The document discusses analysis of cerebrospinal fluid (CSF) through biochemical laboratory testing. It describes CSF as clear fluid found in the brain and spinal cord that acts as a cushion. Clinical analysis of CSF includes physical examination of attributes like color and turbidity, as well as biochemical analysis of components like glucose, protein, electrolytes, and enzymes. Elevated protein and decreased glucose in CSF can indicate conditions like bacterial meningitis. Common tests for CSF analysis include glucose measured via the GOD-POD method and protein measured via the SSA method.

1. (
Biochemical laboratory test:
Analysis of cerebrospinal fluid
(CSF)

2. Cerebrospinal fluid
° CSF is contained in
the cavity that
surrounds the
brain in the skull &
spinal cord in the
spinal column.

3. ° Cerebrospinal fluid (CSF) is a clear, colorless
found in the b u and .
e1 It is produced by specialised
the of the
•
en
brain,
and absorbed in the •
0 There is about 125 ml of CSF at any one time, and
about 500 ml is generated every day.
° CSF acts as a cushion or buffer, providing basic
mechanical and " protection to the
brain inside the . CSF aiso serves a vital function
in the of .

4. FUNCTION
• CSF serves several purposes:
• Buoyancy 00
• Protection
• Prevention of brain ~~~~
0
° Clearing waste

5. Clinical significance
0 Pressure
CSF pressure, as measured by =~
, is 8-15 ,with the patient
lying on the side, 16-24 mmHg ,with the
patient sitting up.
In newborns, CSF pressure ranges 4.4-
7.3 mmHg.
When lying down, the CSF pressure as
estimated by lumbar puncture is similar to
the .

6. CLINICAL SIGNIFICANCE
•
o ~~ ~~~ 1san
abnormal accumulation of
CSF in the vent ricles of
the brain.
0 Hydrocephalus can occur
because of · of
the passage of CSF, such as '
from an infection, injury,
mass, or
I
I ,P, d~

7. CLINICAL SIGNIFICAN CE
'- CSF leak
0
1 ea< from the d as a result of
different causes such as physical trauma
0
or a lumbar puncture, or from
~ - when it is termed a
"
UI .
0 It is usually associated with
0
: low CSF pressure. It can
cause headaches, made worse by st anding,
moving and coughing

8. Biochemical analysis of CSF
CSF
Non-Cellular
component
1- k -
•
organic
components
T
I
Inorganic
components
cellular
component

9. Organic components
Total CSF Proteins
Albumin
Globulins
Urea
Creatinine
Enzymes
Bilirubin
Q
0
1F#F¥~
50-70%
30-50%( a I ,a2, ~ & y-globuins: lgA,
lgM & lgG
5- I Smg/ I00ml
0.5- I .0mg/ I00ml
LDH, CK/CPK &AST
Nil

10. Inorganic components
Potassium
chloride
Bicarbonate
calcium
0
2.5-3.SmEq/litre
I I5- I22mEq/1itre
25-S0mEq/1itre
45-SSmg/litre

11. Exam ination of CSF
Patient has headache, vomiting, fever, altered
✓
✓
•
sen r1um
suspected infec ious meningitis
CSF analysis :
physical
Chemical

12. CSF analysis ( Physical)
COLOR CLOT TURBIDITY
Bright red- Traumatic Inc. Fibrinogen- Bacterial Inc.WBC- Bacterial
Infection infection
Yellow- Xanthochromia-

13. CSF analysis (Chemical)
Microbiological lmmuological Biochemical
Gram stain for bacteria Quantification of I, G- Total Protein, Glucose
0
Multiple Sclerosis
AFB stain for TB Electrolytes, Enzymes

14. Contd....
Due to inc.
BBB
Permeability
Meningitis
0
Total protein: High
Inc. Local
syn hesis
Multiple sceloris
Bacl< in CSF
fl 'w
Tumour

15. Contd...
• Glucose-
<40mg/dl due to consumption by bacteria:
bacterial meningitis.
0 Electrolytes-
D ec. Chloride levels : tubercular meningitis

16. Collection of CSF
Sacru m
'
'
----•~
.~----;,,-
: ~ ~ -
·
"'-----,::..:.:=====-.-
~ I
-
------ Skin
Cauda eq-t.Jsn.a
Su ba.-achno,d
s pa.co
Du,a ma1or
~----- Fourth l umbar ve.Tlebra
"_ • ~ ~~ ------:.~----.:;=1,
Noodle
-

17. Contd...
a) About 0.5ml ( or few drops) of CSF is
tal<en in a sterile tube & is used for
bacteriological tubes.
b) About 3.0-Sml of CSF is taken in a
centrifuge tube & the tube is then
centrifuged.
The sediment ( centrifuged deposit) is used
for Gram's staining, acid- fast staining (Z-
N staining) & DLC.

18. Contd...
• However, the supernatant is used for
quantitative analysis of protein, glucose &
chloride.
Note:-
0 The collected sample of CSF must be
analyzed within Ihr of its collection.
0 Since, CSF may contain virulent
pathogenic organisms, it should be
handled & examined very carefully.

19. Composition of CSF
Analyte
Total volume
Q
0
Normal pressure
Specific gravity
Color
Transparency
Cellularity
pH
···-----· --~
NormalValues 1
- -·
130-1 S0ml( Adult); I0-60ml(
Neonates)
90- I80mm of H20
1.003-1.008
colourless
Clear, free of clots
<5 lymphocyte or monocyte/mm3
7.3-7.4

20. t sea: m:: s 1:
Examination of CSF:
( - ]
1-Physical examination 2-Biochemical analysis of CSF
~ --------------~~~--~
Tests of interest:
• Glucose
• Protein
T
otal
Spec1f1
c:
A
lbumin
lmmunoglobulin
The most reliabled,agnosucal y&
accessible analyt1call
Others (e g.myelin basic protein, MBP)
Lactate
Glutamine (replaced bymeasunng plasma [ammonia})
:¥ * I

21. ~ s- .....,rea.~nee Polymorph Lymphocytes Protein Glucose
Normal Clear
Pyogenic Yellowish,
meningitis turbid
0
Normal
Markedly
increased
Slightly
increased or
Normal
Slightly
Tubercular Y~llowish and increased or Markedly
meningitis viscous increased
Viral Clear fluid
meningitis
Normal
Slightly Markedly
increased or increased
Norma
15-45
mg/di 1
40- 80
mg/di
Markedly Marked
increased Decreased
Increased Decreased
Dcut'~·c'd·togot
SH~htly lD ~•
. d n10fi' c.d
increase

22. • ESTIMATION OF GLUCOSE IS BY
GOD-POD METHOD
o ESTIMATION OF CSF PROTEIN IS BY
SSA METHOD.

23. PROCEDURE BY GOD-POD
METHOD
r.Dispense in to test tube: -
Glucose reagent
Distilled water
Standard
( 100 mg %)
Sample (T1) -
1 ml
10 1,11
-
~
1 ml
-
10 111
-
1 ml
-
-
10 pl

24. CSF PROTEI ESTIMATION BY SSA
METHOD:
.• Dispense in to test tube:
SSA reagent
Distilled water
Standard
( 100 mg%)
Sample (T1) -
Bla,
nli
2 ml
20 ....
-
~ irt
e-1i11
2 ml 2 ml
- -
-
20 111
: '~:=t

25. Principle of SSA method:
• In acidic medium, protein solution has
positive charges. N egative charges of
alkaloidal reagents like sulphosalicylic acid
(protein precipitants) neutralize the
0 0
positive charges on the protein and form
the precipitate.
Sulphosalicylic Acid Test
Negative Trace l+ 2+ 3+ 4+