Dear Mohammed
The revised (and original) guidelines do indeed discuss problems encountered with a bloody tap - see note (a) to the 2008 guidelines on page 242. The specimen
requirements and transport and specimen handling sections also state that the least blood stained fraction of CSF should be used and also that the sample should not be sent in a pneumatic tube system and centrifuged as soon as possible to minimise the effect
of haemoglobin on the measurement and interpretation of the scan.
In the case you describe the fact that 2 lumbar punctures were performed will inevitably complicate the interpretation because of the real possibility that
blood will have been introduced into the CSF during the first attempt and this could have contaminated the CSF collected at the second attempt.
Looking at the scan you provide, is the oxyhaemoglobin peak really over 5.0 AU? If so then I would report
"Oxyhaemoglobin is present in sufficient concentration to impair the ability to detect bilirubin. Subarachnoid haemorrhage not excluded."
as described in the guidelines for NOA
>0.1AU and a visible oxyhaemoglobin peak and also in note (i) on page 242.
Kind regards
Ian
Ian Holbrook
Department of Clinical Biochemistry
York Hospital
Wigginton Road
York
YO31 8HE
01904 725786
A 50-year-old woman presented with sudden severe headache. Head CT scan was normal. LP was performed, the doctor admitted it was a difficult LP and the patient was stabbed twice to get a CSF sample. The CSF sample is heavily blood stained with RBCs 40500/mm3,
CSF protein 0.59 g/L. The CSF scan is attached, what will be your comment?
N.B: The revised national guidelines 2008 didn't mention traumatic tap despite being a common occurence in clinical practice and is a source of difficulty in interpretation of CSF scans.
Many thanks
Mohammad
Dr. M A Al-Jubouri, MB ChB, MSc, FRCP Edin, FRCPath
Consultant Chemical Pathologist
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