CEREBROSPINAL

FLUID
Olar, Majalene DC.
Bsmt3-1

CEREBROSPINAL FLUID
CSF is the only fluid that exists in
quantities sufficient to sample in
healthy individuals.
Present in volumes of 100 to 150 ml in
adults; 60 to 100 ml in children; and 10
to 60 ml in newborns.
This fluid bathes the brain and spinal
column and serves as a cushion to
protect the brain, as a circulating
nutrient medium, as an excretory
channel for nervous tissue metabolism,
and as lubrication for the central

GROSS EXAMINATION
Normal CSF is clear, nonviscous, and
colorless.
A cloudy or hazy appearance may
indicate the presence of WBCs ( greater
than 200/mm3, RBCs (greater than
400/mm3), or microorganisms.
Bloody fluid may be caused by a
traumatic tap, in which blood is acquired
as the puncture is performed or by a
pathologic hemorrhage within the central
nervous system.

GROSS EXAMINATION
If more than 1 tube is received, the
tubes can be observed for clearing
from tube to tube.
If the first tube contains blood but
the remaining tubes are clear of
progressively clearer, the blood is the
result of a traumatic puncture.
If all tubes are uniformly bloody, the
probable cause is a subarachnoid
hemorrhage.

GROSS EXAMINATION
When a bloody sample is received, an
aliquot should be centrifuged, and the
color if the supernatant should be
observed and reported.
A clear, colorless supernatant indicates a
traumatic tap, whereas a yellowish or
pinkish yellow tinge may indicate a
subarachnoid hemorrhage. Yellowish color
sometimes is referred as xanthochromia,
but not all xanthochromia is pathologic.

GROSS EXAMINATION

CLSI recommends simply reporting the actual color of the

supernatant.

Traumatic tap

Pathologic
hemorrhage

Clear supernatant

Colored or hemolyzed
supernatant
Same appearance in all
tubes
Erythrophages

Clearing from tube to

tube
Bone marrow
contamination
Cartilage cells

Sliderophages( may have

bilirubin crystals)

CELL COUNTS(contn)
A CSF cell count is a test to measure
the number of red and white blood cells
that are in cerebrospinal fluid (CSF).
When multiple tubes of spinal fluid are
collected, the cell count is generally
performed on tube 3, or the tube with
the lowest possibility of peripheral
blood contamination.
Normal cell counts in CSF are 0-5
WBCs/mm3 and 0 RBCs/mm3.

CELL COUNTS(contn)
If a high RBC count is obtained, one may
determine whether the source of WBCs is
peripheral blood contamination by using the
peripheral blood ratio of 1 WBC per 500 to
900 RBCs.
If peripheral blood counts are known, the
number of blood WBCs added to the CSF
sample can be calculated as using the
following formula:
WBCBx= WBCs added by traumatic puncture

CELL COUNTS (contn)

Where

WBCb is the WBC count for

peripheral blood, RBCcsf is the RBC
count for csf, and RBCs is the RBC
count for peripheral blood. The
corrected or true csf count (WBCcsf)
is calculated as folows:
True WBCcsf

CELL COUNTS (contn)

A high WBC count may be found in fluid from
patients with infective processes, such as meningitis.
In general, WBC counts are much higher( in
thousands) in patients with viral meningitis( in the
hundreds).
The predominant cell type present on the
cytocentrifuge slide (neutrophils or lymphocytes),
but a better indicator of the type of meningitisbacterial or viral.
Elevated WBC or nucleated cell counts also may be
obtained in patients with inflammatory processes
and malignancies.