Erythrophages do not develop when lumbar CSF and blood samples are mixed in vitro

Dersch, Rick; Benkler, D; Robinson, Tilman; Baumgartner, Annette; Rauer, Sebastian; Stich, Oliver

doi:10.1186/s12987-018-0116-3

Cited by 3 publications

(5 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, it has been supposed that in some cases erythrophages might develop in vitro in the CSF in the presence of artificial blood contamination being not specific for a subarachnoid bleeding (12). Here we have shown that erythrophages and siderophages do not develop in vitro after blood contamination and an incubation time of 24 and 72 h. Our results are in line with the results of Dersch and colleagues who have recently reported that erythrophages do not develop in vitro after 7 h of incubation (13). The presence of xanthochromia in CSF is considered to be another indicator for subarachnoid bleeding in patients with negative CT scan (10, 28–30).…”

Section: Discussionsupporting

confidence: 93%

“…It has been suggested that in some cases erythrophages and siderophages might develop in vitro in the CSF in the presence of artificial blood contamination and thus are not specific for subarachnoid bleeding (12). However, a recent study investigated a short-time (7 h) of incubation of CSF with blood but could not find any evidence of erythrophage development in vitro (13).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Influence of Blood Contamination on Cerebrospinal Fluid Diagnostics

et al. 2019

View full text Add to dashboard Cite

Background: Blood contamination due to traumatic lumbar puncture presents a diagnostic pitfall in cerebrospinal fluid (CSF) analysis. It is controversially discussed if phagocytosis of erythrocytes which can be found in the CSF after subarachnoid hemorrhage can also develop in vitro in the presence of artificial blood contamination. Furthermore, there is no consensus about the acceptable amount of artificial blood contamination on CSF protein results. Methods: Two measurement series were performed in order to investigate the role of artificial blood contamination on the possible development of erythrophages and siderophages in the CSF: (1) blood contamination was simulated in vitro by adding blood into the CSF. (2) CSF was investigated when blood contamination occurred during a traumatic lumbar puncture. In both types of experiments, CSF including blood was incubated for 24 h and for 72 h at room temperature or at 4°C. In the third measurement series, the effects of artificial blood contamination on CSF protein results were investigated. Blood contamination was simulated in vitro by adding different amounts of blood ending up with five different samples containing erythrocyte counts of 2,500, 5,000, 7,500, 10,000, and 20,000 per μl CSF. Results: Cytological examination revealed no evidence of erythrophages or siderophages in vitro . In contrast, already a low blood contamination (2,500 erythrocytes/μl CSF) led to false pathological results of total protein and albumin. Along with increasing amounts of blood, the frequency of false pathological protein results increased. A blood contamination of 5,000 erythrocytes/μl CSF resulted in a false positive intrathecal IgM production in nearly every fifth patient. In contrast, blood contamination with 5,000 erythrocytes/μl CSF was the acceptable amount of blood which did not lead to a false positive intrathecal synthesis of IgG and IgA. Conclusion: Erythrophages and siderophages do not develop in vitro . An extensive diagnostic work up for the source of blood in the CSF should be performed when erythrophages or siderophages are found in the CSF. The contamination of CSF with increasing volume of blood resulted in falsely elevated CSF protein concentrations. Hence, the amount of blood contamination has to be taken into consideration when interpreting CSF protein measurement results.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

The Influence of Blood Contamination on Cerebrospinal Fluid Diagnostics

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Especially for the analysis of subarachnoid hemorrhage, the source of blood is important to know: is it an intrathecal hemorrhage or peripheral blood contamination due to traumatic lumbar puncture? The detection of erythrophages or siderophages does not allow a definitive differentiation in this context [3,36]. In line with our results, Schwenkenbecher et al recently showed that a low amount of blood contamination influences the CSF total protein and CSF/serum albumin quotient, leading to false pathological results.…”

Section: Discussionsupporting

confidence: 61%

Blood Contamination in CSF and Its Impact on Quantitative Analysis of Alpha-Synuclein

Barkovits

Kruse

Linden

et al. 2020

Cells

View full text Add to dashboard Cite

Analysis of cerebrospinal fluid (CSF) is important for diagnosis of neurological diseases. Especially for neurodegenerative diseases, abnormal protein abundance in CSF is an important biomarker. However, the quality of CSF is a key factor for the analytic outcome. Any external contamination has tremendous impact on the analysis and the reliability of the results. In this study, we evaluated the effect of blood contamination in CSF with respect to protein biomarker identification. We compared three distinct measures: Combur10-Test® strips, a specific hemoglobin ELISA, and bottom-up mass spectrometry (MS)-based proteomics for the determination of the general blood contamination level. In parallel, we studied the impact of blood contamination on the detectability of alpha-synuclein (aSyn), a highly abundant protein in blood/erythrocytes and a potential biomarker for Parkinson’s disease. Comparable results were achieved, with all three approaches enabling detection of blood levels in CSF down to 0.001%. We found higher aSyn levels with increasing blood contamination, highlighting the difficulty of authentic quantification of this protein in CSF. Based on our results, we identified other markers for blood contamination beyond hemoglobin and defined a grading system for blood levels in CSF samples, including a lower limit of tolerable blood contamination for MS-based biomarker studies.

show abstract

“…They are a sign of in vivo rather than in vitro hemorrhage, likely formed and activated by the injury to the choroid plexus and ependymal lining. [ 7 ] There could also be differences in the temperature and incubation time in in vivo versus in vitro settings, which cause them to form only in in vivo . [ 7 8 ] These erythrophages, after 36 to 48 hours, form hemosiderin deposits and are called siderophages.…”

Section: Discussionmentioning

confidence: 99%

“…[ 7 ] There could also be differences in the temperature and incubation time in in vivo versus in vitro settings, which cause them to form only in in vivo . [ 7 8 ] These erythrophages, after 36 to 48 hours, form hemosiderin deposits and are called siderophages. They persist months after the bleeding.…”

Section: Discussionmentioning

confidence: 99%

Role of neonatal cerebrospinal fluid cytology in correlation to C-reactive protein, blood culture, risk factors and clinical outcomes in neonatal intensive care

Pradhan

Mishra

Panda

et al. 2023

Journal of Family Medicine and Primary Care

View full text Add to dashboard Cite

A BSTRACT Introduction: The number of neonatal cerebrospinal fluid (CSF) samples sent from the neonatal intensive care unit (NICU) for cytologic examination is rising, warranting accurate analysis and interpretation of the same. This study was taken up to assess the usefulness of CSF cell count and cytology in NICU settings, as it can be used even in a resource-limited setting. Aim and Objective: 1) To study the prevalence of cell count and cytologic changes in CSF from NICU and assess their usefulness in correlation to C-reactive protein, CSF neutrophil percentage, blood, CSF culture, and other biochemical parameters. 2) To correlate cell counts and cytology with age, period of gestation, presence, and absence of sepsis, seizures, intracranial hemorrhage, and their clinical follow-up. Materials and Methods: A retrospective study was done on neonatal CSF samples submitted for cytology over one year (January–December 2016) in the Department of Pathology. CSF cell counts were retrieved, and cytosmears were reviewed for cellularity, cell type, proportion, and background and correlated with the biochemical, microbiological, and clinicoradiological findings. Results: A total of 213 samples were included with 140 males and 73 females with an age range of 0–28 (mean: 7.3) days. The mean CSF cell count was 5.48/cu.mm (0–90 cells/cu.mm). The most frequent cytologic finding was occasional lymphocytes or acellular CSF (63.9%). The CSF leucocyte count and protein levels showed a significant correlation with s C-reactive protein. The CSF cytology showed a significant correlation between the age of the neonate and blood neutrophil percentage ( P = 0.0158). History of intracranial hemorrhage showed a significantly higher frequency of the presence of red blood cells ( P = 0.0147). Conclusion: Accurate cell counts, cytology of neonatal CSF, and biochemical and microbiological workup can help diagnose and manage neonates in intensive care.

show abstract

Erythrophages do not develop when lumbar CSF and blood samples are mixed in vitro

Cited by 3 publications

References 8 publications

The Influence of Blood Contamination on Cerebrospinal Fluid Diagnostics

The Influence of Blood Contamination on Cerebrospinal Fluid Diagnostics

Blood Contamination in CSF and Its Impact on Quantitative Analysis of Alpha-Synuclein

Role of neonatal cerebrospinal fluid cytology in correlation to C-reactive protein, blood culture, risk factors and clinical outcomes in neonatal intensive care

Contact Info

Product

Resources

About