Subarachnoid hemorrhage laboratory findings: Difference between revisions
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==Laboratory findings== | ==Laboratory findings== | ||
===Lumbar puncture (LP)=== | ===Lumbar puncture (LP)=== | ||
[[Lumbar puncture| | Despite of the normal [[head CT]], [[Lumbar puncture|lumbar puncture (LP)]] seems necessary if there is a strong suspicion of subarachnoid hemorrhage. [[Lumbar puncture|Lumbar puncture (LP)]] is the most sensitive techniques to detect the blood in CSF especially 12 hours after onset of symptoms.<ref name="pmid2556195">{{cite journal| author=Miles JS, Wolf CR| title=Principles of DNA cloning. | journal=BMJ | year= 1989 | volume= 299 | issue= 6706 | pages= 1019-22 | pmid=2556195 | doi= | pmc=1837892 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2556195 }} </ref><ref name="pmid2191083">{{cite journal| author=Vermeulen M, van Gijn J| title=The diagnosis of subarachnoid haemorrhage. | journal=J Neurol Neurosurg Psychiatry | year= 1990 | volume= 53 | issue= 5 | pages= 365-72 | pmid=2191083 | doi= | pmc=488050 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2191083 }} </ref> | ||
The classic findings of subarachnoid hemorrhage may include:<ref name="pmid15814927">{{cite journal| author=Heasley DC, Mohamed MA, Yousem DM| title=Clearing of red blood cells in lumbar puncture does not rule out ruptured aneurysm in patients with suspected subarachnoid hemorrhage but negative head CT findings. | journal=AJNR Am J Neuroradiol | year= 2005 | volume= 26 | issue= 4 | pages= 820-4 | pmid=15814927 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15814927 }} </ref><ref name="pmid14503985">{{cite journal| author=UK National External Quality Assessment Scheme for Immunochemistry Working Group| title=National guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage. | journal=Ann Clin Biochem | year= 2003 | volume= 40 | issue= Pt 5 | pages= 481-8 | pmid=14503985 | doi=10.1258/000456303322326399 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14503985 }} </ref><ref name="pmid2769274">{{cite journal| author=Vermeulen M, Hasan D, Blijenberg BG, Hijdra A, van Gijn J| title=Xanthochromia after subarachnoid haemorrhage needs no revisitation. | journal=J Neurol Neurosurg Psychiatry | year= 1989 | volume= 52 | issue= 7 | pages= 826-8 | pmid=2769274 | doi= | pmc=1031927 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2769274 }} </ref><ref name="pmid17478736">{{cite journal| author=Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D et al.| title=Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. | journal=Stroke | year= 2007 | volume= 38 | issue= 6 | pages= 2001-23 | pmid=17478736 | doi=10.1161/STROKEAHA.107.183689 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17478736 }} </ref><ref name="pmid9737490">{{cite journal| author=Morgenstern LB, Luna-Gonzales H, Huber JC, Wong SS, Uthman MO, Gurian JH et al.| title=Worst headache and subarachnoid hemorrhage: prospective, modern computed tomography and spinal fluid analysis. | journal=Ann Emerg Med | year= 1998 | volume= 32 | issue= 3 Pt 1 | pages= 297-304 | pmid=9737490 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9737490 }} </ref> | The classic findings of subarachnoid hemorrhage may include:<ref name="pmid15814927">{{cite journal| author=Heasley DC, Mohamed MA, Yousem DM| title=Clearing of red blood cells in lumbar puncture does not rule out ruptured aneurysm in patients with suspected subarachnoid hemorrhage but negative head CT findings. | journal=AJNR Am J Neuroradiol | year= 2005 | volume= 26 | issue= 4 | pages= 820-4 | pmid=15814927 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15814927 }} </ref><ref name="pmid14503985">{{cite journal| author=UK National External Quality Assessment Scheme for Immunochemistry Working Group| title=National guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage. | journal=Ann Clin Biochem | year= 2003 | volume= 40 | issue= Pt 5 | pages= 481-8 | pmid=14503985 | doi=10.1258/000456303322326399 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14503985 }} </ref><ref name="pmid2769274">{{cite journal| author=Vermeulen M, Hasan D, Blijenberg BG, Hijdra A, van Gijn J| title=Xanthochromia after subarachnoid haemorrhage needs no revisitation. | journal=J Neurol Neurosurg Psychiatry | year= 1989 | volume= 52 | issue= 7 | pages= 826-8 | pmid=2769274 | doi= | pmc=1031927 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2769274 }} </ref><ref name="pmid17478736">{{cite journal| author=Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D et al.| title=Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. | journal=Stroke | year= 2007 | volume= 38 | issue= 6 | pages= 2001-23 | pmid=17478736 | doi=10.1161/STROKEAHA.107.183689 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17478736 }} </ref><ref name="pmid9737490">{{cite journal| author=Morgenstern LB, Luna-Gonzales H, Huber JC, Wong SS, Uthman MO, Gurian JH et al.| title=Worst headache and subarachnoid hemorrhage: prospective, modern computed tomography and spinal fluid analysis. | journal=Ann Emerg Med | year= 1998 | volume= 32 | issue= 3 Pt 1 | pages= 297-304 | pmid=9737490 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9737490 }} </ref> | ||
| Line 40: | Line 40: | ||
*Assess [[hematocrit]] and [[platelet count]] to identify hemorrhagic risk and complications | *Assess [[hematocrit]] and [[platelet count]] to identify hemorrhagic risk and complications | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |[[Basic metabolic panel|'''Basic metabolic panel BMP''']] | | style="padding: 5px 5px; background: #F5F5F5;" |[[Basic metabolic panel|'''Basic metabolic panel (BMP)''']] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Increased or decreased serum NA2+, K+, Ca2+ | *Increased or decreased serum NA2+, K+, Ca2+ | ||
Revision as of 19:29, 12 December 2016
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Subarachnoid Hemorrhage Microchapters |
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AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage (2012)
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Subarachnoid hemorrhage laboratory findings On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
A lumbar puncture (removal of cerebrospinal fluid/CSF with a needle from the lumbar sac under local anesthetic) will identify another 3% of the cases by demonstrating xanthochromia (yellow appearance of centrifugated fluid) or bilirubin (a breakdown product of hemoglobin) in the CSF.
Laboratory findings
Lumbar puncture (LP)
Despite of the normal head CT, lumbar puncture (LP) seems necessary if there is a strong suspicion of subarachnoid hemorrhage. Lumbar puncture (LP) is the most sensitive techniques to detect the blood in CSF especially 12 hours after onset of symptoms.[1][2]
The classic findings of subarachnoid hemorrhage may include:[3][4][5][6][7]
- Elevated opening pressure
- Elevated red blood cell (RBC)
- RBC count does not diminish from CSF tube one to tube four and it helps to differentiate bleeding in SAH from traumatic spinal tap. However, decrease in the number of RBCs in later tubes can also happen in subarachnoid hemorrhage
- CSF samples taken within 24 hours of the ictus usually show a WBC-to-RBC ratio of 1:1000 that is consistent with the normal conditions. After 24 hours, secondary to chemical meningitis the CSF samples may demonstrate a polymorphonuclear and mononuclear polycytosis.
- Xanthochromia (represents Hemoglobin degradation products)
- Indicates that blood has been in the CSF for at least two hour and can last for two weeks or more
- Spectrophotometry
- It detects blood breakdown products (oxyhemoglobin to methemoglobin to bilirubin
- More sensitivity compare to xanthochromia but not widely used
Other lab findings
Beside positive lumbar puncture (LP), other laboratory findings for subarachnoid may include the following:
| Blood test | Test result | Rationale |
|---|---|---|
| Complete blood count and platelet |
| |
| Basic metabolic panel (BMP) |
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| PT/APTT/INR[8][9][10] |
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| BUN/Creatinine[11] |
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| Toxicology screen/Serum alcohol level |
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| Lipid profile |
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| Blood typing |
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| Cardiac enzymes |
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| Pregnancy test |
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References
- ↑ Miles JS, Wolf CR (1989). "Principles of DNA cloning". BMJ. 299 (6706): 1019–22. PMC 1837892. PMID 2556195.
- ↑ Vermeulen M, van Gijn J (1990). "The diagnosis of subarachnoid haemorrhage". J Neurol Neurosurg Psychiatry. 53 (5): 365–72. PMC 488050. PMID 2191083.
- ↑ Heasley DC, Mohamed MA, Yousem DM (2005). "Clearing of red blood cells in lumbar puncture does not rule out ruptured aneurysm in patients with suspected subarachnoid hemorrhage but negative head CT findings". AJNR Am J Neuroradiol. 26 (4): 820–4. PMID 15814927.
- ↑ UK National External Quality Assessment Scheme for Immunochemistry Working Group (2003). "National guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage". Ann Clin Biochem. 40 (Pt 5): 481–8. doi:10.1258/000456303322326399. PMID 14503985.
- ↑ Vermeulen M, Hasan D, Blijenberg BG, Hijdra A, van Gijn J (1989). "Xanthochromia after subarachnoid haemorrhage needs no revisitation". J Neurol Neurosurg Psychiatry. 52 (7): 826–8. PMC 1031927. PMID 2769274.
- ↑ Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D; et al. (2007). "Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group". Stroke. 38 (6): 2001–23. doi:10.1161/STROKEAHA.107.183689. PMID 17478736.
- ↑ Morgenstern LB, Luna-Gonzales H, Huber JC, Wong SS, Uthman MO, Gurian JH; et al. (1998). "Worst headache and subarachnoid hemorrhage: prospective, modern computed tomography and spinal fluid analysis". Ann Emerg Med. 32 (3 Pt 1): 297–304. PMID 9737490.
- ↑ Cucchiara B, Messe S, Sansing L, Kasner S, Lyden P, CHANT Investigators (2008). "Hematoma growth in oral anticoagulant related intracerebral hemorrhage". Stroke. 39 (11): 2993–6. doi:10.1161/STROKEAHA.108.520668. PMID 18703803.
- ↑ Broderick JP, Diringer MN, Hill MD, Brun NC, Mayer SA, Steiner T; et al. (2007). "Determinants of intracerebral hemorrhage growth: an exploratory analysis". Stroke. 38 (3): 1072–5. doi:10.1161/01.STR.0000258078.35316.30. PMID 17290026.
- ↑ Flaherty ML, Tao H, Haverbusch M, Sekar P, Kleindorfer D, Kissela B; et al. (2008). "Warfarin use leads to larger intracerebral hematomas". Neurology. 71 (14): 1084–9. doi:10.1212/01.wnl.0000326895.58992.27. PMC 2668872. PMID 18824672.
- ↑ Miller CM, Vespa PM, McArthur DL, Hirt D, Etchepare M (2007). "Frameless stereotactic aspiration and thrombolysis of deep intracerebral hemorrhage is associated with reduced levels of extracellular cerebral glutamate and unchanged lactate pyruvate ratios". Neurocrit Care. 6 (1): 22–9. doi:10.1385/NCC:6:1:22. PMID 17356187.