CSF Blood

Aka: CSF Blood, CSF Red Blood Cell, CSF RBC, Xanthochromia

1. See Also
   1. Cerebrospinal Fluid
   2. Lumbar Puncture
2. Pathophysiology: Xanthochromia
   1. Xanthochromia is yellow, red or orange CSF discoloration
   2. Indication of free Hemoglobin or a breakdown product in the CSF
   3. Follows RBC lysis, occuring within hours of RBCs first present in CSF
3. Technique
   1. Count Red Blood Cells in first and third tubes
4. Interpretation: For each 500-1000 RBCs/mm3
   1. CSF Leukocytes increase by 1
   2. CSF Protein rises 1 mg/deciliter
5. Causes: CSF Red Blood Cells
   1. Subarachnoid or intracranial bleeding
      1. RBC Count unchanged between first and third tubes
      2. Blood does not clot
      3. Xanthochromia suggests bleeding
         1. See CSF Color
         2. CSF supernatant xanthochromic on centrifugation
         3. Requires at least 2 to 4 hours from onset of bleed
   2. Traumatic tap
      1. RBC Count decreases between first and third tubes
      2. CSF becomes clear on centrifugation
      3. Consider repeating tap at higher interspace
6. Causes: Xanthochromia
   1. Subarachnoid Hemorrhage
   2. Increased Serum Bilirubin
   3. Traumatic Lumbar Puncture (if CSF RBC>100,000)
7. References
   1. Kooiker in Roberts (1998) Procedures in ER, p. 1067-75
   2. Ravel (1995) Lab Medicine, Mosby, p. 294-9
   3. Tunkel in Mandell (2000) Infectious Disease, p. 974-8
   4. Seehusen (2003) Am Fam Physician 68:1103-8 [PubMed]