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CSF cell count
CSF cell count

CSF cell count
Definition:
A CSF cell count is a test to measure the number of red and white blood cells that are in cerebrospinal fluid (CSF). CSF is a clear fluid that circulates in the space surrounding the spinal cord and brain.

How the test is performed:
The CSF is usually obtained through a lumbar puncture (spinal tap).

The cerebrospinal fluid is analyzed in the lab.
How to prepare for the test:
It is important to be well hydrated prior to the test. This will facilitate obtaining the fluid.

Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child's age, interests, previous experience, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child's age:
How the test will feel:

Patients will be asked to either sit up or lie down on their sides with the back parallel to the bed and the chin tucked under and the legs curled in the fetal position. The healthcare provider will use the bony protrusions of the hip to determine the most appropriate location to remove fluid. This is usually at what is known as the L3-L4 vertebral level.

Subsequently iodine will be used to clean off the area and a sterile sheet will be draped over the surrounding area. In infants and small children, EMLA cream, a local anesthetic cream will be used to numb the skin and will be applied about 1 hour prior to the procedure. In adults, lidocaine will be injected under the skin initially, and then deeper such that tissue beneath the skin will also be numbed.

A thin 20-gauge needle will then be inserted into the interspace between the vertebra. Depending on how much subcutaneous tissue there is, this may require shallow or deeper penetration of the needle. There may be an audible "pop" when the needle penetrates the dura (membrane that surrounds the spinal cord and encases the fluid).

At that point there will be fluid flowing out of the needle and this will be collected in plastic containers. Under normal circumstances, the opening pressure will be measured with a manometer and then about 20-30 cc of spinal fluid will be collected and sent for evaluation under the microscope.

Under experienced hands there should not be any pain. There may be a feeling of pressure when the needle is inserted but with appropriate anesthetic, this should not hurt. Occasionally, some people may feel numbness shooting down the leg. This may be due to irritation of a nerve root.

The needle is withdrawn, the sensation subsides and is not permanent. Following the procedure, the patient is advised to remain lying down for an hour or two to prevent low-pressure headaches. The entire procedure takes approximately 20 minutes.
Why the test is performed:
The CSF cell count may help diagnose meningitis and acute infection of the brain or spinal cord, a tumor, abscess, or area of tissue death (infarct), and it helps identify inflammation. The cell count may also help identify a hemorrhage.
Normal Values:
The normal white blood cells are between 0 and 5. The normal red blood cell count is 0.
What abnormal results mean:
An increase of white blood cells indicates infection, inflammation or bleeding into the cerebrospinal fluid. Some causes include: The finding of red blood cells may indicate a hemorrhage. However, red blood cells in the CSF may also be due to a traumatic spinal tap which can happen if the spinal tap needle hits a blood vessel while entering the skin or dura. It is important to see if the red blood cell count clears in samples taken later in the procedure as opposed to earlier. A ratio of the red blood cells to the white blood cells is also calculated to help with diagnosis.

Additional conditions which this test may help diagnose include:
What the risks are:
  • Risks of lumbar puncture include:
    • hypersensitivity (allergic) reaction to the anesthetic
    • discomfort during the test
    • headache after the test
    • bleeding into the spinal canal
    • infection
  • Brain herniation (if performed on a person with increased intracranial pressure), resulting in brain damage and/or death. This test is not done if an examination or a CT scan or MRI reveals signs of increased intracranial pressure.
  • Damage to the spinal cord does not occur as the needle is inserted below the level where the cord ends. However, there may be transient leg discomfort if a nerve root is irritated by the needle. This passes when the needle is withdrawn and replaced.
Review Date: 8/20/2001
Reviewed By: Galit Kleiner-Fisman MD, FRCP(C), Department of Neurology, University of Toronto, Toronto, Ontario, Canada. Review provided by VeriMed Healthcare Network.
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