UNIVERSITY OF SANTO TOMAS

FACULTY OF PHARMACY
DEPARTMENT OF MEDICAL TECHNOLOGY
Principles and Strategies of Teaching in Health Education

TEACHING DEMONSTRATION

SEAT NUMBER: 23 NAME: Laranang, Ryan

YEAR AND SECTION: 2AMT DATE SUBMITTED: 4/30/2019

SUBJECT: CLINICAL MICROSCOPY TOPIC: Cytology of CSF

TOPIC OBJECTIVES

A. Discuss the meningitis in CSF

B. Discuss the cytology of CSF
C. Suggest test on CSF to diagnose CNS disorders
D. Suggest appropriate microbiology procedure for the detection of micro-organism in
CSF
E. Interpret CSF analysis result

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 UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY
DEPARTMENT OF MEDICAL TECHNOLOGY
Principles and Strategies of Teaching in Health Education

TEACHING DEMONSTRATION

CYTOLOGY OF CSF (MICROSCOPIC EXAMINATION)

I. OVERVIEW
Cytological assessment of CSF is a viable method for diagnosing numerous disorder in-
cluding the Central Nervous System (CNS). Preliminary technique for CSF examination are dis-
cussed and responsive condition including lymphoma, leukemia, meningeal carcinomatosis and
subarachnoid spread of essential brain tumors are assessed by primary cytological examination
of CSF.
II. PRINCIPLE
Cerebrospinal Fluid (CSF) is situated inside the subarachnoid space. It is created by the
choroids plexuses and channels into the venous sinuses. Roughly 100mls of CSF is in constant
course. CSF may reflect pathology inside the cerebrum, spinal cord or membrane . CSF cytology
is demonstrated as a major aspect of an examination of known or suspected CNS threat (essential
or auxiliary) or in instances of aseptic meningitis.The principle elements of CSF are mechanical
help for cerebrum, transporter of various biochemical compound, particularly neuromodulators
and evacuation of different metabolites, and upkeep of biochemical homeostasis at the CNS level.
A cytocentrifuged test is treated with a extraordinary recolor and analyzed under microscope for
abnormal cells. This can be regularly done when a central apprehensive framework tumor or
metastatic cancer is suspected. The nearness of certain abnormal cells, such as tumor cells or
immature blood cells, can show what sort of cancer is involved.

III. METHOD
CSF cytology is typically performed related to CSF microbiology and biochemistry
tests. CSF cytology is shown as part of an examination of known or suspected central nervous
system malignancy.

A. Put aliquot for cytology in a clean universal container and complete an indicative
cytology demand structure .

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 UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY
DEPARTMENT OF MEDICAL TECHNOLOGY
Principles and Strategies of Teaching in Health Education

TEACHING DEMONSTRATION
B. There ought to be sufficient clinical data or information provided on the request
form, which should clarify the indication for CSF examination.
C. Indicate on the request form if there is a history of relevant foreign travel.
D .Send a different sample and request form for a microbiological examination if an
disease is suspected.
E. To guarantee best outcomes, we demand that as much fresh specimen (minimum of
2-3mls) be sent to the research facility or laboratory as soon possible, ideally
within 2hrs of collection.If doing lumbar puncture out of hours please save the speci-
men in a fridge overnight (4°C).

IV. NORMAL RANGE

The normal range for Laboratory Values of CSF are the following:
• Test: Cell count in Conventional Units 0-5 lymphocytes/mcL. In SI units 0-5x10 lymphocytes/
• The examination demonstrated that the mean estimation of the all out cell count was 1.45
mononuclear cells per cmm. The ranged went from 0.3 to 6.2 mononuclears per cmm. It was
additionally discovered that CSF regularly contains for the most part lymphocytes, middle 86.5
% with a range from 99 % to 63 %, and monocytoids, middle 10.5 % with a range from 28 %
to 0 %, yet in addition macrophages, middle 2 % going from 9 % to 0 %. Neither in the all out
cell count nor in the differential cell check were polynuclear cells found.

V. TEST FOR INFECTIONS

If meningitis or encephalitis is suspected, tests may be performed to detect micro-
organisms. Normal CSF does not contain any bacteria, fungi, viruses or parasites.
A. CSF GRAM STAIN- For direct perception of microorganisms under a magnifying lens. An
example of CSF is centrifuged and the focused. Part is set on a slide and treated with a gram
stain for examination under the microscope. In the event that microorganisms are available on
a CSF gram stain, at that point the patient most likely has bacterial or parasitic meningitis.
B. CSF CULTURE AND SENSITIVITY- Is utilized to recognize any microorganisms, which will
develop in the culture. On the off chance that microscopic organisms are available, they can
be tried in the laboratory to foresee the best decisions for antimicrobial treatment for the influ-
enced individual and prophylaxis (preventive treatment) of close contacts, if necessary. On the
off chance that there are no microorganisms present, it doesn't preclude a contamination; they

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 UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY
DEPARTMENT OF MEDICAL TECHNOLOGY
Principles and Strategies of Teaching in Health Education

TEACHING DEMONSTRATION
might be available in little numbers or unfit to develop in culture due to earlier anti-infection
treatment.
If any of the initial tests are abnormal or if the health practitioner strongly suspects a central
nervous system infection, then additional testing may be ordered. This may include one or more
of the following:
C. DETECTION FOR VIRUS - there are multiple methods to discover viruses in CSF. Most
commonly, polymerase chain reaction (PCR) testing is used to determine viral genetic
material (DNA, RNA) however viral antigen analyzed and cultures can also be used.
D. CSF CRYPTOCOCCAL antigen – In addition to culture, this test may be done to detect a fungal
infection caused by the yeast Cryptococcus neoformans.
E. SPECIFIC ANTIBODY TEST – Depending on which organism(s) are suspected
Other CSF tests for infectious diseases that are less commonly ordered include:
F. MOLECULAR TEST - specific for Mycobacteria tuberculosis may be performed when tubercu-
losis is suspected.
G. PARASITES- may also be detected in CSF with laboratory tests such as molecular tests or
culture. Parasitic meningitis or encephalitis are rare and can be lethal. One example is an infection
caused by the free-living amoeba, Naegleria fowleri, a single-cell parasite that can be found in
warm water lakes and rivers. Infection occurs when the parasite enters the respiratory system
through the nose of a person swimming in contaminated water.

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 UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY
DEPARTMENT OF MEDICAL TECHNOLOGY
Principles and Strategies of Teaching in Health Education

TEACHING DEMONSTRATION

REFERENCES

A. Books
1.Sunheimer, R. L., Graves, L., & Stockwin, W. (2015). Clinical labor-
atory urinalysis and body fluids. Boston: Pearson.
2.Brunzel, N. A. (2018). Fundamentals of urine & body fluid analysis.
St. Louis (Mo.): Elsevier.
3.Bailey, & Scott. (n.d.). Diagnostic Microbiology (13th ed.) (P. Tillo,
Ed.). Elsevier Mosby

B. Journal Articles
1. Bernard G., M.D. (2008, Jun) Cytology of Cerebrospinal Fluid: Technical and Di-
agnosis Considerations
2. Edmund S. Cibas. (Third Edition),( 2009) Cerebrospinal Fluid Cytology

C. Internet Sources
1. Microscopic Examination and Broth Culture of Cerebrospinal Fluid in Diagnosis of
Meningitis (1998). Retrieved from https://www.ncbi.nlm.nih.gov
2. Role of cerebrospinal fluid cytology in ‘carcinomatous meningitis’ masquerading
as ‘tuberculoma’. (2013). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/
3. Cytopathology service. (2017). Retrieved from http://www.exeterlabora-
tory.com/cellular-pathology/cytopathology-services/

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 UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY
DEPARTMENT OF MEDICAL TECHNOLOGY
Principles and Strategies of Teaching in Health Education

TEACHING DEMONSTRATION
4. Cerebrospinal Fluid (CSF) Analysis (2018). Retrieved from https://lab-
testsonline.org/tests/cerebrospinal-fluid-csf-analysis

ACTIVATED PARTIAL THROMBOPLASTIN TIME

ASSESSMENT AND EVALUATION

TYPE OF EXAM Morse Type

NUMBER OF ITEMS 2

INSTRUCTION: Identify whether

A. Both statement are true
B. Both statement are false
C. The first statement is true and the second statement is false.
D. The first statement is false and the second statement is true.

1. A
a. CSF diagnostic value is only up to 30% of primary CNS lymphomas and 80% of
systematic lymphomas involving in CNS.
b. differential diagnosis should always include lymphocytic pleocytosis, which can be
due to radiation, chemotherapy and infectious in immunosuppressed patients
2. C a. The fluid contain many acute inflammatory cells

b. Glucose level is >50% of the plasma cell level

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 UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY
DEPARTMENT OF MEDICAL TECHNOLOGY
Principles and Strategies of Teaching in Health Education

TEACHING DEMONSTRATION

TYPE OF EXAM Multiple Choice Items

NUMBER OF ITEMS 8

INSTUCTION: Choose the best answer by encircling the correct letter of your choice.

1. Usually diagnosed with clinically

a. Bacterial meningitis
b. Lymphoma
c. Tuberculous meningitis
d. Viral meningitis
2. India ink nigrosin stains that show cryotococcus capsular halos. what type of meningitis?
a. Fungal meningitis
b. Bacterial meningitis
c. Viral meningitis
d. Tuberculous meningitis
3. Cell shed from these tumors have malignant cell cytologic appearance. They all have in
common cells with a high nuclear to cytoplasmic ratio, irregular nuclei, coarse chromatin
and nucleoli, with dense sharply define cytoplasm.
a. Primary CNS tumor
b. Metastatic tumor in CSF
c. Lymphatic in CSF
d. Leukemic cell in CSF
4. Involvement of the tumors is more frequent in All than in AML.
a. Lymphatic in CSF
b. Metastatic tumor in CSF
c. Leukemic in CSF
d. Primary CNS tumor in CSF
5. Involving the leptomeninges are usually high-grade tumors with prominent nucleoli and ex-
presses a B cell phenotype.

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 UNIVERSITY OF SANTO TOMAS
FACULTY OF PHARMACY
DEPARTMENT OF MEDICAL TECHNOLOGY
Principles and Strategies of Teaching in Health Education

TEACHING DEMONSTRATION
a. Leukemic In CSF
b. Primary CNS Tumor in CSF
c. Metastatic Tumor in CSF
d. lymphoma in CSF

6. Are usually a part of mixed cell reaction that include neutrophils, lymphocytes, and plasma cells
a. Increased in CSF Monocytes
b. Increased in CSF Lymphocytosis
c. Increased in CSF Nuetrophillia
d. Increased in CSF Macrophages

7. Meningitis: Viral, tubercular, fungal, syphilitic, leptospiral, parasitic

a. Increased in CSF Nuetrophillia
b. Increased in CSF Lymphocytosis
c. Increased in CSF Macrophages
d. Increased in CSF monocytes

8. Meningitis: bacterial, viral, tubercular, mycotic and amoebic

a. Increased in CSF Nuetrophillia
b. Increased in CSF Lymphocytosis
c. Increased in CSF Macrophages
d. Increased in CSF monocytes