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Xanthochromia is yellowish cerebrospinal fluid caused by bilirubin from red blood cell breakdown, indicating subarachnoid hemorrhage. Laboratory tests can quantify the amount of pigment present, and spinal tap trauma can cause reddish fluid. Xanthochromia can also refer to yellowish skin discoloration caused by bilirubin.
Xanthochromia is a clinical sign usually indicative of subarachnoid hemorrhage, a type of bleeding that occurs within the brain. In patients with xanthochromia, the cerebrospinal fluid is yellowish in color because it contains bilirubin, a pigment generated during the breakdown of red blood cells. This can be physically visible in a sample, although techniques such as spectrophotometry are usually used to quantify the results, ensuring that a diagnosis is not missed and providing information on the amount of yellow pigment present in the fluid sample. These laboratory tests can be performed in an on-site laboratory or the sample can be sent to another location if a hospital or clinic contracts out the laboratory services.
CSF samples are taken using a technique known as lumbar puncture, in which a needle is inserted into the spinal canal and used to take a small sample of the fluid. Trauma during a spinal tap can cause blood to appear in the cerebrospinal fluid, but specifically, the fluid will be reddish, not yellow, because the enzymes in the body haven’t yet had a chance to break down the blood cells. If a sample is yellowish with xanthochromia, it means that blood has been present in the spinal canal long enough for it to be broken down into components such as bilirubin.
Laboratory tests have shown that red blood cells can break down very quickly, causing bilirubin to appear shortly after a bleed develops. One thing professionals need to consider when a patient requests multiple spinal taps is that the xanthochromia could be the result of bleeding or may be caused by trauma during a previous spinal tap. The patient’s history should be considered in such situations, and doctors may also use medical imaging studies to look for other signs of hemorrhage along the brain and spinal cord.
The term “xanthochromia” is also used more generally to refer to patches of yellowish discoloration on the skin. These are also caused by the blood breaking down and releasing bilirubin. As many people have noticed while watching bruises heal, the initial deposits of blood turn from blue to red and fade to yellow-brown over time as the body breaks down blood cells. Eventually, the bilirubin will also be taken away and expressed by the body. Bilirubin is also the culprit for jaundice, a yellowish discoloration of the eyes and skin seen in people with liver disease whose bodies can’t get rid of the yellow pigment.
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