AUBF LAB: CEREBROSPINAL FLUID
C
Before performing a Gram stain on CSF, the specimen must be: A. Filtered B. Warmed to 37°C C. Centrifuged D. Mixed
B
CSF can be differentiated from serum by the presence of: A. Albumin B. Globulin C. Prealbumin D. Tau transferrin
latex agglutination immunoassay
Detection of the fibrin degradation product D-dimer by _____________________________________ indicates fibrin formation at a hemorrhage site.
8-18 mg/dL
The normal concentration of glutamine in the CSF is
CSF/serum albumin index
This method is used to accurately determine whether IgG is increased because it is being produced within the CNS or is elevated as the result of a defect in the blood-brain barrier, comparisons between serum and CSF levels of albumin and IgG
Tube 2
This tube is usually designated for the microbiology laboratory.
cerebrospinal fluid (CSF)
- is a major fluid of the body - provides a physiologic system to supply nutrients to the nerv- ous tissue, remove metabolic wastes, and produce a mechanical barrier to cushion the brain and spinal cord against trauma.
2 hours
40% of the leukocytes in the CSF disintegrate after how many hours?
C
A CSF WBC count is diluted with: A. Distilled water B. Normal saline C. Acetic acid D. Hypotonic saline
D
A CSF glucose of 15 mg/dL, WBC count of 5000, 90% neutrophils, and protein of 80 mg/dL suggests: A. Fungal meningitis B. Viral meningitis C. Tubercular meningitis D. Bacterial meningitis
0.2 mL saline and two drops of the 30% albumin
A daily control slide for bacteria should also be prepared using _______________________________________ currently being used.
tubercular meningitis
A markedly decreased CSF glucose level accompanied by an increased WBC count and a large percentage of lymphocytes indicates what?
bacterial meningitis
A markedly decreased CSF glucose level accompanied by an increased WBC count and a large percentage of neutrophils indicates what?
multiple sclerosis or other degenerative neurologic disorders
A moderately elevated WBC count (less than 50 WBCs/μ L) with increased normal and reactive lymphocytes and plasma cells may indicate what?
B
A patient with a blood glucose of 120 mg/dL would have a normal CSF glucose of: A. 20 mg/dL B. 60 mg/dL C. 80 mg/dL D. 120 mg/dL
D
A total CSF cell count on a clear fluid should be: A. Reported as normal B. Not reported C. Diluted with normal saline D. Counted undiluted
RBC degradation products
A variety of factors can cause xanthochromia, the most common being the presence of what?
A
A web-like pellicle in a refrigerated CSF specimen indicates: A. Tubercular meningitis B. Multiple sclerosis C. Primary CNS malignancy D. Viral meningitis
D
After a CNS diagnostic procedure, which of the following might be seen in the CSF? A. Choroidal cells B. Ependymal cells C. Spindle-shaped cells D. All of the above
biweekly
All diluents should be checked _____________ for contamination by examining them in a counting chamber under 400× magnification.
C
All of the following statements are true about cryptococcal meningitis except: A. An India ink preparation is positive B. A starburst pattern is seen on Gram stain C. The WBC count is over 2000 D. A confirmatory immunology test is available
crystal clear
Appearance of normal CSF
Reye Syndrome (RS)
Approximately 75% of children with _______________ have elevated CSF glutamine levels
increases, decreases
As little as 0.1 mL of CSF combined with one drop of 30% albumin produces an adequate cell yield when processed with the cytocentrifuge. Adding albumin _____________ the cell yield and _____________ the cellular distortion frequently seen on cytocentrifuged specimens.
Bacterial Meningitis
CSF Lactate Levels greater than 35 mg/dL are frequently seen with
choroid plexuses
CSF is produced in the _______________________ of the two lumbar ventricles and the third and fourth ventricles.
third, fourth, or fifth
CSF is routinely collected by lumbar puncture between the ________, _________, _________ lumbar vertebra.
Viral meningitis
CSF lactate levels remain lower than 25 mg/dL are seen with
A
CSF lactate will be more consistently decreased in: A. Bacterial meningitis B. Viral meningitis C. Fungal meningitis D. Tubercular meningitis
arachnoid granulations/villae
CSF maintains a volume of 90 to 150 mL in adults and 10 to 60 mL in neonates, the circulating fluid is reabsorbed back into the blood capillaries in the _______________________ at a rate equal to its production.
90-150 mL
CSF maintains a volume of how many mL for adults?
10-60 mL
CSF maintains a volume of how many mL for neonates?
Heavy hemolysis
CSF supernatant is orange
very slight amount of oxyhemoglobin
CSF supernatant is pink
conversion of oxyhemoglobin to unconjugated bilirubin
CSF supernatant is yellow
A
Cells resembling large and small lymphocytes with cleaved nuclei represent: A. Lymphoma cells B. Choroid cells C. Melanoma cells D. Medulloblastoma cells
cytoplasmic vacuoles, nuclear clefting, prominent nucleoli, indistinct nuclear and cytoplasmic borders, and cellular clumping that resembles malignancy
Cellular distortion may include:
Normal Saline (NS)
Dilutions for total cell counts are made with ___________________, mixed by inversion, and loaded into the hemocytometer with a Pasteur pipette.
IgG
Diseases, including multiple sclerosis, that stimulate the immunocompetent cells in the CNS show a higher proportion of _______.
plasma elevations
Elevated CSF glucose values are always a result of what?
C
Elevated CSF protein values can be caused by all of the following except: A. Meningitis B. Multiple sclerosis C. Fluid leakage D. CNS malignancy
increased blood and CSF ammonia
Elevated levels of CSF glutamine are associated with liver disorders that result in
dark blue or black
Further degradation of the phagocytized RBCs results in the appearance of ___________________ iron-containing hemosiderin granules
C
Given the following information, calculate the CSF WBC count: cells counted, 80; dilution, 1:10; large Neubauer squares counted, 10. A. 8 B. 80 C. 800 D. 8000
C
Given the following results, calculate the IgG index: CSF IgG, 50 mg/dL; serum IgG, 2 g/dL; CSF albumin, 70 mg/dL; serum albumin, 5 g/dL. A. 0.6 B. 6.0 C. 1.8 D. 2.8
B
Hemosiderin granules and hematoidin crystals are seen in: A. Lymphocytes B. Macrophages C. Ependymal cells D. Neutrophils
Infants and people over age 40
Higher values of total CSF protein are found in
refrigerated, room temperature, frozen
Ideally, tests are performed on a STAT basis. If this is not possible, specimens are maintained in the following manner: • Hematology tubes are ______________. • Microbiology tubes remain at __________________. • Chemistry and serology tubes are ___________.
least 15 minutes
If nondisposable counting chambers are used, they must be soaked in a bactericidal solution for at _______________ and then thoroughly rinsed with water and cleaned with isopropyl alcohol after each use.
Microbiology
If only one tube can be collected, it must be tested first by what section?
Lysis of RBCs
In WBC count, this must be obtained before performing the WBC count on either diluted or undiluted specimens.
20 mL
In adults, approximately ___ mL of CSF fluid is produced every hour.
B
In serum, the second most prevalent protein is IgG; in CSF, the second most prevalent protein is: A. Transferrin B. Prealbumin C. IgA D. Ceruloplasmin
Blood Brain Barrier (BBB)
In the choroid plexuses, the endothelial cells have very tight-fitting junctures that prevent the passage of many molecules. This tight-fitting structure of the endothelial cells in the choroid plexuses is called _____________________.
undiluted
In total cell count, clear specimens may be counted ___________, provided no overlapping of cells is seen during the microscopic examination.
Protein
It appears in the CSF as a result of damage to the integrity of the blood-brain barrier contains fractions proportional to those in plasma, with albumin present in the highest concentration.
Tissue destruction within the CNS owing to hypoxia
It cause increases CSF lactic acid levels
immunologic testing results
It is a method that should be confirmed by culture and demonstration of the organisms by India ink, because false-positive reactions do occurs.
Latex agglutination test
It is a sensitive test in detecting the presence of C. neoformans antigen in serum and CSF
Xanthochromia
It is a term used to describe CSF supernatant that is pink, orange, or yellow.
Glutamine
It is produced from ammonia and α-ketoglutarate by the brain cells. This process serves to remove the toxic metabolic waste product ammonia from the CNS.
improved Neubauer counting chamber
It is routinely used for performing CSF cell counts.
blood glucose test
It is test that provides accurate evaluation of CSF glucose
Transferrin
It is the major beta globulin present; also, a sep- arate carbohydrate-deficient transferrin fraction, referred to as "tau," is seen in CSF and not in serum
Prealbumin
It is the second most prevalent fraction in CSF.
Albumin
It makes up most of CSF protein
CSF glutamine
It provides an indirect test for the presence of excess ammonia in the CSF.
Yellow hematoidin crystals
It represent further degeneration. They are iron-free, consisting of hemoglobin and unconjugated bilirubin
Myelin basic protein (MBP)
Its presence in the CSF indicates recent destruction of the myelin sheath that protects the axons of the neurons (demyelination).
D
Macrophages appear in the CSF after: A. Hemorrhage B. Repeated spinal taps C. Diagnostic procedures D. All of the above
2 to 4 hours
Macrophages appear within _______________ after RBCs enter the CSF and are frequently seen following repeated taps.
A
Measurement of which of the following can be replaced by CSF glutamine analysis in children with Reye syndrome? A. Ammonia B. Lactate C. Glucose D. α -Ketoglutarate
lung, breast, renal, and gastrointestinal malignancies
Metastatic carcinoma cells of nonhematologic origin are primarily from what?
Protein determination
Most frequently performed chemical test on CSF
D
Myeloblasts are seen in the CSF: A. In bacterial infections B. In conjunction with CNS malignancy C. After cerebral hemorrhage D. As a complication of acute leukemia
bone marrow contamination
NRBCs are seen as a result of ____________________________ during the spinal tap.
nucleated red blood cell (NRBC)
Neutrophils with pyknotic nuclei indicate degenerating cells and may resemble what?
B
Neutrophils with pyknotic nuclei may be mistaken for: A. Lymphocytes B. Nucleated RBCs C. Malignant cells D. Spindle-shaped cells
0-5 WBCs/uL
Normal adult CSF contains _______________.
D
Nucleated RBCs are seen in the CSF as a result of: A. Elevated blood RBCs B. Treatment of anemia C. Severe hemorrhage D. Bone marrow contamination
elevated serum bilirubin, presence of the pigment carotene, markedly increased protein concentrations, and melanoma pigment
Other causes of xanthochromia include:
B, B, A, A
Place the appropriate letter in front of the statement that best describes CSF specimens in these two conditions: A. Traumatic tap B. Intracranial hemorrhage ____ Even distribution of blood in all tubes ____ Xanthochromic supernatant ____ Concentration of blood in tube 1 is greater than in tube 3 ____ Specimen contains clots
xanthochromic or hemolyzed fluid
RBCs contain high concentrations of lactate, and falsely elevated results may be obtained on what?
2 hours
RBCs must usually remain in the CSF for approximately __________ before noticeable hemolysis begins; therefore, a xanthochromic supernatant would be the result of blood that has been present longer than that introduced by the traumatic tap.
70:30
Ratio of lymphocytes and monocytes in adults
viral infections
Reactive lymphocytes containing increased dark blue cytoplasm and clumped chromatin are frequently present during ___________________ in conjunction with normal cells
15-45 mg/dL
Reference values for total CSF protein
3% glacial acetic acid
Specimens requiring dilution can be diluted substituting _______________________ to lyse the RBCs.
B
Substances present in the CSF are controlled by the: A. Arachnoid granulations B. Blood-brain barrier C. Presence of one-way valves D. Blood-CSF barrier
additional chemical or serologic tests
Supernatant fluid that is left over after each section of CSF has performed its tests may also be used for what?
True
TRUE OR FALSE Decreased CSF glucose values are caused primarily by alterations in the mechanisms of glucose transport across the blood-brain barrier and by increased use of glucose by the brain cells.
True
TRUE OR FALSE: Diseases in which damage to the blood-brain barrier allows increased filtration of protein and coagulation factors also cause clot formation but do not usually produce a bloody fluid.
True
TRUE OR FALSE: Fluid collected from a traumatic tap may form clots owing to the introduction of plasma fibrinogen into the specimen.
True
TRUE OR FALSE: The chamber count should be repeated if too many cells are seen on the slide, and a new slide should be prepared if not enough cells are seen on the slide.
A
The CSF IgG index calculated results in 1.8 indicates: A. Synthesis of IgG in the CNS B. Damage to the blood-brain barrier C. Cerebral hemorrhage D. Lymphoma infiltration
C
The CSF flows through the: A. Choroid plexus B. Pia mater C. Arachnoid space D. Dura mater
B
The CSF tube that should be kept at room temperature is: A. Tube 1 B. Tube 2 C. Tube 3 D. Tube 4
2 hours
The blood glucose should be drawn about ____________ before the spinal tap to allow time for equilibration between the blood and fluid.
elevated CSF protein
The causes of ___________________ include damage to the blood-brain barrier, immunoglobulin production within the CNS, decreased normal protein clearance from the fluid, and neural tissue degeneration.
previous hemorrhage
The finding of increased macrophages indicates a
C
The finding of oligoclonal bands in the CSF and not in the serum is seen with: A. Multiple myeloma B. CNS malignancy C. Multiple sclerosis D. Viral infections
B
The functions of the CSF include all of the following except: A. Removing metabolic wastes B. Producing an ultrafiltrate of plasma C. Supplying nutrients to the CNS D. Protecting the brain and spinal cord
A
The integrity of the blood-brain barrier is measured using the: A. CSF/serum albumin index B. CSF/serum globulin ratio C. CSF albumin index D. CSF IgG index
intracranial hemorrhage
The microscopic finding of macrophages containing ingested RBCs (erythrophagocytosis) or hemosiderin granules in the CSF indicates what?
30 mononuclear cells/uL
The number of WBC in CSF is higher in children, and as many as _________________________ can be considered normal in newborns
Multiple Sclerosis (MS)
The presence of two or more oligoclonal bands in the CSF that are not present in the serum can be a valuable tool in diagnosing _________________, particularly when accompanied by an increased IgG index
C
The presence of which of the following cells is increased in a parasitic infection? A. Neutrophils B. Macrophages C. Eosinophils D. Lymphocytes
C
The presence of xanthochromia can be caused by all of the following except: A. Immature liver function B. RBC degradation C. A recent hemorrhage D. Elevated CSF protein
A
The primary concern when pleocytosis of neutrophils and lymphocytes is found in the CSF is: A. Meningitis B. CNS malignancy C. Multiple sclerosis D. Hemorrhage
Oligoclonal bands
The primary purpose for performing CSF protein electrophoresis is to detect ___________________, which represent inflammation within the CNS.
D
The purpose of adding albumin to CSF before cytocentrifugation is to: A. Increase the cell yield B. Decrease the cellular distortion C. Improve the cellular staining D. Both A and B
B
The reference range for CSF protein is: A. 6 to 8g/dL B. 15 to 45 g/dL C. 6 to 8 mg/dL D. 15 to 45 mg/dL
monthly
The speed of the cytocentrifuge should be checked _________ with a tachometer, and the timing should be checked with a stopwatch.
D
The test of choice to detect neurosyphilis is the: A. RPR B. VDRL C. FAB D. FTA-ABS
nephelometry
The turbidity method has been adapted to automated instrumentation in the form of ________________ .
cloudy, turbid, or milky
These appearance of specimen can be the result of an increased protein or lipid concentration, but it may also be indicative of infection, with the cloudiness being caused by the presence of WBCs.
choroid plexuses
These are capillary networks that form the CSF from plasma by mechanisms of selective filtration under hydrostatic pressure and active transport secretion.
Astrocytomas, retinoblastomas, and medulloblastomas
These are cells from primary CNS tumors and they usually appear in clusters and must be distinguished from leukemia cells. Fusing of cell walls and nuclear irregularities and hyperchromatic nucleoli are seen in clusters of malignant cells.
Lymphoblasts, myeloblasts, and monoblasts
These are cells in the CSF are frequently seen as a serious complication of acute leukemias. Nucleoli are often more prominent than in blood smears.
meningitis, Froin syndrome, and blocked CSF circulation through the subarachnoid space
These are conditions that are associated with clot formation in the CSF.
Meningitis and hemorrhage
These are conditions that damage the blood-brain barrier are the most common causes of elevated CSF protein.
Latex agglutination and enzyme-linked immunosorbent assay (ELISA)
These are methods provide a rapid means for detecting and identifying microorganisms in CSF.
Gram stain, acid-fast stain, India ink preparation, and latex agglutination tests
These are methods used in microbiology lab include what?
IgM, fibrinogen and beta lipoprotein
These are not found in normal CSF.
principles of turbidity production or dye binding ability
These are the two most routinely used techniques for measuring total CSF protein
Lymphoma cells
These cells are also seen in the CSF and indicate dissemination from the lymphoid tissue. They resemble large and small lymphocytes and usually appear in clusters of large, small, or mixed cells based on the classification of the lym- phoma. Nuclei may appear cleaved, and prominent nucleoli are present
Choroidal cells
These cells are from the epithelial lining of the choroid plexus. They are seen singularly and in clumps. Nucleoli are usually absent and nuclei have a uniform appearance
Ependymal cells
These cells are from the lining of the ventricles and neural canal. They have less defined cell membranes and are frequently seen in clusters. Nucleoli are often present
Increased eosinophils
These cells are seen in the CSF in association with parasitic infections, fungal infections (primarily Coccidioides immitis), and introduction of foreign material, including medications and shunts, into the CNS.
Spindle-shaped cells
These cells represent lining cells from the arachnoid. They are usually seen in clusters and may be seen with systemic malignancies
Streptococcus pneumoniae (gram-positive cocci), Haemophilus influenzae (pleomorphic gram-negative rods), Escherichia coli (gram-negative rods), and Neisseria meningitidis (gram-negative cocci)
These microorganisms are the most frequently encountered in CSF gram stain
Abnormally low values
These protein values are present when fluid is leaking from the CNS.
Immunofixation Electrophoresis (IFE) and Isoelectric Focusing (ISE) followed by silver staining
These techniques are also the method of choice when determining whether a fluid is actually CSF.
RBC counts
This cell count are usually determined only when a traumatic tap has occurred and a correction for leukocytes or protein is desired.
Tube 1
This tube is used for chemical and serologic tests because these tests are least affected by blood or bacteria introduced as a result of the tap procedure.
Tube 3
This tube is used for the cell count, because it is the least likely to contain cells introduced by the spinal tap procedure.
Tube 4
This tube may be drawn for the microbiology laboratory to better exclude skin contamination or for additional serologic tests.
simultaneous serum electrophoresis
To ensure that the oligoclonal bands are present as the result of neurologic inflammation, what method must be performed?
centrifuged in a microhematocrit tube and the supernatant examined against a white background
To examine a bloody fluid for the presence of xanthochromia, the fluid should be what?
1 hour
WBCs (particularly granulocytes) and RBCs in the CSF begin to lyse within how many hours?
IgG, with only a small amount of IgA
What are the CSF gamma globulin?
lyphocytes and monocytes
What are the cells found in normal CSF?
encephalitis, neurosyphilis, Guillain-Barré syndrome, and neoplastic disorders
What are the other neurologic disorders produce oligoclonal banding that may not be present in the serum?
A
What department is the CSF tube labeled 3 routinely sent to? A. Hematology B. Chemistry C. Microbiology D. Serology
to remove cellular debris and foreign objects such as RBCs
What is the purpose of macrophages in the CSF?
Leukocytes (WBC)
What is the routinely used for cell count in the CSF specimen?
report only the numbers of the cell types seen
When the differential count is performed, 100 cells should be counted, classified, and reported in terms of percentage. If the cell count is low and finding 100 cells is not possible, what is the next step?
immature liver function
Xanthochromia that is caused by bilirubin due to this condition and commonly seen in premature infants
meningitis of viral, tubercular, fungal, or parasitic origin
a moderately elevated CSF WBC count with a high percentage of lymphocytes and monocytes suggests what?
Traumatic tap
blood vessel punctured; tube 1 will have more blood (uneven distribution of blood). Differentiation tests (between TT and hemorrhage) include D-dimer. Xanthochromia not present, clots present
bacterial meningitis
high CSF WBC count of which the majority of the cells are neutrophils is considered indicative of what?
viral meningitis
if a normal CSF glucose value is found with an in- creased number of lymphocytes, the diagnosis would favor what?
Pleocytosis
increased numbers of normal cells in the cerebrospinal fluid, as is the finding of immature leukocytes, eosinophils, plasma cells, macrophages, increased tissue cells, and malignant cells.
immunoglobulin production
oligoclonal bands are located in the gamma region of the protein electrophoresis, indicating what?
The CSF/serum albumin index is performed to determine:
the integrity of the blood-brain barrier