Body Fluids
Cerebral Spinal Fluids (CSF)
CSF Sample Collection

CSF Order of Draw
3-Tube Draw
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Chemistry
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Microbiology
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Hematology
4-Tube Draw
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Hematology
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Chemistry
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Microbiology
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Hematology


Traumatic Tap
CSF sample collected is pinkish red, indicating the presence of blood.
Will show progressively decreasing RBC in serial samples
Bloody CSF samples can also be resulted from:
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Subarachnoid hemorrhage
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Intracerebral hemorrhage
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Infarct
However, RBCs would be consistent from one tube to the next.
Microscopic Observation of CSF
Color
Xanthochromia:
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Refers to a pink, orange or yellow color of the CSF supernatant after the CSF has been centrifuged
Clinical Indication:
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Hyperbilirubinemia
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Increased Protein
Subarachnoid Hemorrhage vs Traumatic Tap
After centrifuging a pigmented CSF sample, if the supernatant is...
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Clear- traumatic tap
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Xanthochromic- subarachnoid hemorrhage
Clarity
Turbid
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Increased WBC (pleocytosis)
Cell Count in CSF
Increased WBCs:
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inflammation of the CNS, particularly the meninges
Increased Nutrophils (Neutrophilia):
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bacterial infections
Increased Mononuclear Cell:
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Viral Infection
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Cerebral abscess
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Acute Leukemia
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Lymphoma
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Intracranial vein thrombosis
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Cerebral tumor
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Multiple Sclerosis
Ependymal Cells
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Appearance
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Single or in clumps
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Nuclei are round to oval with a definitive smooth nuclear membrane
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No nucleoli present
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Chromatin is distributed evenly & is finely granular or hyperchomatic
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Cytoplasm can be basophilic or pink
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Microvilli may be present

Clinical Indication:
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Traumatic Tap
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CNS Infection
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Subarachnoid hemorrhage
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Hydrocephaly in children
Macrophages
Leukophages
Contains phagocytized WBC
Erythrophages
Contains phagocytized RBC or RBC fragments
Siderophages
Contains phagocytized particles of hemosiderin
Sources:
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Peter Pressman, M. (2020, September 23). Everything You Need to Know About a Spinal Tap. Retrieved October 13, 2020, from https://www.verywellhealth.com/lumbar-punctures-common-questions-answered-2488675
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Yeh, P., & Westerman, D. (2015, March 19). Ependymal cells in cerebrospinal fluid: A traumatic occurrence. Retrieved October 13, 2020, from https://ashpublications.org/blood/article/125/12/2005/33744/Ependymal-cells-in-cerebrospinal-fluid-a-traumatic