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:
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
JohnRadcliffeHospital
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 > > > > ******************************************************************************************************************** > > > > This message may contain confidential information. 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