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Xanthochromia is not pathognomonic for subarachnoid hemorrhage
Author(s) -
Graves Peter,
Sidman Robert
Publication year - 2004
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2004.tb01422.x
Subject(s) - medicine , subarachnoid hemorrhage , cerebrospinal fluid , lumbar puncture , anesthesia , chromatography , pathology , chemistry
Objective: To test the hypothesis that xanthochromia may be observed in traumatic lumbar puncture (LP). Xanthochromia, the yellow discoloration of cerebrospinal fluid (CSF) caused by hemoglobin catabolism, is classically thought to arise within several hours after subarachnoid hemorrhage (SAH). The presence of xanthochromic supernatant is often used to distinguish the elevated red blood cell (RBC) count observed in the CSF of SAH from the elevated RBC count observed after traumatic LP. Methods: The authors developed a model of traumatic LP by adding whole blood to pigment‐free CSF to obtain RBC concentrations of 0, 5,000, 10,000, 20,000, 30,000, and 40,000 RBC/ μ L. Supernatant from centrifuged samples was assessed for xanthochromia by spectrophotometry. Xanthochromia was considered present if the absorption followed a characteristic oxyhemoglobin curve with a maximal absorption greater than 0.023 at 415 nm. Results: Samples with at least 30,000 RBC/ μ L demonstrated xanthochromia immediately. Samples with 20,000 RBC/ μ L demonstrated xanthochromia within one hour, and samples with 10,000 RBC/ μ L or less, within two hours. Conclusions: Cerebrospinal fluid xanthochromia may be observed within two hours after traumatic LP and sooner in samples with greater than 10,000 RBC/ μ L. Conversely, xanthochromia in traumatic LP with less than 5,000 RBC warrants further investigation for SAH. When the CSF RBC count is elevated above 10,000 RBC/ μ L, or the time between sample acquisition and analysis is prolonged, the clinician should not rely on xanthochromia to confirm SAH.