Subarachnoid hemorrhage laboratory findings: Difference between revisions

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==Overview==
==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.
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==
Laboratory findings for intracerebral hemorrhage may include the following:<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>
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Blood test }}
! style="background: #4479BA; width: 250px;" | {{fontcolor|#FFF|Test result}}
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Rationale}}
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Complete blood count|'''Complete blood count and platelet''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Leukocytosis]]
*[[Polycythemia]]
*[[Thrombocytopenia]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Monitor for [[infection]]
*Assess [[hematocrit]] and [[platelet count]] to identify hemorrhagic risk and complications
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Basic metabolic panel|'''BMP''']]/[[Osmolarity|'''Osmolarity''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Increased or decreased serum NA2+, K+, Ca2+
*Change in osmolarity 
| style="padding: 5px 5px; background: #F5F5F5;" |
*Monitor osmolarity for guidance of [[osmotic diuresis]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[PT|'''PT''']]'''/[[APTT]]/[[INR]]'''<ref name="pmid18703803">{{cite journal| author=Cucchiara B, Messe S, Sansing L, Kasner S, Lyden P, CHANT Investigators| title=Hematoma growth in oral anticoagulant related intracerebral hemorrhage. | journal=Stroke | year= 2008 | volume= 39 | issue= 11 | pages= 2993-6 | pmid=18703803 | doi=10.1161/STROKEAHA.108.520668 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18703803  }}</ref><ref name="pmid17290026">{{cite journal| author=Broderick JP, Diringer MN, Hill MD, Brun NC, Mayer SA, Steiner T et al.| title=Determinants of intracerebral hemorrhage growth: an exploratory analysis. | journal=Stroke | year= 2007 | volume= 38 | issue= 3 | pages= 1072-5 | pmid=17290026 | doi=10.1161/01.STR.0000258078.35316.30 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17290026  }}</ref><ref name="pmid18824672">{{cite journal| author=Flaherty ML, Tao H, Haverbusch M, Sekar P, Kleindorfer D, Kissela B et al.| title=Warfarin use leads to larger intracerebral hematomas. | journal=Neurology | year= 2008 | volume= 71 | issue= 14 | pages= 1084-9 | pmid=18824672 | doi=10.1212/01.wnl.0000326895.58992.27 | pmc=2668872 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18824672  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Increased PT/APTT/INR
| style="padding: 5px 5px; background: #F5F5F5;" |
*Identify a [[coagulopathy]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[BUN|'''BUN''']]'''/[[Creatinine]]'''<ref name="pmid17356187">{{cite journal| author=Miller CM, Vespa PM, McArthur DL, Hirt D, Etchepare M| title=Frameless stereotactic aspiration and thrombolysis of deep intracerebral hemorrhage is associated with reduced levels of extracellular cerebral glutamate and unchanged lactate pyruvate ratios. | journal=Neurocrit Care | year= 2007 | volume= 6 | issue= 1 | pages= 22-9 | pmid=17356187 | doi=10.1385/NCC:6:1:22 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17356187  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Increased BUN and creatinine
| style="padding: 5px 5px; background: #F5F5F5;" |
*May be associated with poor prognosis in patients with intracerebral hemorrhage and hematoma expansion
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Toxicology screen|'''Toxicology screen''']]'''/Serum alcohol level'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Increased levels of serum
| style="padding: 5px 5px; background: #F5F5F5;" |
*Identify illicit drug use or excessive alcohol
*Identify exogenous toxins that can cause [[intracerebral hemorrhage]] (ICH)
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[lipid profile|'''Lipid profile''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Decreased levels of lipids
| style="padding: 5px 5px; background: #F5F5F5;" |
*Associated with higher incidence of ICH
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''Blood glucose levels'''<ref name="pmid9249937">{{cite journal| author=Sawyer GJ, Fabre JW| title=Indirect T-cell allorecognition and the mechanisms of immunosuppression by allogeneic blood transfusions. | journal=Transpl Int | year= 1997 | volume= 10 | issue= 4 | pages= 276-83 | pmid=9249937 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9249937  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Increased or decreased levels of blood glucose
| style="padding: 5px 5px; background: #F5F5F5;" |
*May be associated with poor prognosis in patients with [[Intracerebral hemorrhage]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cardiac enzymes|'''Cardiac enzymes''']]<ref name="pmid8219819">{{cite journal| author=Davis AM, Natelson BH| title=Brain-heart interactions. The neurocardiology of arrhythmia and sudden cardiac death. | journal=Tex Heart Inst J | year= 1993 | volume= 20 | issue= 3 | pages= 158-69 | pmid=8219819 | doi= | pmc=325088 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8219819  }}</ref><ref name="pmid21450435">{{cite journal| author=Hasegawa K, Fix ML, Wendell L, Schwab K, Ay H, Smith EE et al.| title=Ischemic-appearing electrocardiographic changes predict myocardial injury in patients with intracerebral hemorrhage. | journal=Am J Emerg Med | year= 2012 | volume= 30 | issue= 4 | pages= 545-52 | pmid=21450435 | doi=10.1016/j.ajem.2011.02.007 | pmc=3684165 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21450435  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Increased serum levels of Trop I, Trop T, CK-MB
| style="padding: 5px 5px; background: #F5F5F5;" |
* May suggest ongoing myocardial ischemia (left ventricular ischemia)
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Pregnancy test|'''Pregnancy test''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Serum and urine B-HCG
| style="padding: 5px 5px; background: #F5F5F5;" |
*Rule out pregnancy in all female patients with hemorrhagic stroke
|-
|}


==References==
==References==

Revision as of 13:12, 12 December 2016

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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

Laboratory findings for intracerebral hemorrhage may include the following:[1]

Blood test Test result Rationale
Complete blood count and platelet
BMP/Osmolarity
  • Increased or decreased serum NA2+, K+, Ca2+
  • Change in osmolarity
PT/APTT/INR[2][3][4]
  • Increased PT/APTT/INR
BUN/Creatinine[5]
  • Increased BUN and creatinine
  • May be associated with poor prognosis in patients with intracerebral hemorrhage and hematoma expansion
Toxicology screen/Serum alcohol level
  • Increased levels of serum
Lipid profile
  • Decreased levels of lipids
  • Associated with higher incidence of ICH
Blood glucose levels[6]
  • Increased or decreased levels of blood glucose
Cardiac enzymes[7][8]
  • Increased serum levels of Trop I, Trop T, CK-MB
  • May suggest ongoing myocardial ischemia (left ventricular ischemia)
Pregnancy test
  • Serum and urine B-HCG
  • Rule out pregnancy in all female patients with hemorrhagic stroke

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ Sawyer GJ, Fabre JW (1997). "Indirect T-cell allorecognition and the mechanisms of immunosuppression by allogeneic blood transfusions". Transpl Int. 10 (4): 276–83. PMID 9249937.
  7. ↑ Davis AM, Natelson BH (1993). "Brain-heart interactions. The neurocardiology of arrhythmia and sudden cardiac death". Tex Heart Inst J. 20 (3): 158–69. PMC 325088. PMID 8219819.
  8. ↑ Hasegawa K, Fix ML, Wendell L, Schwab K, Ay H, Smith EE; et al. (2012). "Ischemic-appearing electrocardiographic changes predict myocardial injury in patients with intracerebral hemorrhage". Am J Emerg Med. 30 (4): 545–52. doi:10.1016/j.ajem.2011.02.007. PMC 3684165. PMID 21450435.

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