Xanthochromia csf Definition, Test, Timing, Guidelines, Interpretation

   

The presence of red blood cells in cerebrospinal fluid (CSF), WBC's, increased protein concentration in CSF and xanthochromia are important findings for the detection of vascular neurological disorders. However, diagnostic information from these results is often insufficiently matched despite the addition of other clinical data. The introduction of cranial CT-Scan is an extremely useful for the detection of vascular lesions, including intracranial hemorrhage and stroke.

Unfortunately, the necessary equipment is quite complicated and expensive and for now it is only available in larger medical centers. Moreover, bleeding near bone structures such as subarachnoid hemorrhage (SAH) may escape diagnosis and hemorrhagic component in cerebral infarctions may be difficult to detect by CT-Scan. Xanthochromia of CSF microscopically observed as discoloration of the Yellowish supernatant with variations to a reddish or brownish color and is generally accepted as a sign of lesion bleeding.

Xanthochromia  of cerebrosponal fluid develops for several hours after bleeding in older children and adults.It is commonly observed that adults with sub-arachnoid hemorrhage develops xanthochromia within 12 hours of ictus or stroke. The identification of xanthochromia in newborns has not been systematically studied well but it happened Slower than older patients.



This slow change may refer to a delay in the induction of the oxyanganase enzyme, which is present in the subarachnoid membrane and is responsible for the conversion of hem to bilirubin, the major pigment of xanthochromia in CSF. In a recent study it has been observed that activity of hem oxygenase reached peak Values ​​at 6 to 12 hours after injection of hem in the subarachnoidial space . Determining the presence of xanthochromia in newborn is sometimes difficult in the presence of elevated serum bilirubin.

Xanthochromia  Test, Timing, Guidelines, Interpretation


Xanthochromia as pink or yellow tint in the cerebrospinal fluid does not rule out the possibility of subarachnoid hemorrhage (SAH). Xanthochromia may reflects hemoglobin degradation and is present anywhere from 6 to 12 hrs after sub-arachnoid hemorrhage. The absence of xanthochromia does not rule out the possibility of sub-arachnoid hemorrhage if the patient presents more than 2 weeks after the onset of headache.

Xanthochromia is measured by visual inspection or by spectrophotometry. Most hospitals measure by visual inspection, which is obviously a much less sensitive test. Xanthochromia happened due to hyperbilirubinemia, accidental hemorrhage or encephalitis might require further unnecessary diagnostic studies. Additional cerebrospinal  studies should be kept in considered in case of ambiguous findings, especially if the patient has been in an endemic area or has compromised immune system.

Xanthochromia visibility in CSF might be due to the following:
  1. Oxyhemoglobin as a result of lysis of red blood cells 
  2. Bilirubin (bilirhachia) in patients with jaundice.
  3. CSF protein levels above 150 mg / dL, which are also present in bloody traumatic taps or pathological conditions such as complete spinal blockade or spinal stenosis, poly-neuritis, and meningitis.
  4. Merthiolate disinfectant contamination 
  5. Carotenoids in people with hypercarotenemia (i.e., hypervitaminosis A).
  6. Melanin (brown) of meningial metastatic melanoma.
  7. Rifampin therapy (red-orange).
Spectrophotometry can also help to distinguish hemoglobin from other xanthochromic pigments with maximum absorption peaks.

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