Reference Range for Cerebrospinal Fluid Protein Concentration in Children and Adolescents

Renuart, Andrew J.; Mistry, Rakesh D.; Avery, R. A.; Licht, Daniel J.; Huh, Jimmy W.; Boswinkel, Jan; Liu, Grant T.; Shah, Samir S.

doi:10.1001/archpediatrics.2011.89

Cited by 7 publications

(4 citation statements)

References 7 publications

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“…cerebrospinal fluids (CSF), amniotic fluids] are usually interpreted on the basis of values reported in reference texts or handbooks; however, current reference texts either present normal CSF parameters without citation or cite studies with significant limitations. Recent developments to determine accurate, age-specific reference values for glucose, protein concentrations and white blood cell counts in CSF, amniotic fluids and aspirations in a large population of neonates and young infants will bring literature up to date at a time when molecular tools are commonly used in clinical practice ( 83 , 84 ).…”

Section: Partitioning By Genetic Effects On Reference Intervalsmentioning

confidence: 99%

Reference intervals: current status, recent developments and future considerations

2016

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Reliable and accurate reference intervals (RIs) for laboratory analyses are an integral part of the process of correct interpretation of clinical laboratory test results. RIs given in laboratory reports have an important role in aiding the clinician in interpreting test results in reference to values for healthy populations. Since the 1980s, the International Federation of Clinical Chemistry (IFCC) has been proactive in establishing recommendations to clarify the true significance of the term ‘RIs, to select the appropriate reference population and statistically analyse the data. The C28-A3 guideline published by the Clinical and Laboratory Standards Institute (CLSI) and IFCC is still the most widely-used source of reference in this area. In recent years, protocols additional to the Guideline have been published by the IFCC, Committee on Reference Intervals and Decision Limits (C-RIDL), including all details of multicenter studies on RIs to meet the requirements in this area. Multicentric RIs studies are the most important development in the area of RIs. Recently, the C-RIDL has performed many multicentric studies to obtain common RIs. Confusion of RIs and clinical decision limits (CDLs) remains an issue and pediatric and geriatric age groups are a significant problem. For future studies of RIs, the genetic effect would seem to be the most challenging area. The aim of the review is to present the current theory and practice of RIs, with special emphasis given to multicenter RIs studies, RIs studies for pediatric and geriatric age groups, clinical decision limits and partitioning by genetic effects on RIs.

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Section: Partitioning By Genetic Effects On Reference Intervalsmentioning

confidence: 99%

Reference intervals: current status, recent developments and future considerations

2016

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“…Concurrent cytopenia and elevated levels of serum ferritin with unexplained liver failure should raise a suspicion of HLH as seen in our previously healthy 22-month-old patient presenting with ALF. 8,9 A definite diagnosis of HLH is established if patient meets five out of eight criteria as depicted in ►Table 2. 3 We could not check for sIL-2R or natural killer cell function as it was not feasible.…”

Section: Discussionmentioning

confidence: 99%

“…15 Survival data in older children and adults are sparse, most of whom underwent liver transplantation or expired. 5,6,8 The third reported case was of a 4-year-old child with influenza infection H3N2 who improved with plasmapheresis and antiviral therapy. 16…”

Section: Discussionmentioning

confidence: 99%

“…However, cerebrospinal fluid protein was elevated (420 mg/L). 8 Magnetic resonance imaging brain was normal. In view of fever, cough, and bilateral perihilar infiltrates on chest X-ray, community infectious profile and rapid respiratory pathogen assay was sent, which depicted H1N1 real-time polymerase chain reaction positive for Influenza A and H1N1.…”

Section: Case Reportmentioning

confidence: 98%

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Early Detection and Rescue of an Unusual Case of Pediatric Acute Liver Failure Associated with Secondary Hemophagocytic Lymphophagocytosis: Case Report from a Liver Transplant Center in India

Mittal

Malhotra

Jerath

et al. 2021

Journal of Child Science

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Hemophagocytic lymphohistiocytosis (HLH) is a rare, multisystem, potentially fatal clinicopathologic syndrome. HLH presenting predominantly as pediatric acute liver failure (PALF) has been rarely reported. Early recognition is imperative to initiate life-saving treatment but is often hampered due to the rarity of this syndrome, variable clinical presentations, and nonspecific clinical and laboratory findings. In this article, we reported a case of secondary HLH (H1N1 and RSV positive) presenting as PALF from India. A previously healthy 22-month-old boy presented with fever, vomiting, and altered sensorium for 10 days. He had coagulopathy and deranged liver functions. He was evaluated for underlying etiology and managed on lines of PALF. Due to persistent bicytopenia and excessively high ferritin levels, HLH was strongly suspected though he did not fulfill all clinical criteria for the diagnosis of HLH. Presence of seizures and cerebrospinal fluid analysis was suggestive of central nervous system involvement. There was no evidence of primary HLH on genetic evaluation. Real-time polymerase chain reaction amplifications were positive for RSV and influenza A H1N1, confirming the causative triggers. After the administration of immunosuppressants and oseltamivir, the patient's symptoms improved dramatically and he recovered completely. To the best of our knowledge, this is the fourth case reported worldwide till date of successful rescue of ALF in a child associated with HLH completely without resorting to liver transplantation. Clinical vigilance is crucial for possible presence of HLH with varied initial presentations in PALF despite incomplete diagnostic criteria, with detailed etiological workup for commencing life-saving therapy in time.

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Validated age-specific reference values for CSF total protein levels in children

Kahlmann

Roodbol

Leeuwen

et al. 2017

European Journal of Paediatric Neurology

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Reference Range for Cerebrospinal Fluid Protein Concentration in Children and Adolescents

Cited by 7 publications

References 7 publications

Reference intervals: current status, recent developments and future considerations

Reference intervals: current status, recent developments and future considerations

Early Detection and Rescue of an Unusual Case of Pediatric Acute Liver Failure Associated with Secondary Hemophagocytic Lymphophagocytosis: Case Report from a Liver Transplant Center in India

Validated age-specific reference values for CSF total protein levels in children

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