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Note that normal CSF samples should be colorless, clear, like water. If CSF samples are centrifuged immediately, xanthochromia due to traumatic tap should not occur. However, if CSF samples are carefully centrifuged immediately and the supernatant is still xanthochromic, this indicates that bleeding may have occurred 2-4 hours before sample collection. Furthermore, in about 10% of patients with subarachnoid hemorrhage, the CSF samples might be clear if the samples are collected 12 hours after the hemorrhage occurred.
CSF samples are usually collected through lumbar puncture between the 3rd, 4th or 5th lumbar vertebrae. Other rarely used methods include collection from a ventricular shunt or drain, cisternal puncture, and ventricular puncture.
In the case of a traumatic tap for CSF collection, the first collection tube will contain CSF with a high number of RBC and high concentration of hemoglobin. Presence of these compounds can lead to inaccurate measurements for some chemistry analytes. Therefore specific corrections (eg, for total proteins concentration) must be considered. (Alternatively, CSF collection from additional tubes (3-4) can be used for chemistry testing.
Similarly, if cell count is evaluated using first tube CSF collection from a traumatic tap, the RBC count will be significantly elevated resulting in misleading results. Therefore, in these circumstances, tube 4 should be used instead. 153554b96e
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