II. Pathophysiology: Xanthochromia
- Xanthochromia is yellow, red or orange supernatant discoloration of centrifuged CSF (due to oxyhemoglobin, Bilirubin)
- Hemoglobin breaks down into oxyhemoglobin (after 2 hours) and then Bilirubin (after 10 hours)
- Indication of free Hemoglobin or a breakdown product in the CSF
- Follows RBC lysis, occuring within hours of at least 400 RBCs first present in CSF
- Xanthochromia may persist for 2 weeks after bleeding event
III. Technique
- Count Red Blood Cells in first and third tubes
IV. Interpretation: For each 500-1000 RBCs/mm3
- CSF Leukocytes increase by 1
- CSF Protein rises 1 mg/deciliter
V. Causes: CSF Red Blood Cells
-
Subarachnoid Hemorrhage or Intracranial Bleeding
- RBC Count unchanged between first and third tubes
- Blood does not clot
- Xanthochromia suggests bleeding
-
Traumatic tap
- RBC Count decreases between first and third tubes
- CSF becomes clear on centrifugation
- Consider repeating tap at higher interspace
VI. Causes: Xanthochromia
-
Subarachnoid Hemorrhage
- Xanthochromia at 6 hours: 20% of Subarachnoid Hemorrhage
- Xanthochromia at 12 hours: 90% of Subarachnoid Hemorrhage
- Sentinel bleeds in prior 2 weeks in half of SAH patients may also persist as Xanthochromia
- Increased Serum Bilirubin >10-15 mg/dl
- CSF Protein >150 mg/dl
- Traumatic Lumbar Puncture (if CSF RBC>100,000)
VII. References
- Aldeen and Rosenbaum (2017) 1200 Questions Emergency Medicine Boards, 3rd ed, Wolters Kluwer, Baltimore, p. 123
- Kooiker in Roberts (1998) Procedures in ER, p. 1067-75
- Ravel (1995) Lab Medicine, Mosby, p. 294-9
- Tunkel in Mandell (2000) Infectious Disease, p. 974-8
- Seehusen (2003) Am Fam Physician 68:1103-8 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Qualitative Concept (T080) |
| SnomedCT | 90998002 |
| LNC | LP18043-7, MTHU003207 |
| English | XANTHOCHROMIA, Yellow color on exam, xanthochromic, yellow coloring, color yellow, colour yellow, xanthochromia, yellow color, colored yellow, Xanthochromia, Yellow color, Xanthochromic, Yellow colour, Yellow color (finding), Coloring yellow, Colouring yellow |
| Italian | Xantocromia, Colorazione giallastra |
| Dutch | geelkleurend, geelkleuring, xanthochromie |
| French | Coloration jaune, XANTHOCHROMIE, Xanthochromie |
| German | Farbe gelb, Gelbverfaerbung, XANTHOCHROMIE, Xanthochromie |
| Portuguese | De cor amarela, XANTOCROMIA, Xantocromia |
| Spanish | Coloración amarilla, De color amarillo, XANTOCROMIA, color amarillo (hallazgo), color amarillo, Xantocromía |
| Japanese | キサントクロミー, 黄染, ｵｳｾﾝ, ｷｻﾝﾄｸﾛﾐｰ |
| Czech | Xantochromie, Žluté zbarvení kůže, Žloutenka |
| Hungarian | sárgás elszíneződés, sárga elszíneződés, Xanthochromia |
Ontology: Erythrocytes:NCnc:Pt:CSF:Qn (C0942423)
| Concepts | Clinical Attribute (T201) |
| LNC | 26454-9 |
| English | Erythrocytes [#/volume] in Cerebral spinal fluid, RBC # CSF, Erythrocytes:NCnc:Pt:CSF:Qn, Erythrocytes:Number Concentration (count/vol):Point in time:Cerebral spinal fluid:Quantitative |
