Subarachnoid hemorrhage laboratory findings: Difference between revisions
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**It detects blood breakdown products (progress from [[oxyhemoglobin]] to [methemoglobin] to [[bilirubin]]. It has more sensitivity compare to xanthochromia but not widely used | **It detects blood breakdown products (progress from [[oxyhemoglobin]] to [methemoglobin] to [[bilirubin]]. It has more sensitivity compare to xanthochromia but not widely used | ||
===Other lab findings=== | ===Other lab findings=== | ||
Beside positive [[Lumbar puncture|lumbar puncture (LP)]], other laboratory findings for subarachnoid may include the following: | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center | {| style="border: 0px; font-size: 90%; margin: 3px;" align=center | ||
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*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|'''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+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* | *To establish a baseline for detection of future complication | ||
|- | |- | ||
| 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;" |[[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> | ||
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*Increased BUN and creatinine | *Increased BUN and creatinine | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* | *To establish a baseline for detection of future complication | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |[[Toxicology screen|'''Toxicology screen''']]'''/Serum alcohol level''' | | style="padding: 5px 5px; background: #F5F5F5;" |[[Toxicology screen|'''Toxicology screen''']]'''/Serum alcohol level''' | ||
| Line 62: | Line 61: | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Identify illicit drug use or excessive alcohol | *Identify illicit drug use or excessive alcohol | ||
*Identify exogenous toxins that can cause | *Identify exogenous toxins that can cause subarachnoid hemorrhage | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |[[lipid profile|'''Lipid profile''']] | | style="padding: 5px 5px; background: #F5F5F5;" |[[lipid profile|'''Lipid profile''']] | ||
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*Decreased levels of lipids | *Decreased levels of lipids | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Associated with higher incidence of | *Associated with higher incidence of subarachnoid hemorrhage | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |'''Blood | | style="padding: 5px 5px; background: #F5F5F5;" |'''Blood typing''' - To prepare for possible intraoperative transfusions | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* | *Blood typing and screening - | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* | *To prepare for possible intraoperative transfusions | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cardiac enzymes|'''Cardiac enzymes''']] | | style="padding: 5px 5px; background: #F5F5F5;" |[[Cardiac enzymes|'''Cardiac enzymes''']] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Increased serum levels of Trop I, Trop T, CK-MB | *Increased serum levels of Trop I, Trop T, CK-MB | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* May suggest ongoing myocardial ischemia | * May suggest ongoing myocardial ischemia | ||
*Useful only as a predictor for the occurrence of pulmonary and cardiac complications. | |||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |[[Pregnancy test|'''Pregnancy test''']] | | style="padding: 5px 5px; background: #F5F5F5;" |[[Pregnancy test|'''Pregnancy test''']] | ||
Revision as of 19:00, 12 December 2016
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Subarachnoid Hemorrhage Microchapters |
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Diagnosis |
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Treatment |
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AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage (2012)
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Case Studies |
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Subarachnoid hemorrhage laboratory findings On the Web |
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American Roentgen Ray Society Images of Subarachnoid hemorrhage laboratory findings |
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Risk calculators and risk factors for Subarachnoid hemorrhage laboratory findings |
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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)
Lumbar puncture (LP) is mandatory if there is a strong suspicion of SAH despite a normal head CT [20,27]. Clinical prediction rules are NOT sufficiently sensitive to exclude SAH without a lumbar puncture [34]. (See 'Head CT scan' above.)[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
- Xanthochromia (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 (progress from oxyhemoglobin to [methemoglobin] to bilirubin. It has 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 - To prepare for possible intraoperative transfusions |
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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.