1. Important
Extra Information
Doctors slides
Doctors notes
" ما تعثرت ارتباكا يا حصى .. او جنوحا لإختصار الالف ميل  ليس ذنبي أن دربي ما استوى..  كان ذنبي ثوب احلامي طويل! "
جلال الدين الرومي
Biochemistry
Cerebrospinal Fluid (CSF) Analysis for total protein

2. CSF Examination Report:
Physical examination:
Color
Appearance
Viscosity
Chemical examination:
CSF protein concentration (g/L)
Group number & Student names.

3. Indications for CSF analysis
CSF examination
Indications for CSF analysis
CNS
infections
Demyelinating diseases
malignancy
Hemorrhage in CNS
Autoimmune disorders
The following examinations are performed for CNS samples:
Physical examination
Microscopic examination
Chemical examination
Microbiological test

4. 1- Physical Examination:
Parameter
Normal
abnormal
Volume
ml (8% of
CNS cavity volume)
Turbidity
Clear
Cloudy/turbid- may indicate the presence of: white, or red blood cells, microorganisms, or an increase in protein level.
Color
Colorless
Changes in color may point to additional substances in the fluid.
Yellow (Xanthochromia)1, orange-brown or red may indicate the presence of blood or hemoglobin pigments2.
Viscosity3
same consistency as water
Thicker CSF may be seen in patients with certain types of cancers or meningitis.
Xanthochromia is the yellow discoloration indicating the presence of bilirubin in the (CSF).
The two most common reasons for blood and hemoglobin pigments in CSF are:
traumatic tap (color is bright and red and erythrocytes number is decreased.
subarachnoid hemorrhage (SAH) = xanthochromia is present.
you should shake the sample to inspect its viscosity.

5. 2- Chemical Analysis: Remember !! Centrifuge:
Before any analysis, the fluid should be centrifuged to avoid contamination by cellular elements.
CSF is the most precious biological material. Often, only small volumes of CSF are available for analysis due to difficulty in collection; hence handle this with care.
The specimen may not be pre-tested for micro-organisms ( may contain virulent organisms), so strict safety precautions should be followed.
Routinely performed biochemical tests in CSF are:
Total protein (total- specific
e.g. albumin &
Immunoglobulin)
glutamine and acid-base parameters
lactate
lactate dehydrogenase
glucose
protein is normally low in CSF: if increased suspect infection, but its decrease is not significant.
lactate and lactate dehydrogenase increase in bacterial infection, but not in viral.
glutamine increase in CSF due to liver disease

6. Abnormal findings of CSF in some pathological conditions
Mind map
Turbidity
Physical Examination
Color
Viscosity
CSF Protein Assay
Spectrophotometer
glucose
Cerebrospinal Fluid (CSF)
protein (total and specific)
Chemical Analysis
Procedure
Mind map by 432 biochemistry team
lactate
Calculation
lactate dehydrogenase
Normal Range
Abnormal findings of CSF in some pathological conditions
glutamine and acid-base parameters

7. CSF Protein Assay Spectrophotometer “Extra Information”
Protein present in the CSF is detected by a series of enzymatic reactions that ultimately form a colored product like kit based on Biuret method.
Biuret reagent when interacts with the peptide bonds in the protein give a blue coloured product.
The intensity of the color is proportional the amount of protein in CSF
Color intensity is determined by measuring the absorbance by the colored solution at a wavelength of 546nm
Absorbance is measured by an instrument, spectrophotometer
Spectrophotometer “Extra Information”
Most of visible spectrophotometers are composed of:
Light source which works with visible wavelengths ( nm)
Monochromator filter for choosing desired wavelength
Sample holder (cuvette)
Detector
Meter or recorder

8. Tuberculous Meningitis
Abnormal findings of CSF in some pathological conditions
Very important
Condition
Parameter
Brain tumor
Viral Meningitis
Tuberculous Meningitis
Bacterial Meningitis
(pyogenic) ↑
Normal ↑↑
Proteins ↓
Normal or slightly ↓ ↓↓
Glucose
Normal or ↓
Chloride

9. Normal reference values for CSF protein:
Procedure
Normal Range
Normal reference values for CSF protein:
mg/dL ( g/L )
Test
Standard
Blank
Reagent
2 ml
CSF sample
40 l -
Dist.H2O
Mix and incubate for 15 minutes at room
temperature
Measure absorbance at 546 nm
Calculation
Protein concentration (g/L) =
Absorbance of sample ”test” X
Conc. of standard (60 g/L)
Absorbance of standard
Important: you must convert from mg/dL to g/L ) , divide on 100 .

10. Case 1
Case scenarios by 433 team

11. Case 2

12. PLEASE CONTACT US IF YOU HAVE ANY ISSUE
THANK YOU
FOR CHECKING OUR WORK
TEAM LEADERS
Mohammad Almutlaq
Atikah kadi