Normal Results

Cerebrospinal fluid (CSF) is normally clear and colorless. Abnormal CSF may appear cloudy, turbid, bloody, viscous, or clotted. Red blood cells (RBCs) should not be present in normal CSF. Typical normal ranges for white blood cells (WBCs) are shown in the table below1,2,3,4,5,6,7,8,9,10.

DemographicNormal Ranges (WBC/µL)
Neonates (<1 year)0-30
Ages 1 to 4 years0-20
Ages 5 to puberty (18 years)0-10
Adults (18 years)0-5

Increased WBCs in the CSF may be indicative of meningitis, malignancy, or demyelinating disease. RBCs in the CSF may be indicative of hemorrhage or the result of a traumatic lumbar puncture.11

Traumatic Tap Versus Hemorrhage

When RBCs in CSF are due to a traumatic tap, a visual comparison between the first and last collection tubes will show a significant decrease in color. There will be no color difference in the case of a hemorrhage. Further, a clear and colorless supernatant following centrifugation indicates a traumatic tap since the cells have not yet broken down. A xanthochromic supernatant reveals a hemorrhage.11

Diagnostic Range Guidelines12

Condition WBCs or RBCs*Major cell typeGlucoseProtein*Pressure*
Acute bacterial meningitis100-100,000 WBC/µLPMND>100 mg/dLI
Viral infections100-2,000 WBC/µLLNN or I N or I
Guillain-Barré syndrome0-100 WBC/µLLN>100 mg/dLN
Multiple sclerosis0-50 WBC/µLLNN or I N
Spinal cord tumor0-50 WBC/µLLNN or IN
Cerebral hemorrhage>500,000 RBC/µL (bloody)RBCNII

*Figures given for pressure, cell counts, and protein are approximations; exceptions are common.
L = lymphocyte; N= normal; PMN = polymorphonuclear leukocyte; I = increased, D = decreased.

References

1Ringsrud, K.M., Linne, J.J. (1995). Urinalysis and Body Fluids A Color Text and Atlas. St. Louis, Missouri: Mosby; 337.

2Brunzel, N.A. (2004). Fundamentals of Urinalysis and Body Fluids (Second ed.). Philadelphia, Pennsylvania: Saunders; 186.

3Kjeldsberg, C., Knight, J. (1993). Body Fluids. Chicago, Illinois: American Society of Clinical Pathologists; 71.

4Hussong, J.W., Kjeldsberg, C.R. (2015). Body Fluids Analysis. Chicago, Illinois: American Society of Clinical Pathologists; 2015.

5Bunis, C.A., Ashvrood, E.R., Bums, D.E. (2006). Textbook of Clinical Chemistry and Molecular Diagnostics. St. Louis, Missouri: Elsevier Saunders; 1633: 962-967.

6Kaplan, P. (2010). Clinical Chemistry: Theory, Analysis, Correlation (Fifth ed.). St. Louis, Missouri: Elsevier Saunders; 904-928.

7King, S.S., Schaub, D.M. Urinalysis and Body Fluids Testing (Fifth ed.). Philadelphia, Pennsylvania: F.A. Davis; 177-199.

8Clarke, W. Contemporary Practice in Clinical Chemistry (Second ed.). AACC; 233-246.

9McPherson, R.A., Matthew, R., Pincus, M.R. (2011). Henry’s Clinical Diagnosis and Management by Laboratory Methods (22nd ed.). Philadelphia, Pennsylvania. Elsevier Saunders; 2545.

10 Wallach, J. (1996). Interpretation of Diagnostic Tests (Sixth ed.). New York, New York. Little Brown; 71.

11Brunzel, N.A. (2013). Fundamentals of Urine & Body Fluid Analysis (Third ed.). St. Louis, Missouri: Elsevier Saunders; 314, 316, 318-320.

12Levin, M.C. (2012, August). Neurologic Diagnostics Procedures. Retrieved from Merck Manual: https://www.merckmanuals.com/professional/neurologic-disorders/approach-to-the-neurologic-patient/neurologic-diagnostic-procedures