LPU-ST. CABRINI SCHOOL OF HEALTH SCIENCES, INC.

Km. 54 National Highway Makiling Calamba Laguna, 4200

DEPARTMENT OF MEDICAL TECHNOLOGY

RATIONALIZATION IN CLINICAL MICROSCOPY
Cerebrospinal Fluid

Name: MALABANAN, Jonathan A.

Section: BSMT 3-3

Directions Code: CM-9-CSF

1. Answer the following questions by supplying the correct answer. (Please BOLD your answers and use the provided
answer sheet)
2. Rationalize your answers indicating the reason(s) why is it the correct answer, and why are the other choices not
the answer.
3. Include your reference(s) per question
4. Deadline of Submission: April 2 (hard copy, print in long bond paper) April 2, 2018 (Soft copy, LMS)
5. Font Style: Calibri Light, Font Size: 11, Spacing: 0, Justified

1. A lumbar puncture should NOT be performed if the patient has:

a. dementia or acute states of acute confusion
b. infection such as encephalitis or meningitis
c. inflammation over or near the puncture site
d. unexplained seizures or multiple sclerosis

Dementia and acute states of confusion may also prompt the physician to perform a lumbar puncture and CSF
examination. Lumbar puncture should not be performed if there is infection or inflammation over the puncture site. Using
such a site may induce meningitis. Contraindication in performing lumbar puncture is the presence of infection at the
puncture site. Lumbar puncture through an area of infection may cause the spread of infection into the meninges.
However, bacteremia is not a contraindication because CSF examination can confirm or rule out concurrent meningitis.

Reference:
Graff’s Textbook of Urinalysis and Body Fluids 2nd Edition by Mundt et. Al

2. Which of the following is NOT a membrane surrounding the brain?

a. arachoidea b. dura mater c. pia mater d. subarachnoid

The brain and spinal cord are enclosed in three layers of membrane, the meninges. The outer most membrane is the dura
mater, the membrane in the middle is the arachnoid (also referred to as arachoidea), and the innermost membrane is the
pia mater.

Reference:
Graff’s Textbook of Urinalysis and Body Fluids 2nd Edition by Mundt et. Al

3. A small amount of CSF is formed by the:

a. cerebral ventricles capillaries c. ependymal lining cells
b. dura mater and pia mater d. ventricular choroid plexuses

Approximately 30% is formed by the ependymal lining cells of the ventricles and the cerebral/subarachnoid space. CSF
volume is normally from 90 to 150 mL in adults, with a rate of production from 500 mL/day or 20 mL/hour.

Reference:
Graff’s Textbook of Urinalysis and Body Fluids 2nd Edition by Mundt et. Al

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4. Pellicle formation in CSF requires:
a. centrifugation b. culture c. refrigeration d. staining

Color and turbidity are noted. If a fourth tube is collected, or when the cell counts are completed, the tube may be
refrigerated and observed for pellicle formation.

Reference:
Graff’s Textbook of Urinalysis and Body Fluids 2nd Edition by Mundt et. Al

5. CSF may appear oily if the patient has:

a. hemorrhage b. had a myelogram c. multiple sclerosis d. normal CSF

An oily appearing CSF may contain radiographic contrast media. Abnormal colors reflect the presence of various
substances. Red blood cells can add a red, pink, or smoky color to CSF. If hemoglobin is present, the CSF can appear red or
xanthochromic if the hemorrhage is older.

Reference:
Graff’s Textbook of Urinalysis and Body Fluids 2nd Edition by Mundt et. Al

6. Typically, the protocol for the performance of CSF analysis when three tubes are collected is which order for cell
counts, chemistries, microbiology?
a. 1, 2, 3 b. 2, 1, 3 c. 3, 1, 2 d. 3, 2, 1

A common protocol is the performance of chemical and immunologic analysis on tube number one, microbiological
procedures on tube number two, and cells counts on tube number three.

Reference:
Graff’s Textbook of Urinalysis and Body Fluids 2nd Edition by Mundt et. Al

7. A cranial hemorrhage is indicated by CSF that is colored

a. pink b. red c. xanthochromic d. all of these

After hemolysis, the CSF will change from a cloudy or hazy pink–red to a clear pink–red and then through various shades
of light orange, yellow, and amber (xanthochromia), as oxyhemoglobin changes to methemoglobin, and then after about
12 hours bilirubin is formed. Gradual decrease in CSF color occurs over the first 2 days, clearing in about 2–4 weeks.
Clotting of CSF is associated with a traumatic tap rather than hemorrhage, because CSF contains nearly no fibrinogen.

Reference:
Graff’s Textbook of Urinalysis and Body Fluids 2nd Edition by Mundt et. Al

8. Cells that may be seen in clusters resembling tumor cells may be:
a. CNS lining cells b. macrophages c. nucleated RBCs d. none of these

Of the few cells normally present in CSF, lymphocytes and monocytes are predominant. Neutrophils are not a common
finding in CSF, and CNS lining cells are only rarely seen. In adults, normal proportions of cells in CSF usually range 28–96%
lymphocytes, 16–56% monocytes, and 0–7% neutrophils. Eosinophils, ependymal cells, and histocytes are only rarely
seen. Other cells that may be present in CSF include CNS lining cells and malignant cells.

Reference:
Graff’s Textbook of Urinalysis and Body Fluids 2nd Edition by Mundt et. Al

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9. The presence of siderophages in CSF indicates
a. a normal finding b. meningitis c. old hemorrhage d. traumatic tap

Within 2–4 days changes in cells present in Cerebrospinal Fluid following hemorrhage includes , Erythrophagocytosis,
vacuolated macrophages (digestion of RBCs), siderophages (macrophages with stored iron).

Reference:
Graff’s Textbook of Urinalysis and Body Fluids 2nd Edition by Mundt et. Al

10. The presence of nucleated red blood cells in CSF indicates:

a. a normal finding b. meningitis c. old hemorrhage d. traumatic tap

Nucleated red blood cells may also be present in specimens from a traumatic tap in which the vertebra was nicked.

Reference:
Graff’s Textbook of Urinalysis and Body Fluids 2nd Edition by Mundt et. Al

11. The presence of which cell may be the only abnormality in multiple sclerosis?
a. choroidal cells b. eosinophils c. macrophages d. plasma cells

Plasmacytes are not normally found in normal CSF. They can appear in the same disorders in which there is lymphocytic
pleocytosis. In addition, plasma cells can be seen in multiple sclerosis, where they may be the only abnormality. Plasma
cells are specific for Multiple Sclerosis.

Reference:
Graff’s Textbook of Urinalysis and Body Fluids 2nd Edition by Mundt et. Al

12. Malignant cells seen in CSF:

a. can be of CNS origin c. metastasize from other sites
b. can be leukemia cells d. may be all of these

Malignant cells arise from various tumors, either primary CNS tumors or one that has metastasized to the CNS. Tumors
that commonly metastasize the CNS include carcinomas of the breast, gastrointestinal tract, lung, and leukemia and
melanoma.

Reference:
Graff’s Textbook of Urinalysis and Body Fluids 2nd Edition by Mundt et. Al

13. CSF protein levels are:

a. higher than serum levels c. decreased in hyperthyroidism
b. independent of puncture site d. increased in young adults

In addition, CSF protein levels are dependent upon site of collection. Protein levels are higher in CSF collected by lumbar
puncture, whereas protein levels on specimens obtained from the ventricles are lower. Along with the presence of
bacteria, bacterial meningitis is accompanied by elevated CSF protein levels and decreased CSF glucose.

Reference:
Graff’s Textbook of Urinalysis and Body Fluids 2nd Edition by Mundt et. Al

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14. A myelin basic protein level of 2 ng/mL indicates
a. brain hypoxia b. head trauma c. myelopathy d. normal results

Normal levels of MBP in CSF are less than 4 ng/mL. During acute exacerbations of multiple sclerosis, MBP levels can be in
excess of 8 ng/mL. Other conditions that may increase CSF MBP levels include trauma to the head, hypoxia, myelopathy,
and intrathecal administration of chemotherapy.

Reference:
Graff’s Textbook of Urinalysis and Body Fluids 2nd Edition by Mundt et. Al

15. Meningitis results in:

a. decreased CSF glucose and decreased CSF protein
b. decreased CSF glucose and increased CSF protein
c. increased CSF glucose and decreased CSF
d. increased CSF glucose and increased CSF protein

Along with the presence of bacteria, bacterial meningitis is accompanied by elevated CSF protein levels and decreased
CSF glucose. Increased numbers of leukocytes (pleocytosis) is present with neutrophils comprising the greatest
percentage.

Reference:
Graff’s Textbook of Urinalysis and Body Fluids 2nd Edition by Mundt et. Al

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