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Specimen Collection Manual and Test Catalog

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SUBARACHNOID HEMORRHAGE EVAL CELL COUNT AND DIFF, CSF

Geisinger Epic Procedure Code:  LAB5034    Geisinger Epic ID:  190583

SPECIMEN COLLECTION
Specimen type: 

Cerebrospinal fluid (CSF) including lumbar puncture or shunt


Preferred collection container: 
Specimen required: 

2-3 mL (preferred), 1 mL (minimum)


Special notes: 

Cell Count will be performed on Tube 1 and last tube in sequential draw (i.e., tube 4 preferred). Differential will only be performed on the last tube in sequential draw.
Indicate specimen source on label and requisition. Clotted and partially clotted specimens will receive a comment, "Fluid clotted cell count questionable". 
 



SPECIMEN PROCESSING
Processing instructions: 

Do not centrifuge or freeze.


Transport temperature: 

Room temperature


Specimen stability: 

Room temperature for 4 hours


Rejection criteria: 

SEE SUPERVISOR



TEST DETAILS
Reference interval: 

Color: Colorless
Clarity: Clear
Newborn (0-7 days) TNC <30 cells/uL RBC <1,000 cells/uL Neutrophils 0-8% Lymphocytes 5-35% Monocytes 50-90% Eosinophils 0-1%
Infant (7 days - 3 months) TNC <7 cells/uL RBC <50 cells/uL Neutrophils 0-8% Lymphocytes 5-35% Monocytes 50-90% Eosinophils 0-1%
Child (3 months - 18 years) TNC <5 cells/uL RBC <5 cells/uL Neutrophils 0-6% Lymphocytes 40-80% Monocytes 15-45% Eosinophils 0-1%
Adult (>18 years) TNC <5 cells/uL RBC <5 cells/uL Neutrophils 0-6% Lymphocytes 40-80% Monocytes 15-45% Eosinophils 0-1%
Other cells rarely present in CSF fluid.
Reference ranges modified from Body Fluid Analysis for Cellular Composition; Proposed Guideline, Clinical and Laboratory Standards Institute, H56-P, Vol. 25, Nov. 20, 2005.


Interpretation guide: 

Cell Counts performed on 2 separate tubes to aid in the diagnosis of Subarachnoid Hemorrhage.
Red cells are increased in trauma and hemorrhage.
White blood cells are increased in inflammatory and infectious processes:
- neutrophils predominate in bacterial infections
- lymphocytes predominate in viral infection
- macrophages may be increased in inflammatory and infectious processes
- eosinophils may be increased in parasitic or fungal infections.


CPT code(s): 
Note: The billing party has sole responsibility for CPT coding.  Any questions regarding coding should be directed to the payer being billed.
The CPT codes provided by GML are based on AMA guidelines and are for informational purposes only.

Test includes: 

Color, Clarity, Total Nucleated Cell count (TNC) (Note: This includes WBC count and other nucleated cells including epithelial cells, histiocytes, macrophages, mesothelial cells etc.) , RBC, TNC differential = % of each cell type in 100 total nucleated cells


Methodology: 
Electronic resistance detection enhanced by hydrodynamic focusing and flow cytometry
Hemocytometer
Microscopic Examination
Synonyms: 

BFC, cell count, fluid cell count, CSF cell count, SAH


Clinical significance: 

This test is intended to help clinicians determine the cause of red blood cells (RBCs) in the CSF.  RBCs in the CSF may be due to a subarachnoid bleed (an early finding) or trauma to an epidural vein during the lumbar puncture.  If RBC count decreases from tube 1 to last tube, this may suggest a traumatic tap.  Correlation with clinical findings during procedure, macroscopic evaluation of supernatant (i.e. xanthochromia), and microscopic evaluation is required.


Doctoral Director(s): 
Mary Dhesi MD
Review Date:  11/20/2024

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