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Ian makes a valuable comment.  A tiny mention that the in vitro decline in CSF glucose is usually negligible, even when the mononucleated cell count is high.  Only when there is a high PMN count does glucose decline significantly.  Obviously, the fluoridated blood glucose can also fall significantly during a delay, and I wonder whether the fall in blood glucose may be even greater than that in the CSF, thereby actually increasing the CSF/blood glucose ratio occasionally.  Does anyone have data on this?  I can only find this:

http://www.reference-global.com/doi/abs/10.1515/CCLM.2010.040


Is it known now whether the cause of the reduction of glucose in meningitis is hypoxia or glucose uptake by invading cells?  If it is the latter, would it actually be a bad thing to let glucose be consumed even more in vitro, and having it reanalysed after some time?!  Sorry; silly question.

Reza



Reza Morovat

Clinical Biochemist

John Radcliffe Hospital

Oxford



> Date: Thu, 24 Jun 2010 14:09:14 +0100
> From: [log in to unmask]
> Subject: Re: FW: CSF analysis
> To: [log in to unmask]
>
> I know this is a widely held view, but can anyone prove to me that
> fluoride (by which we mean 5.0 mg of sodium fluoride in a maximum of
> 2.0 ml of sample) "stops lactate production immediately"? (see below)
>
> Nick Miller
> London
>
> On 24 June 2010 11:08, Holbrook, Ian B <[log in to unmask]> wrote:
> >
> > ________________________________
> > From: Holbrook, Ian B
> > Sent: 24 June 2010 11:07
> > To: 'Turner Helen (NHS Grampian)'
> > Cc: 'Dina'
> > Subject: RE: CSF analysis
> >
> > Dear Helen
> >
> > On behalf of the UK Specialist Advisory Group for EQA of CSF Proteins and
> > Biochemistry we would ALWAYS recommend analysing CSF if sufficient sample is
> > received. This is precious material that often cannot be repeated.
> >
> > If a blood stained CSF sample has a protein level within the reference range
> > then this is useful information to the clinician. If it is above the
> > reference range then of course appropriate comments must be added to help in
> > interpretation. If the results could have been affected by the state of the
> > CSF, delays in transport, not protected from the light etc. then comments on
> > interpretation will form part of the report.
> >
> > I would think that you could analyse CSF glucose in an unpreserved sample as
> > long as this was done within an hour of collection. Fluoride stops lactate
> > production immediately but does not stop glucose utilisation for an hour or
> > so. There would probably be little difference, therefore, between preserved
> > and unpreserved samples within an hour of collection.
> >
> > Kind regards
> >
> > Ian
> >
> >
> > Ian Holbrook
> >
> > Department of Clinical Biochemistry
> >
> > York Hospital
> >
> > Wigginton Road
> >
> > York
> >
> > YO31 8HE
> >
> > 01904 725786
> >
> >
> >
> > ________________________________
> > From: Clinical biochemistry discussion list
> > [mailto:[log in to unmask]] On Behalf Of Turner Helen (NHS
> > Grampian)
> > Sent: 22 June 2010 17:52
> > To: [log in to unmask]
> > Subject: CSF analysis
> >
> > Dear readers,
> >
> > We are currently having a few disagreements regarding CSF analysis and hence
> > I'm looking for some advice.
> >
> > 1- How to deal with blood stained samples for CSF protein, glucose, IgG,
> > albumin and oligoclonal band analysis. Should these be reported as
> > unsuitable, or analysed with a comment to say interpret with caution due to
> > blood stained sample? In the case of oligoclonal bands- does the fact the
> > sample is blood stained have an effect?
> >
> > 2- Tube type for CSF Glucose analysis. Does this have to be a Fl-Ox tube, or
> > can a plain universal be used if received in the lab quickly (<1hr).
> >
> >
> > Thanks in advance
> >
> > Helen
> >
> > Clinical Biochemist
> > Department of Clinical Biochemistry
> > 1st Floor Link Building
> > Aberdeen Royal Infirmary
> > Foresterhill
> > Aberdeen
> > AB25 2ZD
> >
> > Tel: 01224 552831
> >
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