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Xanthochromia.

Jonathan A Edlow1, Kathy S Bruner, Gary L Horowitz

  • 1Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. jedlow@caregroup.harvard.edu

Archives of Pathology & Laboratory Medicine
|March 20, 2002
PubMed
Summary
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Most US hospital labs visually inspect cerebrospinal fluid for xanthochromia, not spectrophotometry. This finding suggests current recommendations for delaying lumbar puncture for subarachnoid hemorrhage diagnosis may need reevaluation.

Area of Science:

  • Clinical Chemistry
  • Neurology
  • Laboratory Medicine

Background:

  • Subarachnoid hemorrhage diagnosis often relies on CT scans, but lumbar puncture (LP) for cerebrospinal fluid (CSF) analysis is sometimes required.
  • CSF analysis for xanthochromia is crucial, with some guidelines recommending a 12-hour delay post-symptom onset for accurate spectrophotometric measurement.
  • The study questions the widespread use of spectrophotometry in hospital labs for xanthochromia detection.

Purpose of the Study:

  • To ascertain the proportion of hospital clinical laboratories in the United States that employ spectrophotometry for xanthochromia analysis.
  • To compare the utilization of spectrophotometry versus visual inspection methods in clinical laboratories.

Main Methods:

  • A mail survey was distributed to 3500 hospital clinical laboratory directors in January 2001.

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  • The survey, conducted in collaboration with the College of American Pathologists, involved voluntary participation.
  • Results were tabulated one month after mailing, focusing on methods used for xanthochromia evaluation.

    • Main Results:

    • A response rate of 72.9% (2551 laboratories) was achieved.
    • Of the responding laboratories, 76.2% (1944) reported evaluating for xanthochromia.
    • An overwhelming 99.7% (1947) of laboratories reporting their method used visual inspection, not spectrophotometry.

    Conclusions:

    • Nearly all US hospital clinical laboratories utilize visual inspection for xanthochromia assessment in CSF.
    • The prevalent use of visual inspection contrasts with the spectrophotometry-based recommendations for timing LP.
    • Current guidelines recommending a 12-hour delay for LP due to spectrophotometry may require reassessment in light of common laboratory practices.