Corrections for Leukocytes and Percent of Neutrophils Do Not Match Observations in Blood-Contaminated Cerebrospinal Fluid and Have No Value Over Uncorrected Cells for Diagnosis

Bonsu, Bema K.; Harper, Marvin B.

doi:10.1097/01.inf.0000195624.34981.36

Cited by 33 publications

(28 citation statements)

References 7 publications

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“…However, the CSF RBC contribution to the model was low with an R 2 value of only 3.4% overall. These data are similar to those reported by Bonsu et al (42). Our data indicate that for CSF profiles with RBC counts < 10,000/mm 3 adjustments to the CSF WBC count are not warranted and that blood in the CSF is not sufficient to explain CSF pleocytosis.…”

Section: Discussionsupporting

confidence: 93%

Normative Cerebrospinal Fluid Profiles in Febrile Infants

Byington

Kendrick

Sheng

2011

The Journal of Pediatrics

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Objectives-To describe the cerebrospinal fluid (CSF) profiles of febrile infants 1-90 days with negative bacterial cultures and negative testing for enteroviruses by polymerase chain reaction. Study design-Statistical analysis of a retrospective cohort.Results-CSF profiles from 823 infants with negative evaluations for infection were analyzed. For 677 with atraumatic lumbar punctures (RBC < 1,000/mm 3 ), the mean and median CSF WBC counts were 4.3/mm 3 and 3.0/mm 3 respectively with a range from 0-12/mm 3 . Mean CSF WBC counts (6.1/mm 3 vs. 3.1/mm 3 and 3.0/mm 3 ) and protein levels (75.4 mg/dl vs. 58.9 mg/dl and 39.2 mg/dl) were higher in the first month compared with months two and three, respectively (p<0.001 for all). CSF glucose levels were lower in the first month compared with month three (45.3 mg/dl vs. 48.0 mg/dl and 57.7 mg/dl) (p< 0.001). Increasing RBC counts were statistically associated with increasing WBC counts (p< 0.001). However, the contribution of RBC < 10,000/mm 3 was small and the normal range for WBC in uninfected infants with traumatic lumbar punctures was 0-16/mm 3 .Conclusions-CSF WBC counts in febrile infants without evidence of bacterial or enteroviral infection, even in those with traumatic lumbar puncture, are lower than reported in pediatric references.Fever in infants 1-90 days of age is a commonly encountered clinical problem. The medical evaluation of these infants often includes an analysis of cerebrospinal fluid (CSF) to exclude bacterial meningitis.(1) Controversy exists regarding the interpretation of CSF profiles from young infants. We identified eighteen publications that analyzed the CSF profiles in presumptively uninfected infants.(2-19) Many did not include the precise age of the infants and most did not document all bacterial and viral testing performed. The majority of studies included data from 50 or fewer infants and only three studies included data for 100 or more infants making it difficult to determine normative values for the CSF profile in young infants. (2,9,19) The normal values referenced in US pediatric textbooks for infant CSF profile are based on four studies with small numbers of infants. (10,(15)(16)(17) Three studies were performed before polymerase chain reaction (PCR) testing for enteroviruses (EV), the most common cause of aseptic meningitis in this age group, was available. (10,15,16) Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The objectives of this study were: (1) describe the cerebrospinal fluid (CSF) profiles of febrile infants with negative bacterial cultures of blood, urine, and CSF and ne...

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Section: Discussionsupporting

confidence: 93%

Normative Cerebrospinal Fluid Profiles in Febrile Infants

Byington

Kendrick

Sheng

2011

The Journal of Pediatrics

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“…2–5 As introduction of blood into the cerebrospinal fluid (CSF) complicates the interpretation of CSF results, infants with traumatic LPs have higher rates of hospitalization and are more likely to receive parenteral antibiotics than infants with non-traumatic LPs. 2,6,7 Although several methods for correction of the CSF white blood cell (WBC) count for the presence of red blood cells (RBCs) have been investigated, 8–14 these approaches have not been extensively evaluated in the youngest infants and remain controversial. 4,10 …”

Section: Introductionmentioning

confidence: 99%

Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture

Lyons

Cruz

Freedman

et al. 2017

Annals of Emergency Medicine

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Study Objective To determine the optimal correction factor for cerebrospinal fluid (CSF) white blood cell (WBC) counts in infants with traumatic lumbar punctures (LPs). Methods We performed a secondary analysis of a retrospective cohort of infants ≤ 60–days-old with a traumatic LP [CSF red blood cell (RBC) count ≥ 10,000 cells/mm3] at 20 participating centers. CSF pleocytosis was defined as a CSF WBC count ≥ 20 cells/mm3 for infants ≤ 28 days, ≥ 10 cells/mm3 for infants 29–60 day and bacterial meningitis as growth of pathogenic bacteria from CSF culture. Using linear regression, we derived a CSF WBC correction factor and compared the uncorrected to the corrected CSF WBC count for the detection of bacterial meningitis. Results Of the eligible 20,319 LPs, 2,880 (14%) were traumatic of whom 33 (1.1%) had bacterial meningitis. The derived CSF RBCs:WBCs ratio was 877:1 [95% confidence interval (CI) 805–961:1]. Compared with the uncorrected CSF WBC count, the corrected CSF WBC count had lower sensitivity for bacterial meningitis [88% uncorrected vs. 67% corrected; difference 21%, 95% CI 10–37%] but resulted in fewer infants with CSF pleocytosis [78% uncorrected vs. 33% corrected; difference 45%, 95% CI 43–47%]. CSF WBC count correction resulted in 7 additional infants with bacterial meningitis being misclassified as not having CSF pleocytosis; only one of these infants was > 28-days-old. Conclusion Correction of the CSF WBC count substantially reduced the number of infants with CSF pleocytosis while misclassifying only one infant with bacterial meningitis 29 to 60 days of age.

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“…In older pediatric patients and adults, physicians have evaluated several methods to account for the extra WBCs from peripheral blood in traumatic LPs 9–15. Some authors have assessed the use of an established average ratio of 500 or 1000 red blood cells (RBCs) to 1 WBC in the CSF 9.…”

Section: Introductionmentioning

confidence: 99%

“…Some authors have assessed the use of an established average ratio of 500 or 1000 red blood cells (RBCs) to 1 WBC in the CSF 9. The number of WBCs that can be accounted for by the number of RBCs in the specimen is simply subtracted from the number of WBCs observed in the CSF.…”

Section: Introductionmentioning

confidence: 99%

Traumatic Lumbar Punctures in Neonates

Greenberg

Smith²,

Cotten

et al. 2008

Pediatric Infectious Disease Journal

101

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Background-Cerebrospinal fluid (CSF) findings are often used to diagnose meningitis in neonates given antibiotics before the lumbar puncture is performed. Traumatic lumbar punctures are common and complicate interpretation of CSF white blood cell counts. The purpose of this study is to evaluate the diagnostic utility of adjusting CSF white blood cell counts based on CSF and peripheral red blood cell counts.

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Corrections for Leukocytes and Percent of Neutrophils Do Not Match Observations in Blood-Contaminated Cerebrospinal Fluid and Have No Value Over Uncorrected Cells for Diagnosis

Abstract: In blood-contaminated CSF, there is poor to modest correlation between observed and predicted counts of leukocytes and of neutrophils. Adjusted blood counts in CSF have no advantage over uncorrected counts for predicting bacterial meningitis.

Cited by 33 publications

References 7 publications

Normative Cerebrospinal Fluid Profiles in Febrile Infants

Normative Cerebrospinal Fluid Profiles in Febrile Infants

Interpretation of Cerebrospinal Fluid White Blood Cell Counts in Young Infants With a Traumatic Lumbar Puncture

Traumatic Lumbar Punctures in Neonates

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