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CSF normal differential WBC counts


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Dear All,

Please enlighten me on how to come to a conclusion on following CSF report

30 weeker, LP done on day 3 of starting antibiotics prophylactically for prematurity. Only indication was to do a LP was positive blood culture for Group B strep and high CRP. Infant didn't have signs of Meningitis.

CSF report-

RBC 15/mm3

WBC 7/mm3 (Neutrophils 3, Lymphocytes 4)

Protein 40mg/dl

CSF sugar 65mg/dl

RBS 75mg/dl

CSF Antigen/culture both Negative

My concern mostly is 3 neutrophils, Would you consider this LP as positive and please comment on normal differential counts of WBC in premature/Term neonates.

Many Thanks!

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Hi

I think the CSF values are benign at the moment . At 30 weeks of gestation , in the first week of life , the following CSF values are generally acceptable

Leukocytes - 4 +/- 4 ( 1 to 10 )

PMN - 4 +/_ 10 ( 0 - 28 % )

Glucose - 74 +/- 19 ( 50 - 96 )

Protein - 136 + / - 5 ( 85 - 176 )

The values may vary from article to article ... but this appeared to be a reasonable one .

Since the antigen studies are normal , and the baby is presumably doing well ( I hope ) , we could rule out meningitis for the time being given the values

Regards

Gopan

Dear All,

Please enlighten me on how to come to a conclusion on following CSF report

30 weeker, LP done on day 3 of starting antibiotics prophylactically for prematurity. Only indication was to do a LP was positive blood culture for Group B strep and high CRP. Infant didn't have signs of Meningitis.

CSF report-

RBC 15/mm3

WBC 7/mm3 (Neutrophils 3, Lymphocytes 4)

Protein 40mg/dl

CSF sugar 65mg/dl

RBS 75mg/dl

CSF Antigen/culture both Negative

My concern mostly is 3 neutrophils, Would you consider this LP as positive and please comment on normal differential counts of WBC in premature/Term neonates.

Many Thanks!

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Thanks a lot Gopan,

I presume you mean there could be up to 10 leukocytes in a normal 30 weeker in the 1st week of life and out of it up to 28% PMN is normal. Is that what you meant? Are there POG matched CSF normal cell counts in literature? That's interesting, please let me know if there are further references. Thanks again,

Regards

Nilan

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Hi Nilan

Yes .. thats what I meant . But I was wondering about the red blood cells in the CSF . We are not usually expected to find that in a normal atraumatic LP .

However , otherwise , for all practical purposes , the CSF values that you gave appears to be well within normal limits ... provided the general condition of the baby is improving as well

Regards

Gopan

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I agree with dr Gopan on csf value,but a gram stain slide of csf is somtime a valuable addition, in early meningitis, there may be organisms , with normal csf values and cells very few. Clincal evidence of meningitis may be difficult to evaluate in small babies, a cranial ultrasound before attempting lp may be helpful too.

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"atraumatic lumbar punctures : - defined as red blood cell [RBC] count < 1000/mm3"

Ref: http://www.ncbi.nlm.nih.gov/pubmed/8866797

Ref: http://www.medscape.com/viewarticle/738182

"Traumatic LPs were defined as CSF specimens with 500 RBCs/mm"

Ref: http://www.ncbi.nlm.nih.gov/pubmed/12612231

Also this is a nice read: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730657/?tool=pubmed

Edited by JACK
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We tend not to bother about a few red blood cells. 15 is an almost "clean tap" :)

When it comes to red blood cells, I think one needs to remember that subarachnoidal bleeds can happen also in newborns, and be the cause of a larger nb of RBCs.

The suspicion can arise at the actual tap, if the needle is inserted easily and the CSF coming is dripping evenly pink, we usually check the "CSF wavelength" (do not have the proper English word for measurement) which change if there are hemolyzed red cells in the CSF.

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