Professional Documents
Culture Documents
Chapter One
Specimen:
the third tube in the sequentially collected tubes
must be counted within 1 hour of collection (cells
disintegrate rapidly). If delay is unavoidable store 2-
8oC.
All specimens should be handled as biologically
hazardous
Uptake and Utilization of
Glucose
Glucose is major energy substrate for brain as
well as a major carbon source for many
molecules.
Brain uses 20-25% of total oxygen and 15% of
cardiac output is directed to CNS.
Glucose Utilization
When body glucose supply is decreased, other organs
decrease glucose utilization to maintain adequate
supply of glucose to brain.
Other organs can readily switch to oxidation of another
substrate for energy production.
Under certain conditions, such as chronic starvation,
the brain can oxidize other substances but maintains a
minimal obligatory requirement for glucose.
Brain Utilization of Glucose
Glycolysis--conversion to lactic acid
Hexokinase has high activity in brain
Serves to trap glucose and maintain concentration
gradient for diffusion
Brain Utilization of Glucose
2-deoxyglucose is also taken up by brain and
phosphorylated by hexokinase, but then
becomes trapped
Marker to correlate changes in neural activity with
changes in glucose utilization.
Enolase, an enzyme in glycolytic pathway,
exists in nerve cells in unique isoform (neuron
specific enolase, NSE)
Used as a specific marker for neurons.
Brain Utilization of Glucose
Pentose shunt
Provides source of D-ribose for synthesis of
DNA and RNA
Produces NADPH required for lipid syntheses
Most active during development
Utilization of Amino Acids
Concept: Amino acids serve many functions in
CNS
Peptide and Protein synthesis
Precursors for transmitters
Neurotransmitters
Proteins in the CNS
Concept: Neurons must produce those proteins
essential for their special functions:
conduction of action potentials
synaptic transmission
axoplasmic transport
establishment of specific connections
Specific Neural/GlialPeptides/Proteins
Structual-cytoskeletal
Cell Surface proteins play a role during
development in directing neural connections
Contractile proteins
function in axoplasmic movement
Neurotubular protein
Glial proteins (glial fibrillary protein)
Specific Neural/Glial Peptides/Proteins
Enzymes for transmitter synthesis and
degradation
Transmitter receptors
Membrane transporters
Ion Channels
Growth Factors
Synaptic Vesicle
MICROSCOPIC OBSERVATIONS
OF CEREBRAL SPINAL FLUID
Neutrophils and Bands
Morphologically identical to neutrophils and
bands in blood
Occasionally granulation disappears and
pseudo-hypersegmentation is observed.
Lymphocytes
Almost identical morphology to lymphocytes
in the blood
Due to "flattening-out" of the lymphs during
cytocentrifugation, nucleoli may be visible.
Found in all fluid
Macrophages
Leukophages:Macrophagescontaining phagocytized
WBC. WBCs are often pyknotic and easily confused
with NRBC's. Found in all fluids.
Erythrophages: Macrophages containing phagocytized
RBC or RBC fragments. May contain several RBC.
Found in all fluids.
Siderophages: Macrophages containing phagocytized
particles of hemosiderin, which stain a blue-black color.
Hematoidin Crystals
These are bright-yellow diamond-shaped
crystals of hemosiderin
intracellular or extracellular on the slide.
They are iron-negative on the Prussian blue
stain and therefore
Can be noted on the patient report without
performing an iron stain.
Immature Granulocytes
Metamyelocytes, myelocytes, and
promyelocytes may be found in fluids, though
they are rarely seen.
They are morphologically identical to those in
the blood
May be due to bone marrow contamination in
CSF
Blasts
Morphologically similar to blasts found in the
blood
There may be some clover-leaf shaped nuclei
due to cytocentrifugal distortion.
May be found in all fluids
Seen in association with leukemias,
lymphomas
Bone marrow contamination of CSF
Nucleated Red Blood Cells
NRBC are rarely seen body fluids. If observed,
they should be reported as the number of
NRBC per number of WBC counted
They must be differentiated from pyknotic
WBCs
NRBC’s are commonly due to peripheral blood
or bone marrow contamination of CSF
Abnormal Lymphocytes
Plasmacytoid lymphs: Identical in morphology
to plasmacytoid lymphs in blood
Found in all fluids.
Mott cells: Plasma cells with numerous clear
cytoplasmic vacuoles containing
immunoglobulins
Reactive Macrophages
These are most common in CSF from small
children with subarachnoid hemorrhage but
may be found in all body fluids
May be very difficult to distinguish
morphologically from large atypical
lymphocytes
Malignant Cells
Malignant cells may be shed from solid tissue
(non-hematopoietic) neoplasms into CSF or
body cavity fluid submitted for cell counts
Fluid will be turbid or bloody
Malignant cells are usually seen in clusters of 3-
5 or more, but may occur singly
Microorganisms
Intracellular bacteria or yeast can be observed
in acute bacterial or fungal infections
It is important to coordinate your findings with
those of the Microbiology Section of the
laboratory
Bloody CSF
When the CSF is pinkish red, this usually
indicates the presence of blood, which may
have resulted from:
Sub arachnoid hemorrhage
Intra cerebral hemorrhage
Infarct
traumatic tap
Order of Draw of Lumbar Puncture
1st - Chemistry
2nd - Microbiology
3rd - Hematology
Physical Examination
Color – Xanthochromia
Hyperbilirubinemia
Increased Protein
Turbidity
Increased White Blood Cells (Pleocytosis)
CSF Supernatant
A traumatic tap shows progressively
decreasing RBC in serial samples
Generally, in subarachnoid hemorrhage, the
RBC would be consistent from one tube to the
next
CSF Supernatant
After the CSF is centrifuged, the supernatant
fluid is clear in a traumatic tap, but it is
xanthochromic in a subarachnoid hemorrhage
Xanthochromia of the CSF refers to a pink,
orange, or yellow color of the supernatant after
the CSF has been centrifuged
Cell Count
The white cell count is increased when there is
inflammation of the central nervous system,
particularly the meninges
Bacterial infections are usually associated with
the presence of neutrophils in the CSF
Cell Count
• Viral infections are associated with an increase
in mononuclear cells
• An increase in mononuclear cells may also be
seen with:
– cerebral abscess
– acute leukemia
– Lymphoma
– intracranial vein thrombosis
– cerebral tumor
– multiple sclerosis
Cell Count cont’d
A white cell count with an indication whether
the cells are pus cells or lymphocytes, is
required when the c.s.f. appears slightly cloudy
or clear or when the
Gram smear does not indicate pyogenic
bacterial meningitis
Cell Count cont’d
Method
To identify whether white cells in the c.s.f. are
polymorphonuclear neutrophils (pus cells) or
lymphocytes, dilute the c.s.f. in a fluid which stains
the cells. Istonic 0.1% toluidine blue is
recommended because it stains lymphocytes and
the nuclei of pus cells blue. C. neoformans yeast
cells stain pink. Red cells remain unstained. The
motility of trypanosomes is not affected by the dye.
When toluidine blue is unavailable, isotonic
methylene blue can be used which will also stain the
nuclei of leucocytes.
CSF Cell Count procedures
1 Mix 1 drop of the c.s.f. (sample No. 2 uncentrifuged
c.s.f.) with 1 drop of toluidine blue diluting fluid,
2 Assemble a modified Fuchs-Rosenthal ruled
counting chamber, making sure the chamber
and cover glass are completely clean.
Granulomatous Meningitis
Carcinomatous Meningitis
Syphilis (protein may be normal if longstanding)
Guillain-Barre Syndrome (Infectious polyneuritis)
Cushing's Disease
Connective tissue disease
Uremia
Myxedema
Cerebral hemorrhage
Cerebrospinal Fluid Glucose
Urinalysis and body fluids / Susan King Strasinger, 5th ed. 2008
District laboratory practice in tropical countries. 2nd ed. Part I. Monica
Cheesbrough, 2005
Text book of urinalysis and body fluids. Doris LR, Ann EN, 1983
Urinalysis and body fluids: A color text and atlas. Karen MR, Jean JL.
1995
Clinical chemistry: Principles, procedures, correlation. 3rd ed. Michael
L. Bishop et al. 1996
Tietz Text book of clinical chemistry. 3rd ed. Carl AB, Edward RA,
1999
Clinical chemistry: Theory, analysis, correlation 4th ed. Lawrence AK.
2003
ASCP Document
Urinalysis lecture note . Mistire W. , Dawite Y.
76