Revised national guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage

Ann Clin Biochem 2008;45:238-244
doi:10.1258/acb.2008.007257
© 2008 Association for Clinical Biochemistry

 

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What’s this?

Guidelines


Anne Cruickshank1,
Peter Auld2,
Robert Beetham3,
Gillian Burrows4,
William Egner5,
Ian Holbrook6,
Geoff Keir7,
Emma Lewis8,
Dina Patel5,
Ian Watson8 and
Peter White, Produced by the UK NEQAS Specialist Advisory Group for EQA of CSF Proteins and Biochemistry5


1 Department of Biochemistry, Southern General Hospital, Glasgow G51 4TF;
2 Department of Clinical Biochemistry, Belfast Trust Hospital, Belfast BT12 6BA;
3 Department of Clinical Biochemistry, Frenchay Hospital, Bristol BS16 1LE;
4 Department of Biochemistry, Stepping Hill Hospital, Stockport SK2 7JE;
5 Department of Immunology, Northern General Hospital, Sheffield S5 7YT;
6 Department of Clinical Biochemistry, York Hospital, York YO31 8HE;
7 Department of Neuroimmunology, National Hospital for Neurology and Neurosurgery, London, WC1 N 3BG;
8 Department of Clinical Biochemistry, University Hospital, Aintree, Liverpool L9 7AL, UK


Corresponding author: Dr Anne Cruickshank. Email: anne.cruickshank{at}sgh.scot.nhs.uk

It is crucially important to detect subarachnoid haemorrhage (SAH) in all patients in whom it has occurred to select patients for angiography and preventative surgery. A computerized tomography (CT) scan is positive in up to 98% of patients with SAH presenting within 12 h, but is positive in only 50% of those presenting within one week. Cerebrospinal fluid (CSF) bilirubin spectrophotometry can be used to determine the need for angiography in those few CT-negative patients in whom clinical suspicion of SAH remains high; it may remain positive up to two weeks after the event. A lumbar puncture (LP) should only be performed >12 h after the onset of presenting symptoms. Whenever possible collect sequential specimens. Always ensure that the least blood-stainedCSF sample taken (usually the last) is sent for bilirubin analysis.Protect the CSF from light and avoid vacuum tube transport systems,if possible. Always use spectrophotometry in preference to visualinspection. All CSF specimens are precious and should alwaysbe analysed unless insufficient sample is received. Centrifugethe specimen at >2000 rpm for 5 min as soon as possible afterreceipt in the laboratory. Store the supernatant at 4°Cin the dark until analysis. An increase in CSF bilirubin isthe key finding, which supports the occurrence of SAH but isnot specific for this. In most positive cases, bilirubin willoccur with oxyhaemoglobin.


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