
  • CSF leakage
  • Rhinorrhea /Otorrhea
  • Used to differentiate CSF from serum
A

Transferrin (tau)

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21
Q

Chemistry – Protein Fractions

Familiarize the protein fractions

A
  • Albumin
  • Pre albumin (second most abundant in CSF)
  • transferrin (tau)
  • IgG (second most abundant in serum)
  • IgA
  • ceruloplasmin
  • haptoglobin
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22
Q

Chemistry – Protein Fractions

↑ albumin and globulin indicates

a. BBB damage
b. CNS
c. ALL
d. NOTA

A

a. BBB damage

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23
Q

Chemistry – Protein Fractions

↑ globulin only

a. BBB damage
b. CNS
c. ALL
d. NOTA

A

b. CNS

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24
Q

Chemistry - Protein Indices

What are the (3) protein indices

A
  • CSF/Serum albumin index
  • CSF/Serum IgG index
  • CSF IgG/albumin
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25
# Chemistry - Protein Indices What is the probable cause CSF/Serum albumin ratio: INCREASED CSF/Serum IgG ratio: INCREASED CSF IgG/Albumin index: NORMAL
Increased permeability of blood-brain barrier
26
# Chemistry - Protein Indices What is the probable cause CSF/Serum albumin ratio: NORMAL CSF/Serum IgG ratio: INCREASED CSF IgG/Albumin index: INCREASED
Increased intrathecal synthesis of proteins
27
# Chemistry - Protein Electrophoresis Whare the the 2 bands of comparison in protein electrophoresis?
* Serum * CSF
28
# Chemistry - Protein Electrophoresis Bands in Serum and CSF indicate what (2) conditions
* Leukemia * Lymphoma infection
29
# Chemistry - Protein Electrophoresis Bands in CSF indicate what (3) conditions
* Multiple sclerosis * Encephalitis * G-B syndrome | MEGGGGG???
30
# Chemistry - Protein Electrophoresis * This condition will start as a simple cold and cough * Legs will become heavy to the point person cannot walk anymore * If not rushed to the hospital, paralysis may take over the body and cause death | Band in CSF only
Guillain-Barré syndrome
31
# Chemistry - Protein Electrophoresis * Looks pretty much the same but has a darker area at the end * A valuable tool in assessing multiple sclerosis when accompanied by increases IgG index
Unusual band
32
# Chemistry - Protein Electrophoresis Familiarize the possible diseases in finding oligoclonal bands in CSF
* Multiple Sclerosis * Subacute sclerosing panencephalitis * Viral CNS infections * Neurosyphilis * Guillain Barre Syndrome
33
# Chemistry - Glucose What percentage of blood glucose levels does normal cerebrospinal fluid (CSF) glucose typically represent?
60-70 % of blood glucose
34
# Chemistry - Glucose Normal volume range for CSF glucose levels
45-80 mg/dl is normal
35
# Chemistry - Glucose Abnormal volume range for CSF glucose levels
< 40 mg/dl is abnormal
36
# Chemistry - Glucose Why check blood glucose 2–3 hours before a lumbar puncture?
CSF glucose lags behind blood glucose by 30–50 minutes
37
# Chemistry - Glucose CSF glucose lagging time behind blood glucose
Lags 30-50 minutes
38
# Chemistry - Glucose What two processes cause CSF glucose to decrease?
* increased glycolysis by tissues * increased utilization by microorganisms (except viruses).
39
# Chemistry - Glucose T or F Viruses don’t decrease CSF glucose because they use nucleic acids, not glucose, for replication.
T
40
# Chemistry - Glucose Elevated sugar is evidence of what condition?
traumatic tap ## Footnote no correction is done
41
# Chemistry - Glucose T or F A correction is done when there is elevated glucose in CSF
F (**no correction** is done)
42
# Chemistry –Lactic Acid All of the following increases with lactic acid except a. Aerobic glucose metabolism in bacterial b. tubercular and fungal infection c. Hypoxia d. Xanthochromia e. ALL f. NOTA
a. Aerobic glucose metabolism in bacterial (should be **Anaerobic glucose metabolism** in bacterial)
43
# Chemistry –Lactic Acid At what lactic acid level in CSF is bacterial infection indicated? ## Footnote Anaerobic glucose metabolism in bacterial
>35 mg/dL
44
# Chemistry –Lactic Acid What lactic acid level suggests tubercular or fungal infections in CSF? ## Footnote tubercular and fungal infection
>25 mg/dL
45
# Chemistry - Enzymes (4) Enzymes measured
* Adenosine Deaminase (ADA) * Creatine Kinase (CK) * Lactate Dehydrogenase (LDH) * Lysozyme
46
# Chemistry - Enzymes * Rarely requested * PCR is done instead * Detects Tuberculosis | (4) Enzymes measured
Adenosine Deaminase (ADA)
47
# Chemistry - Enzymes * Nowadays, it is not needed anymore * Detects Severity of concussion | Chemistry - Enzymes
Creatinine Kinase
48
# Chemistry - Enzymes * MRI is done now instead of this * Detects Intracranial hemorrhage and Leukemia
Lactate Dehydrogenase (LDH)
49
# Chemistry - Enzymes T or F Leukemia can also be detected using LDH and PET scan
T
50
# Chemistry - Enzymes * Not done anymore because it can be seen in a blood smear * Detects bacterial meningitis
Lysozyme
51
# Chemistry - Glutamine T or F Glutamine is rarely requested and decreases in CSF as ammonia increases
F (Glutamine chem test is rarely requested BUT **increases in CSF as ammonia increases**)
52
# Chemistry - Glutamine (1) What happens to blood ammonia when it is elevated? | What process happens next
It crosses into the CSF “as if a gas.” ## Footnote diffuses across the blood-brain barrier into the CSF
53
# Chemistry - Glutamine (2) How is ammonia detoxified in the brain?
Ammonia combines with α-ketoglutarate to form glutamine NH3 + aKG ➔ glutamine ## Footnote Means of NH3 removal
54
# Chemistry - Glutamine When glutamine increases in CSF, it is indicative of all except? a. Reye syndrome b. Severe kidney disease c. >35 mg/dL causes coma d. ALL e. NOTA
b. Severe kidney disease (should be **severe liver disease**)
55
# SEROLOGY 2 methods mentioned in serology?
* “Phadebact” or BAT * Enzymes (Limulus Lysate, Latex Agglutination, VDRL)
56
# SEROLOGY * Aka Bacterial antigen test * Expensive * Cannot always detect the presence of diseases * The type of infection detected are rare except for TB * In the Philippines, it is only done in RITM * Detects Pneumococcal, H. influenza type b, Strep B, Meningococcal
“Phadebact” Bacterial antigen test (BAT)
57
# SEROLOGY 3 tests under serology using enzymatic method
* Limulus Lysate * Latex Agglutination * VDRL
58
# Serology - Enzymes * detects endotoxins produced by gram-negative bacteria * Little to no request for this exam * Detects not the bacteria but the endotoxins only * For gram-negative bacteria only * Detects N. meningitidis, H. influenza type b, E. coli, Pseudomonas | 3 methods
Limulus Lysate
59
# Serology - Enzymes * Commonly requested but not all can accommodate * Very easy test * If the hospital/laboratory cannot accommodate this, it is redirected to RITM * Detects Cryptococcus neoformans | 3 methods
Latex Agglutination
60
# Serology - Enzymes * Specific for syphilis only * Detects syphilis | 3 methods
VDRL

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