Finding red blood cells (RBCs) in cerebrospinal fluid (CSF) can indicate various medical conditions.
Normally, there are no RBCs or nearly none (<1 RBC/mm3). While a traumatic lumbar puncture ("bloody tap") can result in RBCs being present in the CSF, the blood will progressively clear with each tube of CSF withdrawn. By the third tube, the CSF should be nearly clear, even with a bloody tap.
RBC counts provide little diagnostically useful information. They can be performed to aid in the differentiation of a recent hemorrhage from a traumatic puncture procedure. Another application of the RBC count is to correct the WBC count and total protein determinations obtained from a CSF specimen known to be contaminated with peripheral blood. These calculated “corrections” have limited accuracy, usually overcorrect the counts, assume that all of the RBCs present result from contamination, and have little clinical use
What does it mean if your CSF RBC result is too high?
When RBCs are present in CSF, it can be a sign of several conditions, including:
→ Traumatic Tap: If RBCs are primarily found in the first tube of CSF collected during a lumbar puncture (spinal tap), it may be due to a traumatic tap, where blood from the puncture site contaminates the sample.
Blood that is evenly distributed throughout the three tubes reflects CNS bleeding, such as:
→ Subarachnoid hemorrhage [A subarachnoid hemorrhage means that there is bleeding in the space that surrounds the brain. Most often, it occurs when a weak area in a blood vessel (aneurysm) on the surface of the brain bursts and leaks. The blood then builds up around the brain and inside the skull increasing pressure on the brain.]
→ Cerebral hemorrhage [A brain bleed, also known as a cerebral hemorrhage, refers to bleeding between the brain tissue and the skull or inside the brain tissue. This is a life-threatening condition that requires immediate medical attention. Brain bleeds can limit the oxygen supplied to the brain, causing headaches, nausea, vomiting, tingling in the extremities, or facial paralysis.]
→ Spinal cord bleeding [Spinal cord hemorrhage is a rare vascular condition that is characterized by spontaneous bleeding into the spinal cord. The etiology of spinal cord hemorrhage varies by location, but is most often attributed to traumatic injury, but can also be caused by vascular malformations and coagulation disorders.]
→ Infections: In certain infections, such as meningitis, RBCs may be present in CSF along with other abnormal findings.
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