University of Al-

Ameed
College of Pharmacy
.Biochemistry Lab
3rd stage

Chloride & Protein in

CSF
by

Najah Hamza
MSc. Pharmacy/Clinical Biochemistry
2024
 Cerebrospinal fluid (CSF)
CSF acts as a cushion, protecting the brain and spine from injury. The
.fluid is normally clear. It has the same consistency as water
Cerebrospinal fluid (CSF) collection is a test to look at the fluid that
.surrounds the brain and spinal cord
The Chloride CSF test is performed on a sample of CSF to
.measure level of Chloride in the CSF
It is performed to confirm the diagnosis of various forms of
.meningitis, especially tuberculous meningitis
 Evaluation of CSF
CSF evaluation involves a series of tests to
analyze the composition of the fluid surrounding
.the brain and spinal cord
 Evaluation of CSF

:Chemical Analysis
Various chemical components are measured, including -
.glucose, chloride, proteins and others
Deviations from normal levels can indicate specific
.conditions, such as infections or metabolic disorders
 Evaluation of CSF

:Physical Examination
The collected CSF is examined for its color, -
clarity, and any signs of blood. Changes in
these physical characteristics can provide
.initial clues about potential issues
 Chloride in CSF
Chloride is an electrolyte that helps maintain -
the fluid balance in the body, and its concentration
.is regulated to support proper cellular function

Abnormal chloride levels in CSF can be -

indicative of disturbances in the balance of
electrolytes, potentially signaling underlying health
.issues
 ?What is the concentration of chloride in CSF

Normal chloride levels in CSF range from 113 - 130 mEq/L

Abnormal levels may indicate a problem with the brain or spinal cord
or an imbalance in the body's electrolytes
 Uses of Chloride CSF Test

Decreased levels of Chloride in the CSF usually suggest the presence of

.tuberculous meningitis

On the other hand, Chloride content is elevated in poliomyelitis, viral

.meningitis and encephalitis
 Procedure for Chloride (CSF) Test
You will lie on your side with your knees pulled up toward the chest,
.and chin tucked downward
After the back is cleaned, the health care provider will inject a local
.anesthetic into the lower spine
A spinal needle will be inserted. Once the needle is in position, the CSF
.pressure is measured and a sample of CSF is collected
The needle is removed, the area is cleaned, and a bandage is placed
.over the needle site
 Proteins in CSF. 3
Proteins play a crucial role in various -
physiological processes and are present in CSF,
although in
.smaller quantities compared to blood

Elevated protein levels in CSF may suggest -

inflammation, infection, or other conditions
.affecting (CNS) the central nervous system
 CSF Protein
The spinal fluid normally contains very little protein since
serum proteins are large molecules that do not cross the blood-
.brain barrier
.Most of the protein that is normally present is albumin

:CSF protein concentration may rise due to 2 factors

either an increased permeability of the blood brain barrier- 1
allowing more protein and higher molecular weight proteins to
enter the CSF
proteins may be synthesized within the cerebrospinal canal- 2
.by inflammatory or other invading cells
 CSF Protein
Mild protein elevation may be caused by
,viral meningitis
,neurosyphilis
,subdural haematoma
,cerebral thrombosis
,brain tumor
multiple sclerosis (rarely >1.00 g/L)
 CSF Protein
Moderate or pronounced elevation may be caused by
,acute bacterial meningitis
,tuberculous meningitis
,spinal cord tumor
,cerebral hemorrhage
.Guillain-Barre syndrome

When CSF protein levels are low it can indicate

.rapid CSF production
 In Protein detection
CSF volume: Minimum 0.25 mL (6 drops)
Sample tube: Plain Universal container (tubes containing
gel or anticoagulant are not suitable for analysis of CSF
.protein)
 :Sample Collection

CSF is typically collected through a lumbar

.puncture, also known as a spinal tap

A needle is inserted into the space around the

.spinal cord to obtain a small amount of CSF
 Why CSF Test is Performed
:This test may be done to diagnose
Tumors
Infections
Inflammation of the central nervous system
Delirium
Other neurological and medical conditions
 Procedure
Serum Total Protein
Blank Standard Test
Reagent 1000µl 1000µl 1000µl
Standard -- 20µl --
Test -- -- 20µl
Mix and incubate for 10 minute at 37ºC . Measure absorbance of standard and test
. against the reagent blank at 546 nm