Three tubes of CSF containing evenly distributed visible blood are drawn from a

Question

Three tubes of CSF containing evenly distributed visible blood are drawn from a 75-year-old disoriented patient and delivered to the lab. Initial results follow:

Test

Patient

Reference

Test

Patient

Reference

WBC count

250/uL

Protein

150 mg/dL

Glucose

70

Gram Stain

No organisms seen

Differential: Segmented, 68%, Monocytes, 3%, Lymphocytes, 28%, eosinophils: 1%

          Many macrophages containing ingested RBCs

1.What is the most probable condition indicated by these results? State two reasons for your answer.

2.Are the elevated WBC count and protein of significance? Explain your answer.

3.Are the percentages of the cells in the differential of any significance? Explain

4.If the blood was unevenly distributed and nucleated RBCs and capillary structures were seen instead of macrophages, what would this indicate?

Please explain the 4 questions

Test

Patient

Reference

Test

Patient

Reference

WBC count

250/uL

Protein

150 mg/dL

Glucose

70

Gram Stain

No organisms seen

Differential: Segmented, 68%, Monocytes, 3%, Lymphocytes, 28%, eosinophils: 1%

          Many macrophages containing ingested RBCs

Explanation / Answer

1) The most probable condition indicated by these results appears to be subarachnoid hemorrhage. Following are the two major reasons for this conclusion: (a) Elevated WBC count and protein levels and normal glucose levels (b) Presence of macrophages containing ingested RBCs.

2) Usually the WBC count and protein levels are low. Although this could mean more than one reason but since the result also states that there were macrophages containing RBCs, this mainly points to a hemorrhage situation.

3) An elevated neutrophils and lymphocytes may indicate a bacterial/viral or parasitic infection too.

4) Unevenly distributed blood might mean that during "lumbar puncture" there has been damage to the blood vessel due to which intact RBCs and capillary structures seeped into the CSF. Lumbar puncture is a technique used to draw CSF from the patients.

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