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Usually ordered as paired CSF and blood samples.

CSF-Must be collected into a set ofÌý5 special tubesÌýobtained from Laboratory Services Specimen Reception

LABORATORY INFORMATION TEST CODES

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

REQUESTING DOCTOR SHOULD:

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

2.Ìý°¿²ú³Ù²¹¾±²ÔÌýspecial CSF tubesÌýfrom Laboratory Services Specimen Reception (Level 4 East Building).

3.ÌýOrder 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.ÌýCollect paired blood samples in appropriate tubes for lactate, glucose, pyruvate,Ìýamino acids and additional tests as required.

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

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

• 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.ÌýLabel all tubes but ensure the tube number is clearly visible.

7. Protect from light (wrap in foil).ÌýPlace CSF micro tubes on anÌýice-pillowÌý(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 fromÌýChildren's Hospital at Westmead, SydneyÌý(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.ÌýÌý

Microtubes 3-5- Freeze CSF/supernatant and place in -70C freezer LS-F-003 in sendaway box.ÌýTransport 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.ÌýIf cell count (M/C/S) requested,ÌýsendÌý'extraÌýCSFÌýtube' to RCH Haematology for cell count, use CSF procedure code then send to bacteriology.

6.ÌýIf cell count (Cytospin) requested,ÌýsendÌý'extraÌý CSF tube' to RCH Haematology.