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The page below is a sample from the LabCE course Cerebrospinal Fluid. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Clot formation is always abnormal and is often due to increased levels of protein, especially fibrinogen. When the protein level is 1000 mg/dL, clot formation will most likely occur. However, clots may also form at protein levels below 1000 mg/dL.
Some clots may be very fine and appear as a thin membrane or "scum" on the surface of the CSF specimen. This type of clot is referred to as a pellicle. Pellicles are composed of fibrinogen and white blood cells.
The type of clot formed may give some specific information about the disease state. Table 3 provides some examples.
Table 3. CSF Specimen Clots.
Example of ConditionType of Clot
Bacterial meningitisPellicle forms in a short time; large clot formation follows
TB meningitisWeb-like clot (pellicle) after 12–24 hours (enhanced by refrigeration)
ParesisIncomplete clot
Blockage of CSF circulationCompletely clotted due to presence of high levels of protein