Supernatant CSF

Sample type: Cerebrospinal fluid (CSF)
Clear
If the supernatant cerebrospinal fluid (CSF) is clear, it generally indicates that there are no abnormal particles or substances present in the fluid. CSF is normally a clear and colorless fluid that surrounds the brain and spinal cord, providing protection and nutrients.
Yellow
If the supernatant cerebrospinal fluid (CSF) appears yellow, it is a clinical sign called xanthochromia. Xanthochromia is the presence of a yellow color in the CSF and can be indicative of various underlying medical conditions. The yellow color in CSF can result from the breakdown of red blood cells (hemolysis) and the release of hemoglobin into the fluid. Common causes of xanthochromia include subarachnoid hemorrhage, where there is bleeding into the space around the brain, as well as other conditions like traumatic taps, intracranial bleeding, and certain infections.
Pink
If the supernatant cerebrospinal fluid (CSF) is pink, it typically indicates the presence of xanthochromia. Xanthochromia refers to the yellow or pink discoloration of the CSF due to the presence of bilirubin or its breakdown products. This discoloration is often observed after a traumatic tap or in cases of subarachnoid hemorrhage.
Green
If the supernatant cerebrospinal fluid (CSF) appears green, it may indicate a condition called xanthochromia. Xanthochromia is the abnormal yellow or yellow-green discoloration of CSF and is typically associated with the presence of bilirubin. Bilirubin can enter the CSF as a result of bleeding into the subarachnoid space, often caused by a ruptured cerebral aneurysm or bleeding within the brain. The green color in the CSF supernatant suggests that bilirubin has oxidized, leading to this distinct coloration. Xanthochromia is an important finding in the evaluation of patients with suspected subarachnoid hemorrhage (SAH). It is typically assessed by examining the color of the CSF supernatant after centrifugation during a lumbar puncture. However, it's crucial to note that the presence of xanthochromia does not confirm the diagnosis of SAH; additional diagnostic tests, such as imaging studies (CT or MRI), are usually required to confirm the presence of a cerebral aneurysm or bleeding in the brain.
Brown
If the supernatant cerebrospinal fluid (CSF) is brown, it may indicate the presence of xanthochromia. Xanthochromia is a term used to describe the yellow or brownish discoloration of CSF due to the presence of bilirubin or its breakdown products. This can occur when there is bleeding in the central nervous system, such as in cases of subarachnoid hemorrhage, traumatic brain injury, or other conditions that lead to blood entering the CSF. Xanthochromia is typically assessed visually when examining the CSF collected during a lumbar puncture (spinal tap). The presence of xanthochromia can help clinicians diagnose certain neurological conditions and determine the cause of the discoloration, which may be critical for patient management. However, it's important to note that while brown supernatant CSF can suggest xanthochromia and the possibility of bleeding, further diagnostic tests and medical evaluation are usually needed to determine the exact cause and appropriate treatment. Therefore, if you or someone you know has brown supernatant CSF, it's crucial to consult a healthcare professional for a comprehensive assessment and diagnosis.

Normal CSF is crystal clear. However, as few as 200 white blood cells (WBCs) per mm3 or 400 red blood cells (RBCs) per mm3 will cause CSF to appear turbid (=cloudy).

Xanthochromia is a yellow, orange, or pink discoloration of the CSF, most often caused by the lysis of RBCs resulting in hemoglobin breakdown to oxyhemoglobin, methemoglobin, and bilirubin.

Discoloration begins after RBCs have been in spinal fluid for about two hours, and remains for two to four weeks.

Xanthochromia is present in more than 90 percent of patients within 12 hours of subarachnoid hemorrhage onset (=bleeding in the space that surrounds the brain) and in patients with serum bilirubin levels between 10 to 15 mg per dL (171 to 256.5 μmol per L).

CSF protein levels of at least 150 mg per dL (1.5 g per L)—as seen in many infectious and inflammatory conditions, or as a result of a traumatic tap that contains more than 100,000 RBCs per mm3—also will result in xanthochromia.

Newborn CSF is often xanthochromic because of the frequent elevation of bilirubin and protein levels in this age group.

Supernatant CSF
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