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CSF Leukocyte

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CSF Leukocyte, Cerebrospinal Fluid Cell Leukocyte, CSF White Blood Cell, CSF Cell Count, Pleocytosis, CSF WBC, CSF WBC Differential

  • See Also
  1. Cerebrospinal Fluid Examination
  2. Cerebrospinal Fluid
  3. Lumbar Puncture
  • Interpretation
  • Normal Findings
  1. No Polymorphonuclear Lymphocytes (Neutrophils)
    1. Normal CSF may have 1-2 PMNs present
  2. Adults: 5 or less WBC/mm3
  3. Newborns: 20 or less WBC/mm3
  • Interpretation
  • Correction of WBCs for CSF RBC
  1. Adults
    1. One WBC for every 500-1500 CSF RBCs
    2. WBCpredicted = RBCcsf x (WBCblood/RBCblood)
  2. Infants
    1. One WBC for every 1000 CSF RBCs
    2. Lyons (2017) Ann Emerg Med 69(5): 622-31 [PubMed]
  • Interpretation
  • Cell Differential
  1. Differential does not distinguish Bacterial from viral
    1. Lymphocyte predominance in 10% Bacterial Meningitis
  2. Monocytes (Up to 50 cells/mm3)
    1. Guillain-Barre Syndrome
    2. Multiple Sclerosis
  3. Eosinophils
    1. Intracranial Parasite infection
    2. Aseptic Meningitis
    3. Malignancy
    4. Ventriculoperitoneal Shunt
  • Interpretation
  • Pleocytosis (WBCs in CSF) Causes
  1. Bacterial Meningitis
    1. PMNs predominate
    2. CSF WBCs >100/mm3 in 99% of cases (>1000 for most)
  2. Viral Meningitis
    1. Lymphocytes predominate
    2. CSF WBCs usually <100/mm3
  3. Chronic intracranial inflammation (Lymphocytes)
  4. Subarachnoid Hemorrhage
  5. Thrombosis
  6. Infectious Mononucleosis
  7. CNS Parasitic Infection (Eosinophils predominate)
  8. Carcinomatous Meningitis (<100 cells)
  • Interpretation
  • Examination pointers
  1. Acetic acid lyses CSF RBCs but leaves CSF WBCs intact
  2. Methylene blue distinguishes PMNs and Lymphocytes
  • References
  1. Kooiker in Roberts (1998) Procedures in ER, p. 1067-75
  2. Ravel (1995) Lab Medicine, Mosby, p. 294-9
  3. Tunkel in Mandell (2000) Infectious Disease, p. 974-8
  4. Seehusen (2003) Am Fam Physician 68:1103-8 [PubMed]