This table lists reference values for the most common laboratory tests and is intended for interpretation of the results as they are provided in the examination. Reference values vary based on several factors, including the demographics of the healthy population from which specimens. Importance of normal values of csf parameters in term versus. Burt 1993 reference values for normal csf levels are shown in table 1. Reference values intervals for blood, urine, csf, stool, and other fluids eg, gastric acid and commonly used panels are included. A lumbar puncture, also called a spinal tap, is the. Role of mri csf flowmetry in evaluation of hydrocephalus. Association of cerebrospinal fluid analysis findings with. There is about 125ml of csf at any one time, and about 500 ml is. Cerebrospinal fluid csf analysis and interpretation in. Normally, there are no rbcs in the cerebrospinal fluid, and there should be no more than five wbcs per cubic millimeter of csf. However,as few as 200 white blood cells wbcs per mm3 or 400 red blood cells rbcs per mm 3 will cause csf to appear turbid. The presence of any neutrophils in the csf is unusual in normal children and should raise concern about bacterial meningitis. The 95th percentile values were 116 mgdl for infants 0 to 28 days and 80 mgdl for infants 29 to 56 days.
Idiopathic normal pressure hydrocephalus nph is an important cause of dementia in the elderly. Normal laboratory values of blood, plasma, serum, urine, csf. There is about 125ml of csf at any one time, and about 500 ml is generated every day. Interpretation of csf results from lumbar puncture lp. This guide provides a structured approach to cerebrospinal fluid interpretation csf interpretation, including typical csf results for specific disease processes.
Agerelated changes in csf total protein values in children. Cerebrospinal fluid pressure an overview sciencedirect. For exampl e, healthy neonates may have leukocytes in the csf in the absence of infection or neuropathology. The 90th percentile values of 30 mgdl ages 19 years and 45 mgdl ages 1018 years represent reference values to be used to guide the interpretation of csf protein concentration. However, evidencebased, standardized assessments of csf protein concentration do not exist. Total cell count tcc was determined with a hemocytometer, by counting all cells within 10 large squares of the grid. May 26, 2018 you will not be expected to know this skill for examinations, however you may be asked to interpret some csf results. Chemistry test value comments bicarbonate total co2 normal csf is clear and colorless. Csf acts as a cushion, protecting the brain and spine from injury. Urinalysiscerebrospinal, serous, and synovial fluids. This is performed if the doctor suspects certain conditions such as meningitis or subarachnoid haemorrhage you will not be expected to know this skill for examinations, however you may be asked to interpret some csf results. Csf spaces in idiopathic normal pressure hydrocephalus.
Normal csf circulation the ispn guide to pediatric neurosurgery. Csf pressure determines intracranial pressure with physiological values ranging between 3 and 4 mmhg before the age of one year, and between 10 and 15 mmhg in adults. In normal adults approximately 20ml is produced each hour, and the csf volume is 125ml to 150ml. Reference range for cerebrospinal fluid protein concentration. Hematology absolute neutrophil count male 17805380l 1. This multicenter, crosssectional study included infants. Proper evaluation of csf depends on knowing which tests to order, normal ranges for the patients age, and the tests limitations. Cerebrospinal fluid csf is a clear, colorless body fluid found in the brain and spinal cord. Csf collection and analysis cerebellomedullary csf samples were collected with hypodermal 1. Production matches reabsorption so, at any one time in an adult, the average volume of csf is about 150 ml. Lumbar puncture csf interpretation oxford medical education. Cerebrospinal fluid csf is found in the subarachnoid space of the brain within the ventricles and spinal canal.
Cerebrospinal fluid csf collection is a test to look at the fluid that surrounds the brain and spinal cord. In all subgroups, the upper limits of csf wbc counts were lower when defined using 1. Educational commentary differential cell count on cerebrospinal fluid cont. Because the relationship between csf protein values and age appeared to be nonlinear for children aged csf protein values as the dependent variable in group 2. This station tests your knowledge of both the normal values of various components of csf, and also your ability to make a differential diagnosis of a condition purely from a set of csf results. Agespecific reference values for cerebrospinal fluid protei. To determine agespecific reference values and quantify agerelated changes for cerebrospinal fluid csf white blood cell wbc counts and protein and glucose concentrations in infants. Csf wbc values did not decline significantly with increasing postnatal age in either preterm infants 95% ci for weekly rate of change. Cerebrospinal fluid protein concentrations in children. Cerebrospinal fluid analysis in infectious diseases of the. Cerebrospinal fluid csf is an ultrafiltrate of plasma formed by active, atpdependent pumps located predominantly in the choroidal epithelium. Lumbar puncture spinal tap merck manuals professional edition. For the introduction of these assays in clinical practice, adequate reference values are of importance.
Cerebrospinal fluid reference ranges in term and preterm. The resulting clinical reference values obtained were discussed in light of the published normal values for csf from horses, other animals, and man. The initial lumbar puncture should include csf pressure measurement, and csf pressure in excess of normal i. Cerebrospinal fluid reference values for young infants. Normal values csf clarity clear csf glucose 6070% of blood glucose csf glucose adult 4070 mgdl csf glucose child 6080 mgdl csf wbc count 05 leukocytesmm3 csf rbc count values intervals for blood, urine, csf, stool, and other fluids eg, gastric acid and commonly used panels are included. It is produced by the choroid plexus in the ventricles of the brain and the cerebral vessels, at the rate of 500 mlday. Normal laboratory values of csf during pregnancy jama. Under normal conditions, the composition of csf remains constant. Note that the range of csf values in bacterial meningitis is so wide that there is substantial overlap with the findings in viral meningitis. Laboratory values see inside back cover for continuation. It is recommended that csf should be analysed immediately after collection. Accurate reference ranges are required to facilitate the interpretation of csf laboratory values, including white blood cell. The proper interpretation of csf results depends on knowledge of normal values in the group of patients being evaluated 3,4,15,16. Interpretation of cerebrospinal fluid parameters in.
Proteincytologic dissociation increased total protein, normal number of elements, present in tumours and. Of the two centrifugation methods, cytocentrifugation is the method of choice. Normal laboratory values of blood, plasma, serum, urine. Normal csf circulation the ispn guide to pediatric. Cerebrospinal fluid csf is collected by performing a lumbar puncture on your patient. Csf flowmetry was added to their study after obtaining oral informed consent from their parents. Cerebrospinal fluid protein concentration in pediatric. Normal laboratory values merck manuals professional edition. If your fluid contains rbcs, this may indicate bleeding.
Normal cerebrospinal fluid values in fullterm gestation. In the case of a traumatic tap, rules based on a predicted white cell count in the csf are not reliable. Csf pressure determines intracranial pressure with physiological values ranging between 3 and 4 mmhg before. The reference range for csf glucose is generally set at 2. The tests may look for proteins, sugar glucose, and other substances.
The reference values provided in these tables should be used as guidelines only. However, in various neurological disease especially in acute conditions, the composition, quantity and its pressure can be altered. Reference ranges vary between labs, so always consult your local medical school or hospital guidelines. Csf samples were obtained from 231 neurologically and psychiatrically. Foam test slight foam that disappears normal protein levels take csf in test tube and shake after few minutes the test tube more foam that remains at least for 5 minutes protein lvesl increased 2. If storage is needed 12 ml of csf should be partitioned into three to four sterile tubes. Cerebrospinal fluid samples from 44 pregnant women undergoing spinal anesthesia for delivery were studied to determine whether an abdomen distended with a fullterm fetus could alter the dynamics of lumbar csf. If the csf is abnormal the safest course is to treat as if it is bacterial meningitis.
Aug 09, 2015 note that normal csf samples should be colorless, clear, like water. Reference values vary based on several factors, including the demographics of. Feb 22, 2016 cerebrospinal fluid csf is found in the subarachnoid space of the brain within the ventricles and spinal canal. Objectives to define clinically relevant reference normal values for cerebrospinal fluid csf protein concentrations in pediatric patients who were evaluated for meningitis by traditional criteria and by enteroviruspolymerase chain reaction evpcr design and patients a cohort of 906 consecutive pediatric patients to receive csf analysis at st louis childrens hospital, st louis, mo. Albumin csf serum ratio q alb should be preferred to total protein measurement and normal upper limits should be related to patients age. The mean csf values for opening pressure, csf cell count, and protein concentration were all normal. Diagnostic importance of cerebrospinal fluid in pathognomic condition 442 sr. The test is also used to measure pressure in the spinal fluid. Our study quantifies the agerelated increase in csf protein concentration between 1 and 18 years of age. Csf pressure may be a critical factor in determining outcome, and measurements of pressure, especially in the acute stage, can be valuable. Analysis of cerebrospinal fluid is used in the diagnosis of a wide variety of diseases and conditions affecting the central nervous system. Cerebrospinal fluid csf is a clear fluid circulating in the intracranial and spinal compartments.
Normal opening pressure ranges from 10 to 100 mm h. Pmn leukocytes in the csf may occasionally be a normal finding, but their presence should not be taken lightly, especially if anc is 1mm 3 15. Pdf interpretation of cerebrospinal fluid parameters in. Inset, correlation in infants csf protein concentration and the mid point of each age group. Common laboratory lab values csf analysis globalrph. Several authors have pointed out that there is an acceptable variability in the csf profile, especially csf wbc count, in neonates1,35,815. Cerebrospinal fluid results csf interpretation other.
If csf samples are centrifuged immediately, xantochromia due to traumatic tap should not occur. Bloody fluid may indicate a traumatic puncture pushing the needle in too far, into the venous plexus along the anterior spinal canal or subarachnoid hemorrhage. Urea nitrogen bun, serum outpatients only 80 mgdl courtesy call uric acid, serum 12. Interpretation of csf protein concentration requires established reference values.
It is quick, requires minimal training, and uses small samples. Several studies have shown that protein levels are increased at least to some degree in more than 95% of patients, and its absolute value is over 80 mgdl in more than 80% of patients. However, if csf samples are carefully centrifuged immediately and the supernatant is still xantochromic, this indicates that bleeding may have occurred 24 hours before sample. Increased csf protein 50 mgdl is a sensitive but nonspecific index of disease. Csf is a clear fluid that surrounds and protects the brain and spinal cord. Although normal values are wellestablished for csf cell counts and protein and glucose contents in children and adults, this is not the case for neonates.
Aug 06, 2012 furthermore, since the concentrations of csf glucose and csf lactate in ventricular csf differ from lumbar csf values, we have excluded all ventricular csf samples. Csf cell counts in children with shunts children may have different csf counts compared to adults. The use of this index is potentially limited, however, because the large variability of csf albumin in normal animals at least in dogs and horses andrews et al. The median csf protein value was 62 mgdl interquartile range iqr. These values and curves can be used to interpret the results of lumbar puncture in infants. Possible sites of origin include the choroid plexus 80%, the parenchyma 20%, and the ependyma negligible. Cerebrospinal fluid csf interpretation geeky medics. Cerebrospinal fluid reference values for young infants undergoing. After exclusions based on parameterspecific outliers, 7496 were included in the analysis for csf wbc count, 7738 were included in the analysis for csf protein concentration, and 7761 were included in the analysis for csf glucose concentration fig 1.
Compared to serum, csf is low in protein, glucose, potassium and calcium, but high in sodium, magnesium, and chloride. Albumin csfserum ratio q alb should be preferred to total protein measurement and normal upper limits should be related to patients age. In the present study, we present data on csftau and csfa. Values above the normal range indicate increased barrier permeability. Elevated cerebrospinal fluid csf protein concentration measured during diagnostic lumbar puncture lp can indicate a pathologic central nervous system process. It is produced by specialised ependymal cells in the choroid plexuses of the ventricles of the brain, and absorbed in the arachnoid granulations. Given the following data, determine the corrected csf wbc count. Cerebrospinal fluid csf analysis is a group of laboratory tests that measure chemicals in the cerebrospinal fluid. Reference values vary based on several factors, including the demographics of the healthy population from which specimens were obtained and the specific methods andor. Csf analysis includes measurement of normal csf compounds eg, proteins, glucose, as well as examining for abnormal elements eg, cells, pathogens, abnormal proteins, serology. Morphology and volumetry hajime kitagaki, etsuro mori, kazunari ishii, shigeru yamaji, nobutsugu hirono, and toru imamura purpose. These patients had no hydrocephalus and came to our institute to undergo mri for other neurological causes. Normal laboratory values msd manual professional edition.
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