CSF细胞计数和差分细胞计数

Cerebrospinal fluid (CSF) is a clear liquid that cushions and surrounds the brain and spinal cord. It helps support the venous structures around the brain, and it’s important in brain homeostasis and metabolism. This fluid is continually replenished by the choroid plexus in the brain and absorbed into the bloodstream. The body completely replaces CSF every few hours.

CSF细胞计数和差分单元计数是一系列实验室测试中的两个组件，以分析一个人的CSF。这些测试有助于诊断中枢神经系统的疾病和条件，包括您的脑和脊髓。中枢神经系统的条件包括meningitis，导致大脑和脊髓的炎症，多发性硬化，脑周围的出血，以及脑卒中的癌症。

虽然获得脊髓液样品有点疼痛，但测试CSF样本是正确诊断特定条件的最佳方法之一。这是因为CSF与大脑和脊髓直接接触。

收集脑脊髓液最常见的方法是alumbar puncture，有时称为脊椎龙头。

CSF细胞计数和差分细胞计数may be ordered for people who have cancer with associated confusion or who have experienced trauma to the brain or spinal cord. The test may also be done when infectious diseases, hemorrhaging, or immune response disorders are suspected as possible causes of a person’s symptoms.

Symptoms that may prompt CSF analysis include:

  • severe headache
  • stiff neck
  • hallucinations or confusion
  • seizures
  • flu-like symptoms that persist or intensify
  • fatigue, lethargy, or muscle weakness
  • 意识的变化
  • severe nausea
  • fever or rash
  • light sensitivity
  • numbness or tremor
  • 头晕
  • trouble walking or poor coordination

A lumbar puncture usually takes less than 30 minutes and is performed by a doctor specially trained to safely collect CSF.

CSF通常从下背区域撤回。保持完全静止以避免对脊柱不正确的针放置或创伤是非常重要的。如果您认为您将仍有困难，请提前告诉您的医生。

你将与你的脊柱是坐在卷曲forward or lie on your side with your spine curved and your knees drawn up to your chest. Curving the spine allows the doctor to find ample space to insert a thin spinal needle between the bones in the lower back (vertebrae). Sometimes fluoroscopy (X-ray) is used to guide the needle safely between the vertebrae.

当您到位时，医生或护士将用无菌溶液如碘清洁背部。在整个过程中保持无菌区域，以降低感染的风险。

在用麻醉剂（止痛药）溶液注射部位之前，麻木乳膏可以施加到皮肤上。当网站麻木时，医生插入脊针。

Once the needle is in, CSF pressure is usually measured using a manometer, or pressure gauge. High CSF pressure can be a sign of certain conditions and diseases, including meningitis, bleeding in the brain, and tumors. Pressure may also be measured at the end of the procedure.

The doctor then takes fluid samples up through the needle and into an attached syringe. Several vials of fluid may be taken.

当流体收集完成时，医生将针从背部移除。用无菌溶液再次清洁穿刺部位，涂抹绷带。

If your doctor suspects that you have a brain tumor, brain abscess, or brain swelling, he or she will probably order a CT scan of your brain before attempting the spinal tap to make sure that it’s safe to perform the procedure.

在这些情况下，腰椎穿刺会导致脑疝气，这发生的是，当部分大脑被困在脊髓出口的颅骨的开口中被捕获。它可以切断血液供应到大脑，导致脑损伤甚至死亡。如果怀疑脑质量，则不会进行木材穿刺。

Rarely, if you have a back deformity, infection, possible brain herniation, or increased pressure around the brain due to a tumor, abscess, or swelling, it is necessary to use more invasive CSF collection methods. These methods usually require hospitalization. They include:

  • Ventricular puncture: A doctor drills a hole into the skull and inserts a needle directly into one of the ventricles of the brain.
  • Cisternal puncture: A doctor inserts a needle below the base of the skull.

Cisternal and ventricular puncture have additional risks. These procedures may cause damage to the spinal cord or brain, bleeding within the brain, or disturbance of the blood/brain barrier in the skull.

A lumbar puncture requires a signed release stating that you understand the risks of the procedure.

Be sure to tell your doctor if you take any blood-thinning medications, such as warfarin, because you may need to stop taking them for a couple of days before the procedure.

在程序之前，可能会要求您清空肠道和膀胱。

Primary risks associated with lumbar puncture include:

  • 从穿刺部位进入脊髓液（创伤龙头）
  • 手术期间和之后的不适
  • 对麻醉剂的过敏反应
  • 穿刺部位感染
  • 测试后头痛
  • damage to spinal cord nerves, especially if you move during the procedure
  • persistent leaking of the CSF at the puncture site after the procedures

If you take blood thinners, your risk of bleeding is higher.

Lumbar puncture is extremely dangerous for people who have低血小板计数or other blood clotting problems.

The CSF cell count and differential cell count involve microscopic examination of blood cells and their components in a laboratory.

CSF细胞计数

In this test, a lab technician counts the number of red blood cells (RBCs) and white blood cells (WBCs) present in a drop of your fluid sample.

CSF differential cell count

For a CSF differential cell count, a lab technician examines the types of WBCs found in the CSF sample and counts them. He or she also looks for foreign or abnormal cells. Dyes are used to help separate and identify cells.

身体中有几种类型的WBC：

  • Lymphocytes通常占WBC总数的25％或更多。有两种形式：B细胞，其制造抗体和T细胞，识别和去除异物。
  • Monocytesnormally make up 10 percent or less of the total WBC count. They ingest bacteria and other foreign particles.
  • 中性粒细胞are the most abundant type of WBC in healthy adults. They perform an essential role in the body’s immune system and are the first line of defense against pathogens.
  • Eosinophils通常仅占WBC总数的约3％。这些细胞被认为抵抗某些感染和寄生虫并反应过敏原。

CSF细胞计数

通常，脑脊液中没有RBC，每立方毫米的CSF不超过五种WBC。

If your fluid contains RBCs, this may indicate bleeding. It is also possible that you had a traumatic tap (blood leaked into the fluid sample during collection). If you had more than one vial collected during your lumbar puncture, these will be checked for RBC to test the bleeding diagnosis.

A high WBC count may indicate infection, inflammation, or bleeding. The associated conditions may include:

  • intracranial hemorrhage (bleeding in the skull)
  • meningitis
  • tumor
  • 脓肿
  • 多发性硬化症
  • stroke

Differential cell count

正常结果意味着发现正常的细胞计数，并且各种类型的白细胞的计数和比率在正常范围内。发现没有异物。

Increases, however slight, in your WBC counts may indicate certain kinds of infection or disease. For example, a viral or fungal infection may cause you to have more lymphocytes.

异常细胞的存在可能表明癌症肿瘤。

如果CSF细胞计数和差分单元计数发现异常，则可能需要进一步的测试。将根据发现导致症状的病症提供适当的治疗。

If test results suggest bacterial meningitis, it is a medical emergency. Prompt treatment is essential. The doctor may put you on broad-spectrum antibiotics while conducting additional tests to find the exact cause of the infection.