Redefining true leukocytosis in the traumatic lumbar puncture

Abstract

Objective: To compare and contrast the observed versus predicted number of white blood cells (WBCs) in a traumatic cerebrospinal fluid (CSF) sample in children and adults. Background: Clinicians rely on a correction formula (Predicted_CSF_WBC=CSF_RBC×Blood_WBC/Blood_RBC) to determine if a true CSF leukocytosis exists. This formula may overestimate true CSF leukocytosis and lead to delayed treatment of meningitis. Methods: A retrospective review of CSF data of 105 patients who met the following criteria: 1) CSF from lumbar puncture (LP) contained≥1000 RBC/mm^3 and 2) CBC performed≤24 hours of LP; 3) negative CSF cultures. Regression analysis was performed to determine the relationship between actual and predicted CSF WBC values. Results: Regression modeling indicated a discrepancy in the predicted versus actual WBC values. Mean adult age was 48.9 years; CSF profile (mean WBC 146.3×10^6/L; RBC 17374×10^6/L; glucose 4.1 mmol/L; protein 1.4 g/L); mean peripheral WBC was 8.2×10^9/L; RBC 3.9×10^9/L. Mean pediatric age was 1.4 years; CSF profile (mean WBC 171.8x10^6/L; RBC 41763x10^6/L; glucose 2.7 mmol/L; protein 1.7 g/L); mean peripheral WBC was 12×10^9/L; RBC 7.2×10^9/L. Observed LP CSF WBC value was 47% of predicted (r^2=0.54 pediatric cohort; r^2=0.91 adults). Conclusion: True CSF leukocytosis could be missed in a traumatic CSF sample based on a currently applied correction formula. We propose the following modifcation: Observed_CSF_WBC=0.5x[CSF_RBC×Blood_WBC/Blood_RBC].