Recommendations for cerebrospinal fluid examination in acute leukemia

Abstract

L'identification cytologique de blastes dans le liquide céphalorachidien (LCR) au cours des hémopathies aiguës, lymphoïdes ou myéloïdes, de l'adulte et de l'enfant, au diagnostic initial ou lors de leur évolution conduit au diagnostic d'infiltration blastique méningée. La mise en place de thérapeutiques basées sur un risque « méningé », selon une classification standard internationale, a permis de réduire le nombre de rechutes cérébroméningées. Établie en 1993, cette classification permet, d'uniformiser les approches thérapeutiques en fonction du status de l'atteinte méningée. Basée sur la numération des hématies, des éléments nucléés, la présence de blastes, elle nécessite de disposer d'un mode opératoire uniforme pour obtenir des résultats d'analyse comparables entre laboratoires de biologie médicale. Afin d'améliorer la qualité d'analyse du LCR dans les leucémies aiguës, des recommandations préanalytiques (délai d'acheminement), analytiques (cytocentrifugation, addition de sérum enrichi en protéine, vitesse et durée de cytocentrifugation) et postanalytiques (durée de conservation) sont établies par le Groupe francophone d'hématologie cellulaire.Abstract. Cytological identification of blasts in cerebrospinal fluid in acute leukemia, lymphoid or myeloid, in adult and child, at diagnosis or during follow up lead to the diagnosis of leukemic meningitidis. Suitable CNS therapy based on a defined "CNS status" following an international standardized classification, lead to decrease cerebrospinal relapses. Established in 1993, this classification allows to treat patients based on their CNS status. Based on the red blood cells count, nucleated cells count and presence of blasts, it requires a standard technical procedure that guarantees the comparability of results coming from different medical laboratory. To improve the quality of cerebrospinal fluid analysis, in acute leukemias, preanalytical guidelines (turn around time), analytical guidelines (cytocentrifugation, adding serum protein, speed and duration of cytocentrifugation) and postanalytical guidelines (duration of conservation) are set by the Groupe francophone d'hématologie cellulaire.

Technological features of blast identification in the cerebrospinal fluid: A systematic review of flow cytometry and laboratory haematology methods

“…Since morphologic review is often performed on cytospin preparations, distortion of cell morphology may make the distinction of blasts from other cell types such as reactive lymphocytes and germinal matrix cells challenging (Figure 2). 24–26 Factors such as time‐in‐transit, specimen preparation, and cytocentrifuge instrumentation/ rotor speed may impact the quality of cell preparations, and efforts to harmonise these systems may result in a more reliable product 27 . The use of albumin or other proteins to stabilise cell membranes has been recommended to improve cell preservation 27 .…”

“…[24][25][26] Factors such as time-in-transit, specimen preparation, and cytocentrifuge instrumentation/ rotor speed may impact the quality of cell preparations, and efforts to harmonise these systems may result in a more reliable product. 27 The use of albumin or other proteins to stabilise cell membranes has been recommended to improve cell preservation. 27 Despite efforts such as a scoring system to more precisely categorise difficult cases, 28 sensitivity and imprecision remain a problem.…”

“…27 The use of albumin or other proteins to stabilise cell membranes has been recommended to improve cell preservation. 27 Despite efforts such as a scoring system to more precisely categorise difficult cases, 28 sensitivity and imprecision remain a problem.…”

Systematic review and meta-analysis of the effect of continuous cerebrospinal fluid drainage on keyhole surgery during the perioperative period

“…To further the research reliability and reference ability, research methods and designs should be improved in the future. Continuous lumbar pool CSF drainage is routinely used to treat aSAH, and can reduce mortality and complications among patients with this condition (16,17). Locking neurosurgery is suitable for patients with intracranial aneurysm, hypertension, cerebral hemorrhage, and other diseases.…”

Supervivencia y factores asociados a infiltración del Sistema Nervioso Central por Leucemia Linfoblástica Aguda, en SOLCA-Cuenca, período 2012 - 2016 - Survival and factors associated with infiltration of the Central Nervous System by Acute Lymphoblastic Leukemia, in SOLCA-Cuenca, period 2012 - 2016

“…Es causada por un bloqueo en la maduración de un precursor hematopoyético a nivel de la médula ósea 2 . La afectación o infiltración leucémica al Sistema Nervioso Central (SNC) se define por la presencia de células neoplásicas (blastos) en el líquido cefalorraquídeo (LCR) 3 . Existen factores que aumentan el riesgo de infiltración leucémica al momento del diagnóstico, o que están presentes antes del inicio de la terapia, como son: edad menor de 1 año, raza negra, glóbulos blancos (GB) elevados, plaquetas menores a 100 000/μL cuando se realiza la primera intratecal (IT), niveles elevados de deshidrogenasa láctica (DHL), día de la fase de inducción en que se realiza la primera IT, inmunofenotipo T, presencia de cromosoma Philadelphia o translocación (9;22), ausencia de anestesia general durante los procedimientos de IT, punción lumbar traumática (PLT>10 glóbulos rojos (GR)/μL), punción lumbar hemorrágica (>500 GR/ μL) y la carencia de un área de procedimientos 4,5 .…”