The Impact Of Different Tube Methods On The Accuracy Of CSF Detection And The Diagnosis Of Central Nervous System Leukemia

Background and ObjectiveCentral nervous system leukemia(CNSL)is caused by the infiltration of leukemic cells into the meninges or brain parenchyma.The CNSL patients show corresponding neurological and/or mental symptoms.CNSL can be seen in any stage of leukemia,and most common seen in the remission stage or at leukemia relapse after chemotherapy,affecting the recurrence and mortality rates.Thus,early and accurate diagnosis is essential to improve the long-term survival of leukemia patients.Cerebrospinal fluid(CSF)detection is one of the most important evidence for the diagnosis of CNSL,including CSF routine,biochemistry and cytology smear.Physicians often use different tube methods to save CSF for further detection.In clinical practice,we found that when CSF samples were placed in red cap blood collection tubes,the results of CSF routine CSF routine,biochemistry and cytology smear were inconsistent with the clinical manifestations of the patient,which caused confusion to the diagnosis of CNSL.We also found that when using different tube methods to detect the CSF routine of same patient,the results were distinct,which suggested that the type of tubes may have impact on the accuracy of the CSF detection results.There have been various reports of different tubes affecting the accuracy of blood examine results,however,rare studies have been found about the impact of different tube methods on the accuracy of CSF detection results and the diagnosis of CSNL.The purpose of this study is to analyze the impact of different tube methods on the CSF detection and to improve the accuracy of CNSL diagnosis.MethodsThis study conducted a self-controlled study on CSF specimens of 60 patients with leukemia.According to the different tube methods,the CSF specimens of 60 leukemia patients were divided into 3 groups:experimental group A(red cap blood collection tube group,disposable transparent sterile plastic tube group),experimental group B(purple top blood routine tube group,disposable transparent sterile plastic tube group)and experimental group C(red cap blood collection tube group,purple top blood routine tube group,disposable transparent sterile plastic tube group).CSF routine(instrument method),CSF cytology and CSF biochemistry(protein,glucose,chloride)were conducted in each group.SPSS24.0 statistical software was used for data statistics and analysis.Results1.In the experimental group A,the positive rate of the routine Pan’s test of the CFS in the red cap blood collection tube group was 100%,and the positive rate of the Pan’s test in the disposable transparent sterile plastic tube group was 5%,the difference was statistically significant(P<0.001).Compared with the disposable transparent sterile plastic tube group,the red cap blood collection tube group showed increased white blood cell count,monocyte count and multinuclear cell count[M(P25,P75)×106/L]:67(30,89)vs 1(1,2),31(13,44)vs 0(0,1)and 31(14,49)vs 1(1,1),respectively(P<0.001).The CSF biochemistry(protein,glucose and chloride)and CSF cytological smears of the two groups showed no significant difference(P>0.05).2.In the experimental group B,the positive rate of the routine Pan’s test of the CSF in the purple top blood routine tube group was 5%,and the positive rate of the Pan’s test in the disposable transparent sterile plastic tube group was 5%.Compared with the disposable transparent sterile plastic tube group,the white blood cell count,mononuclear cell count,and multinuclear cell count of purple top blood routine tube group[M(P25,P75)X 106/L]were 2(1,2)vs 2(1,2),1(1,1)vs 1(1,1)and 1(0,2)vs 1(0,1),respectively(P>0.05).There was no significant difference in CSF cytological smears between the two groups(P>0.05).3.In the experimental group C,the positive rate of the routine Pan’s test of the CSF in the red cap blood collection tube group was 100%,the positive rate of the Pan’s test in the purple top blood routine tube group was 5%,and the positive rate of the Pan’s test in the disposable transparent sterile plastic tube group was 5%(P<0.001).Compared with the disposable transparent sterile plastic tube group and the purple top blood routine tube group,the white blood cell count,mononuclear cell count and multinuclear cell count[M(P25,P75)X 106/L]were increased in the red cap blood collection tube group:39(23,63)vs 2(1,2)vs 2(1,2),25(14,36)vs 1(0,1)vs 1(1,1),18(8,24)vs 1(1,2)vs 1(1,1)(P<0.001).The results of CSF routine and cytology smear showed no significant difference among the three groups(P>0.05).4.Under the inverted microscope,the CSF from the red cap blood collection tube can be seen with different sizes of impurities,while the CSF from the the purple top blood routine tube and the disposable transparent sterile plastic tube can be seen clearly under the microscope.1 ml of 5%carbolic acid solution was added into the above-mentioned tubes respectively,and then 0.9%normal saline was added.Under the black background,only white precipitates were formed in the red cap blood collection tube.Conclusions1.The type of tube affected the accuracy of the CSF detection.Improper tube selection may disturb the accurate diagnosis of CNSL.2.The red cap blood collection tube contains many impurities,which can cause the false positive of the Pan’s test and can lead to an increase in the number of pseudocells during the CSF routine detection.Therefore,it is contraindicated to save the CSF specimen in the red cap blood collection tube.3.The CSF specimen saved by the red cap blood collection tube can be used for CSF biochemistry and cytology smear examination.4.The CSF specimen saved by the purple top blood routine tube can be used for CSF routine and cytology smear examinations.5.The CSF saved in the disposable transparent sterile plastic tube can be used for CSF routine,biochemistry and cytology smear examinations.