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.
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