CSF Xanthochromia

Clinical Indications

This test is performed to attempt to identify those patients who have had a subarachnoid haemorrhage (SAH) but in whom the CT scan is negative. Analysis of the CSF may detect bilirubin and this finding is consistent with a bleed into the CSF.

The formation of bilirubin after haemorrhage is a time-dependant process and bilirubin may not be detectable soon after the event (e.g. onset of severe headache). On current evidence it is recommended that CSF is not sampled until at least 12 hours after a suspected event.

Collection of samples

Label 4 white-topped universal containers and one grey-topped fluoride/EDTA tube with:

  • the patient’s name,
  • NHS number
  • ward
  • date of birth
  • time that CSF was obtained
  • the sequence order of sampling (e.g. sample no 3)

Collect the first specimen (0.5 mL) into the grey-topped fluoride tube for glucose and protein estimations. Obvious blood stained samples will not be analysed.

Collect the next universal containers numbered 1- 3 (aim for a total of 2 mL) and send with the blue request form to Microbiology, informing them by telephone that the samples will be arriving.

Collect the 4th universal container containing a minimum of 1 ml CSF (approx 20 drops from a Luer connector on a needle). Protect this sample from the light, and send with the CSF fluoride sample and a gold-top blood sample to Clinical Biochemistry with a green request form.

Last updated: November 27, 2020