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(CSF)
Ruland D.N.Pakasi
Coverage Topics
Laboratory Procedure
Laboratory Examinations
Lab. Findings in selected disorders/
diseases
SEPTEMBER 2013 FK UNISMUH 2
Specimen collection
CSF obtianable by
1. Lumbar puncture
2. Cisternal puncture
3. Lateral cervical
puncture
4. Ventricular cannulas
Operator:
Neurologist/
Neuropsichyartist
Certified doctors
• 90-180 mmH2O
• Lateral decubitus position
slightly:
• Sit up
• Obese
• Vary up to 10 mmH2O with respiration
OP > 200 mmH2O no 2 ml should be drawn
SEPTEMBER 2013 FK UNISMUH 4
Specimen collection & Opening
pressure
OP seen with/ in:
Patient tension or straining
Congestive Heart Failure, Meningitis, Superior
Vena Cava Syndrome, thrombosis of venous
sinuses, cerebral edema, mass lesions,
hypoosmolality, and condition inhibiting CSF
absorption
Latex
agglutination Negative Positive
immunoassay
Spinal cord
N 0–50 L N N or
tumor
Guillain-Barré
N 0–100 L N > 100 mg/dL
syndrome
Lead
0–500 L N
encephalopathy
Pseudotumor
N L N
cerebri
Ruland D.N Pakasi
LAB.FINDINGS
IN SELECTED DISEASE/DISORDERS
Routine tests
CBC & Differential count
Moderate leucocytosis
Platelet count may be H or N
ESR (~60%)
CRP
Serologic
Available for some pathogens (e.g.IgG)
PCR for toxoplasmosis
Blood culture
At least 2, preferably before antibiotic
CSF
WBC ,
When abscess ruptures: 100.000/L RBC
Lactic acid > 500 mg/dL
Basic Coagulation
Panel
Abnormal PT, aPTT, Platelet
Count.
Prothrombin time
CBC determination
Urinalysis
Stat urine or serum toxicology screening
to exclude acetaminophen, tricyclic
antidepressants, aspirin, and other
potential toxins: Individuals who abuse
drugs may ingest a substance called
Urine Luck, or pyridinium
chlorochromate (PCC), to produce
invalid results on urine drug screens.
PCC alters the results for cannabis and
opiates but elevates levels of
amphetamines.
Blood test for an alcohol level if the
patient appears intoxicated
HIV and rapid plasma reagin (RPR)
tests
Other Tests
Laboratory Studies
Arterial blood gas determination: This test may be useful in patients
with either marked tachypnea or a decreased serum bicarbonate
level to further delineate the etiology.
Cocaine can caus e either myocardial is chemia or inf arction. This can
s ubs equently lead to ST depression or elevation depending on the
is chemia/infarct region. H owever, many young patients w ho abus e
cocaine have a bas eline J - point elevation that may be dif ficult to
dif ferentiate f rom an inf arct pattern. In addition, normal ECG
f indings do not rule out the pos s ibility of myocardial injury in a
patient w ho abus es cocaine w ho has chest pain.
Acute cocaine toxicity als o may res ult in hyperkalemia. This can lead
to a dif fuse peak ing of T w aves, w idening of the Q RS, los s of P w aves,
or, in the mos t s evere cas es, a s inus oidal w ave pattern.