Usually ordered as paired CSF and blood samples.

CSF-Must be collected into a set of 5 special tubes obtained from Laboratory Services Specimen Reception

LABORATORY INFORMATION TEST CODES

SACPN, CSF Gluc/Protein (CSFGP) CSF Lactate  (CSFLAC), CSF Amino Acids (CSVAAC) CSF Pyruvate (SAVPYRC)

REQUESTING DOCTOR SHOULD:

1. Consider consultation with the Metabolic Unit before collection (refer to Metabolic Fellow). Collection should be performed at a time when symptoms are most severe.

2. Obtain special CSF tubes from Laboratory Services Specimen Reception (Level 4 East Building).

3. Order tests in EPIC as directed following metabolic consultation; this may include paired CSF and blood lactate, CSF and blood glucose, CSF and plasma amino acids, CSF pyruvate, neurotransmitters and pterins. Check the Neurology IP order set for Lumbar Puncture for guidance.

4. Collect paired blood samples in appropriate tubes for lactate, glucose, pyruvate, amino acids and additional tests as required.

5. Perform lumbar puncture and collect a minimum of 0.5 mL of CSF in each micro tube in numerical order. DO NOT INTERCHANGE TUBES.

Collect CSF in plain sterile tubes for additional tests as required; 

• 1.0 mL CSF for cell count and cytospin (keep at room temperature)
• 1.0 mL CSF for bacteriology amicro and culture
• Any additional tests

6. Label all tubes but ensure the tube number is clearly visible.

7. Protect from light (wrap in foil). Place CSF micro tubes on an ice-pillow (keeping plain tubes at room temperature) and hand-deliver to specimen reception within 5 minutes of collection. Hand directly to staff member indicating nature of specimen and urgency.

Lab Notes:

1. CSF microtubes are kept in the tube drawer in specimen reception. Tubes are sourced from Children's Hospital at Westmead, Sydney (2 weeks from order to receipt).

2. Process samples immediately upon arrival.

3. If micro tubes are blood-stained, centrifuge and aliquot the supernatant with a sterile pipette- biochemistry staff.

Microtube 1- RCH Biochemistry testing- glucose, protein and lactate.

Microtube 2- Freeze CSF/supernatant and place in -70C freezer LS-F-003 in sendaway box. Transport frozen on dry ice to VCGS- amino acids and pyruvate.  

Microtubes 3-5- Freeze CSF/supernatant and place in -70C freezer LS-F-003 in sendaway box. Transport frozen on dry ice to Children's Hospital at Westmead.

Note: tubes are NOT interchangeable. Microtube 4 contains special additive.

4. Process additional tubes- as per individual tests.

5. If cell count (M/C/S) requested, send 'extra CSF tube' to RCH Haematology for cell count, use CSF procedure code then send to bacteriology.

6. If cell count (Cytospin) requested, send 'extra  CSF tube' to RCH Haematology.