Test ID: TPSF
Protein, Total, Spinal Fluid
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
To detect increased permeability of the blood-brain barrier to plasma proteins
To detect increased intrathecal production of immunoglobulins
Method Name A short description of the method used to perform the test
Measure by Reflectance Spectrophotometry
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Container/Tube: Sterile vial
Specimen Volume: 1 mL
Collection Instructions: Centrifuge specimen to remove any cellular material.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | NA |
| Lipemia | NA |
| Icterus | NA |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| CSF | Refrigerated (preferred) | 72 hours |
| Frozen | 180 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Cerebrospinal fluid (CSF) is secreted by the choroid plexuses, around the cerebral vessels, and along the walls of the ventricles of the brain. It fills the ventricles and cisternae, bathes the spinal cord, and is reabsorbed into the blood through the arachnoid villi. CSF turnover is rapid, exchanging about four times per day. More than 80% of CSF protein content originates from plasma by ultrafiltration through the walls of capillaries in the meninges and choroid plexuses; the remainder originates from intrathecal synthesis. Because CSF is mainly an ultrafiltrate of plasma, low-molecular plasma proteins such as prealbumin, albumin, and transferrin predominate. No protein with a molecular weight greater than that of IgG is present in sufficient concentration to be visible on electrophoresis.
The permeability of the blood-brain barrier to plasma proteins is increased by high intracranial pressure due to brain tumor; intracerebral hemorrhage; traumatic injury; or by inflammation due to bacterial or viral meningitis, encephalitis, or poliomyelitis.
Increased intrathecal synthesis of immunoglobulins, particularly IgG, is seen in demyelinating diseases of the central nervous system (CNS), especially multiple sclerosis. Increased immunoglobulins are also seen in other chronic inflammatory diseases of the CNS such as chronic meningoencephalitis due to bacteria, viruses, fungi or parasites; subacute sclerosing panencephalitis; and Guillian-Barre syndrome.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
> or =12 months: 0-35 mg/dL
Reference values have not been established for patients that are <12 months of age.
Interpretation Provides information to assist in interpretation of the test results
Striking elevations of cerebrospinal fluid (CSF) total protein are noted in bacterial meningitis; smaller elevations occur in the other inflammatory diseases and with tumor or hemorrhage. The effect of any of these conditions is that the proportions of specific proteins in CSF increasingly resemble serum.
In order to assess increased permeability or increased intrathecal production of proteins, simultaneous serum specimen and CSF specimens should be taken.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Specimens should be collected prior to the intrathecal administration of contrast media. Significant positive bias can occur when cerebrospinal fluid (CSF) contains contrast media. If possible, the patient should be recumbent for about one hour before the specimen is drawn. Erect posture causes a redistribution of the body fluid, increasing total serum protein concentration.
Blood in the CSF specimen invalidates the protein value.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Tietz Textbook of Clinical Chemistry. Fourth edition. Edited by CA Burtis, ER Ashwood, DE Bruns. Philadelphia, WB Saunders Company, 2006
2. Killingsworth LM: Clinical applications of protein determinations in biological fluids other than blood. Clin Chem 1982;28:1093-1103
Method Description Describes how the test is performed and provides a method-specific reference
Patient sample is deposited on the slide and is evenly distributed by the spreading layer. Protein in the sample forms a complex with cupric ion and results in the dissociation of the cupric ion from the copper-azo dye complex. The decrease of the copper-azo dye complex is measured by the reflectance spectrophotometry and is proportional to the concentration of proteins in the sample.
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Sunday; Continuously
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
84157
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| TPSF | Protein, Total, CSF | 2880-3 |
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