Cerebrospinal Fluid
Continuing Education Credits
This course covers the preanalytic processes of cerebrospinal fluid (CSF) specimen collection and handling and the analytic procedures for CSF analysis in the hematology laboratory. The participant will learn about the physical characteristics of normal and abnormal CSF and the possible cellular findings in an abnormal specimen. The course also provides a review of the manual procedures for counting cellular elements in CSF. The comprehensive treatment is perfect for laboratory cross-training, continuing education, and is appropriate for students preparing for exams.
Objectives
- Identify the origin, function, and composition of cerebrospinal fluid (CSF).
- Identify proper CSF specimen handling procedures.
- Describe the macroscopic appearance of normal and abnormal CSF.
- Explain manual cell counting techniques for undiluted and diluted CSF samples.
- State CSF smear preparation techniques.
- Identify nucleated cells that may be observed on a stained CSF smear.
- Explain the significance of various cells that may be observed in CSF.
Course Outline
- Introduction to Cerebrospinal Fluid
- What is Cerebrospinal Fluid (CSF)?
- Three Main Functions of CSF
- Chemical Substances Present in CSF
- Cells Present in Normal CSF
- CSF Evaluation and Diagnosis
- What is the approximate volume of spinal fluid in an adult?
- Normal adult CSF may have 0–5 white blood cells (WBCs)/µL. Which of the following cell types account for 40–80% of these WBCs?
- Specimen Collection and Processing
- CSF Specimen Collection Process
- Collection Tubes
- Specimen Labeling and Transport
- Specimen Handling and Storage
- Initial Specimen Examination
- Safety Precautions
- Which of the following sites is used most often for CSF collection?
- Cell counts on CSF specimens should be performed within what time frame following collection of the CSF sample?
- Macroscopic Characteristics
- Abnormalities
- Turbidity
- Clot/Pellicle
- Bloody Specimen
- Detecting Subarachnoid Hemorrhage
- Xanthochromia
- Other Causes of Xanthochromia
- Important Aspects of Xanthochromia
- Which of the following are characteristics of normal CSF?
- Which of the following situations suggest a traumatic tap occurred?
- True or False: Xanthochromia in a premature infant may be due to an immature blood-brain barrier.
- Cell Counting Techniques
- Normal Cell Counts
- Examining CSF Using the Hemocytometer
- Examining CSF Using the Hemocytometer, continued
- Counting Nucleated Cells in a Bloody CSF Specimen
- Cell Counting Guidelines
- True or False: Clear cerebrospinal fluid samples should be examined and counted undiluted.
- A spinal fluid that is slightly hazy is briefly examined microscopically. The medical laboratory scientist performing the count decides to make a 1:10 dilution using 30 µL of sample. What volume of diluent should be used?
- In a moderately bloody specimen, 250 cells are counted in 10 squares. The dilution is 1:100. What is the count/µL?
- A 1:10 dilution is made on a CSF sample. Five squares on each side of the hemocytometer are counted for a total of 10 squares and a total of 150 cells are recorded. What is the count per microliter (µL)?
- A cell count is ordered on a CSF sample that is bloody. Which of the following procedures would improve count accuracy?
- Cell Identification
- Stained Cytospin Preparations of CSF
- Cytocentrifuge Technique
- Nucleated Cells That May Be Present in CSF
- Lymphocytes
- Neutrophils
- Bacterial Meningitis
- Monocyte/Macrophage
- Macrophages As Indicators of Previous Subarachnoid Hemorrhage (SAH)
- Normal Peripheral Blood Cells
- Bone Marrow Contamination of CSF Sample
- Blast Cells
- More Blast Cells
- Malignant Cells
- Malignant Cells, continued
- Malignant Cells, continued
- True or False: Cytocentrifugation is the recommended method for preparing a cerebrospinal fluid (CSF) sample for examination of cellular morphology.
- Match the conditions listed below with the elements that may be seen on a stained CSF smear when this condition is present.
- The image on the right is a Wright-Giemsa stained CSF smear (1000x). What structures are indicated by the arrows?
- The arrows in the images below indicate cells that may be observed in CSF samples. Match each image to the cell's identification.
- References
- References
Additional Information
Level of Instruction: Intermediate
Intended Audience: Medical laboratory scientists, medical laboratory technicians, medical laboratory science students, and pathology residents.
About the Course: This revised course originated as part of a series of courses adapted for the web by MediaLab Inc. under license from Educational Materials for Health Professionals Inc. Dayton OH, 45420. Copyright EMHP.
Reviewer Information: Heather K. Mayers, MS, MLS(ASCP)CM, is currently working for the Department of Medical Laboratory Science at the University of North Dakota in Grand Forks, North Dakota. Previously, she worked clinically at Sanford Health and Essentia Health hospitals in Fargo, ND. Heather also shared her knowledge as an Immunology Adjunct Instructor at Rasmussen University in Moorhead, Minnesota, and as an Immunology Instructor at Sanford Health in Fargo, North Dakota. Heather holds both a Bachelor's and a Master's Degree in Medical Laboratory Science, both earned from the University of North Dakota.
Course Description: This illustrated course discusses cerebrospinal fluid analysis including specimen collection and handling, macroscopic characteristics, cell counting techniques, and cell identification. Numerous images of cells, and interactive questions throughout the course reinforce concepts and cell identification.