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Cerebrospinal fluid (CSF) is normally clear and colorless. Abnormal CSF may appear cloudy, turbid, bloody, viscous, or clotted. Red blood cells (RBCs) should not be present in normal CSF. Typical normal ranges for white blood cells (WBCs) are shown in the table below1,2,3,4,5,6,7,8,9,10.
|Demographic||Normal Ranges (WBC/µL)|
|Neonates (<1 year)||0-30|
|Ages 1 to 4 years||0-20|
|Ages 5 to puberty (18 years)||0-10|
|Adults (18 years)||0-5|
Increased WBCs in the CSF may be indicative of meningitis, malignancy, or demyelinating disease. RBCs in the CSF may be indicative of hemorrhage or the result of a traumatic lumbar puncture.11
Traumatic Tap Versus Hemorrhage
When RBCs in CSF are due to a traumatic tap, a visual comparison between the first and last collection tubes will show a significant decrease in color. There will be no color difference in the case of a hemorrhage. Further, a clear and colorless supernatant following centrifugation indicates a traumatic tap since the cells have not yet broken down. A xanthochromic supernatant reveals a hemorrhage.11
Diagnostic Range Guidelines12
|Condition||WBCs or RBCs*||Major cell type||Glucose||Protein*||Pressure*|
|Acute bacterial meningitis||100-100,000 WBC/µL||PMN||D||>100 mg/dL||I|
|Viral infections||100-2,000 WBC/µL||L||N||N or I||N or I|
|Guillain-Barré syndrome||0-100 WBC/µL||L||N||>100 mg/dL||N|
|Multiple sclerosis||0-50 WBC/µL||L||N||N or I||N|
|Spinal cord tumor||0-50 WBC/µL||L||N||N or I||N|
|Cerebral hemorrhage||>500,000 RBC/µL (bloody)||RBC||N||I||I|
*Figures given for pressure, cell counts, and protein are approximations; exceptions are common.
L = lymphocyte; N= normal; PMN = polymorphonuclear leukocyte; I = increased, D = decreased.
1Ringsrud, K.M., Linne, J.J. (1995). Urinalysis and Body Fluids A Color Text and Atlas. St. Louis, Missouri: Mosby; 337.
2Brunzel, N.A. (2004). Fundamentals of Urinalysis and Body Fluids (Second ed.). Philadelphia, Pennsylvania: Saunders; 186.
3Kjeldsberg, C., Knight, J. (1993). Body Fluids. Chicago, Illinois: American Society of Clinical Pathologists; 71.
4Hussong, J.W., Kjeldsberg, C.R. (2015). Body Fluids Analysis. Chicago, Illinois: American Society of Clinical Pathologists; 2015.
5Bunis, C.A., Ashvrood, E.R., Bums, D.E. (2006). Textbook of Clinical Chemistry and Molecular Diagnostics. St. Louis, Missouri: Elsevier Saunders; 1633: 962-967.
6Kaplan, P. (2010). Clinical Chemistry: Theory, Analysis, Correlation (Fifth ed.). St. Louis, Missouri: Elsevier Saunders; 904-928.
7King, S.S., Schaub, D.M. Urinalysis and Body Fluids Testing (Fifth ed.). Philadelphia, Pennsylvania: F.A. Davis; 177-199.
8Clarke, W. Contemporary Practice in Clinical Chemistry (Second ed.). AACC; 233-246.
9McPherson, R.A., Matthew, R., Pincus, M.R. (2011). Henry’s Clinical Diagnosis and Management by Laboratory Methods (22nd ed.). Philadelphia, Pennsylvania. Elsevier Saunders; 2545.
10 Wallach, J. (1996). Interpretation of Diagnostic Tests (Sixth ed.). New York, New York. Little Brown; 71.
11Brunzel, N.A. (2013). Fundamentals of Urine & Body Fluid Analysis (Third ed.). St. Louis, Missouri: Elsevier Saunders; 314, 316, 318-320.
12Levin, M.C. (2012, August). Neurologic Diagnostics Procedures. Retrieved from Merck Manual: https://www.merckmanuals.com/professional/neurologic-disorders/approach-to-the-neurologic-patient/neurologic-diagnostic-procedures