Author Archives: د.حسام أبو فرسخ

(CSF Index (IgG/ Albumin

Normal range: up to 0.70 Index

Comment: Multiple sclerosis is relapsing and remiting demyelinating disease of the central nervous system for which there are no specific diagnostic laboratory tests. About 50% of multiple sclerosis patients have elevated CSF protein levels and about 75% have increased gamma globulin. Several tests have been devised to determine if the elevated gamma globulin is the result of intrathecal IgG synthesis. The most useful tests to aid in the diagnosis of multiple sclerosis are detection of oligoiclonal bands in the CSF and estimations of the intrathecal synthesis of IgG. The detection Oligoclonal bands is the most helpful of the laboratory tests. Synthesis of IgG in the central nervous system is typically Oligoclonal, for reasons that are unknown. Estimates of intrathecal protein synthesis include calculations of IgG index. CSF IgG index, and the IgG synthesis rate. All methods require quantitation of serum and CSF albumin and IgG The most helpful of the estimates of intrathecal protein synthesis is the IgG index. An abnormal IgG index or IgG synthesis rate (indicative of increased CSF IgG production) is noted in some 90% of cases of clinically definite MS. The IgG synthesis rate is a complex formula which provides no more useful clinical information than the IgG index

Sample: CSF, serum

CSF IgG

Normal range: CSF IgG: 3% to 12% of total CSF protein. IgG in CSF is normally < 5 mg/dL

Comment: To assist in the interpretation of elevated CSF protein. Differential diagnosis of intrathecal synthesis of IgG from increased meningeal and vascular permeability, haemorrhage or traumatic tap. A raised CSF/serum protein ratio may occur in multiple sclerosis, and oligoclonal bands are found in 90% of patients with this disease

Sample: CSF

(.CSF analysis (glucose, TP, Cl, cell count & diff

:Normal range

Colour              : colourless

Appearance     : clear

Glucose             : 45-80 mg/dl

Protein              : 15-45 mg/dl

Choride             : 120-130 mmol/L

RBC                   : Up to 5×106/L

WBC                  : Up to5x106/L

In case of WBC/CSF more than 5×106/L then do differential count

Comment: Apperance of CSF may indicate cerebral heamrrhage or gross infection. The latter can be confirmed by culture or increase of neutrophilis. Viral meningitis may present with a moderate increase in lymphocytes

Sample: CSF

Cryoglobulins

Normal range: Negative

Comment: Cryoglobulins may occur in all conditions associated with paraproteinaemia (heavy chain disease excepted).May give rise to Raynaud’s phenomenon if they precipitate at temperatures above 22oC

Sample: Serum clotted at 37oC

Creatinine, 24hr urine

:Normal range

(M: 1-2 g/24hrs (8.8-17.7 mmol/24 hrs

(F : 0.8-1.8 g/24 hrs (7-16 mmol/24 hrs

Comment: Normally very constant for individual concerned. Of little diagnostic value except for the calculation of creatinine clearance

Sample: 24hr urine

Creatinine clearance

:Normal range

Child: 50-90 mL/min

M     : 98-156 mL/ min

F      : 95-160 mL/ min

Comment: Used to evaluate renal function, estimate glomerular filtration rate (GFR), follow possible progression of renal disease and adjust dosages of medications in which renal excretion is pivotal (e.g: aminoglycosides, methotrexate, cisplatin). Values of creatinine clearance are raised in exercise and pregnancy and are higher in males than in females. Low values are found in renal damage or renal circulatory insufficiency

Sample: serum and 24 hr urine

Creatinine

:Normal range

(M: 0.7-1.36 mg/dL (62-120 mmol/L

(F : 0.6-1.13 mg/dL (53-100 mmol/L

Comment: Raised in renal failure. A more sensitive indicator of early failure than blood urea. Of especial value for monitoring after renal transplant . Low values may accompany reduced muscle mass or low protein diet

Sample: serum

(Coxsackie A, B (IgG/IgM

Normal range: Negative

Comment: The majority of infections with Coxsackie A and B, two groups of nonpolio enteroviruses, are mildly symptomatic. Patients with Coxsackievirus infections can have a variety of symptoms from meningitis, exanthems, pericarditis, myocarditis, hand-foot and moth syndrome and conjunctivitis. Other nonpolio viruses include echoviruses. Twenty-three Coxsackie viruses group A are recognized and six Coxsackie viruses group B are recognized

Sample: serum