PENGAMBILAN

SPESIMEN LCS
Liquor Cerebro Spinal (LCS)
Cairan otak adalah cairan yang berada di
dalam ruang atau ventrikel otak, ependymal
lining ventricle dan rongga subarachnoid.

Cairan yang menyelimuti susunan saraf

pusat

Cairan otak yang diambil melalui pungsi

lumbal
 FUNGSI LCS
Pengatur
Pelindung otak atau eksitabilitas dengan
tulang belakang mengatur komposisi
ion

Membawa keluar
metabolit – metabolit Memberikan
(otak tidak perlindungan
mempunyai terhadap tekanan
pembuluh limfe)
TUJUAN PEMERIKSAAN LCS
Mengetahui adanya
kelainan pada otak
Meningitis
maupun sumsum
tulang

Tumor Abcess

Ensefalitis dan
infeksi virus pada
daerah tersebut.
 PEMERIKSAAN LCS
Pemeriksaan
1. Rutin
- Makroskopis
-
-
Mikroskopis 2. Pemeriksaan Fisik
Kimia
- Tekanan
- Bakteriologi

Pemeriksaan
3. Khusus
- Elektroforesa Protein
- Imunoelektroforesa
- Serologi
- Immunoglobulin
PEMERIKSAAN MAKROSKOPIS

Warna

Kekeruhan

PH

Konsistensi (Bekuan)

Berat Jenis
 PEMERIKSAAN MAKROSKOPIS
Metode Visual (Manual)

Tujuan Untuk mengetahui cairan LCS secara makroskopis

meliputi warna, kekeruhan , PH ,konsistensi (bekuan),
dan berat jenis

Alat - Tabung Reaksi

- Beaker Gelas

- Kertas Indikator PH Universal

- Refraktometer Abbe

Spesimen Cairan LCS

Prinsip Pada keadaan normal wujud LCS seperti air, dengan

membandingkannya dapat dinilai adanya perubahan
pada LCS
 Cara Kerja
• Tabung reaksi diisi aquadest secukupnya sebagai
pembanding
• Contoh bahan diisikan pada tabung reaksi yang sama
Tes Warna, Kekeruhan, ukurannya dengan pembanding
dan Bekuan • Kedua tabung diletakkan berdekatan dengan latar
belakang kertas putih
• Bandingkan contoh bahan dengan aquadest

• Cairan LCS diteteskan 1-2 tetes dan

Tes Berat Jenis
diperiksa pada eye piece BJ
 Interpretasi Hasil
Warna
Diamati warna pada
LCS dengan aquades Bekuan
sebagai pembanding.
Kejernihan / Kekeruhan

Tidak ada
0 = jernih (negative)
+1 = berkabut Ada bekuan
+2 = kekeruhan ringan (positif)
+3 = kekeruhan nyata
+4 = sangat keruh
No. Parameter Penilaian Normal
1. Warna Tidak berwarna, Kuning Tidak Berwarna
muda,Kuning,
Kuning Tua, Kuning coklat,
Merah, Hitam Coklat

2. Kejernihan Jernih, agak keruh, keruh, Jernih

sangat keruh, keruh
kemerahan

3. Bekuan Tidak ada bekuan, ada Tidak ada

bekuan bekuan

4. Ph 7,3 atau setara dengan pH

plasma / serum
5. BJ 1.000 – 1.010 1.003 – 1.008
 Konsistensi Bekuan
Bekuan -> banyak darah yang
masuk LCS yang bercampur
darah dalam jumlah
Normal -> tidak terlihat banyak pada kedua
bekuan Adanya bekuan
tabung, tidak dapat
Bekuan -> banyak fibrinogen diperiksa, karena akan terlihat berupa kabut
yang berubah menjadi fibrin. sama hasilnya dengan putih yang
Disebabkan: trauma pungsi, menggumpal karena
pemeriksaan dalam
meningitis supurativa, atau bekuan terdiri atas
darah terutama bila
meningitis tuberculosa. benang fibrin.
ada bekuan merah
Jendalan sangat halus LCS sebagaimana darah
didiamkan di dalam almari es
membeku
selama 12-24 jam
 PEMERIKSAAN MIKROSKOPIS
Syarat Pemeriksaan :
Dilakukan dalam waktu < 30’, karena bila lebih dari 30’jumlah sel akan
berkurang yang disebabkan :
• Sel mengalami sitolisis
• Sel akan mengendap sehingga sulit mendapat sampel yang homogen
• Sel terperangkap dalam bekuan
• Sel cepat mengalami perubahan morfologi
 HITUNG JUMLAH SEL
Metode Bilik Hitung

Prinsip LCS diencerkan dengan larutan Turk pekat akan ada

sel leukosit dan sel lainnya yang lisis dan dihitung
selnya dalam kamar hitung di bawah mikroskop.

Tujuan Untuk mengetahui jumlah sel dalam cairan LCS

Alat dan Reagensia - Mikroskop

- Hemaocytometer : Bilik hitung Improved

Neaubauer, kaca penutup, pipet thoma leukosit

- Larutan Turk pekat : Kristal violet 0,1 gram, asam

asetat glacial 10 ml dan aquadest 90 ml
Cara Kerja - Larutan turk pekat diisap sampai tanda 1 tepat
- Larutan LCS diisap sampai tanda 11 tepat
- Dikocok perlahan dan dibuang cairan beberapa
tetes
- Diteteskan pada bilik hitung dan dan dihitung sel
dalam kamar hitung pada semua kotak leukosit di
mikroskop lensa objective 10x/40x

Interpretasi Jumlah sel normal = 0 – 5 sel / mm3

 HITUNG JENIS SEL
Metode • Tetes tebal dengan pewarna Giemsa

• Objek glass
• Kaca penghapus
• Sentrifuge
Alat dan reagensia • Tabung reaksi
• Metanol absolut
• Giemsa
• Timer

Spesimen • LCS
 Cara Kerja
 Cairan LCS dimasukkan dalam tabung secukupnya
 Disentrifugasi selama 5 menit 2000 rpm
 Supernatant dibuang dan endapan diambil
 Diteteskan dalam object glass dan dibuat preparat hapusan tebal
 Dikeringkan dan difiksasi selama 2 menit dengan methanol
absolut
 Diwarnai dengan Giemsa selama 15 – 20 menit
 Dicuci dan diperiksa di mikroskop lensa objektif 100x dengan
imersi
 Interpretasi Hasil

Normal MN PMN
100% 0%
 BAKTERIOSKOPI
• Dari pemeriksaan bakteliologi terhadap LCS, bakteri yang sering muncul
ialah :
Mycobacterium tuberculosa, Neisseria meningitidis, Streptococcus
pneumoniae, dan Haemophillus influenzae.
• Dengan melakukan pemeriksaan bakteriologi, sering sudah di dapatkan
petunjuk ke arah etiologi radang.
• Pemeriksaan yang paling diperlukan adalah pewarnaan Gram dan Ziehl
Neelsen.
• Specimen yang dipakai untuk pewarnaan ini sebaiknya memakai
sedimen dari LCS. Untuk pewarnaan tahan asam (Ziehl Neelsen) baik
juga dipakai specimen bekuan halus dekat permukaan LCS.
 KIMIAWI

• Analisa kimia LCS membantu diagnosis / menilai prognosis.

• Pemeriksaan rutin yang dilakukan :
- penetapan protein secara kualitatif
- kadar protein
- kadar glukosa
- kadar klorida 
 PROTEIN KUALITATIF
• Keadaan normal cairan otak mengandung sedikit sekali
protein
• Perbandingan antara albumin dan globulin LCS leih
kecil daripada dalam plasma
• Konsentrasi protein ↑ :
- Permeabilitas sawar darah-otak ↑ oleh radang
- Meningitis yang berat 
 PANDY
• Prinsip : reagen pandy memberikan reaksi terhadap protein (albumin dan globulin) dalam bentuk
kekeruhan. Pada keadaan normal tidak terjadi kekeruhan atau kekeruhan yang ringan seperti kabut.

• Alat dan reagen yang dipakai

- Tabung serologi (garis tengah 7 mm)
- Kertas putih
- Reagen Pandy (larutan phenol jenuh dalam air) 

• Cara pemeriksaan :
- Ke dalam tabung serologi dimasukkan 1 ml reagen Pandy
- Tambahkan 1 tetes LCS
- Kemudian dilihat segera ada tidaknya kekeruhan.

• Interprestasi hasil
- Negatif : tidak ada kekeruhan
- Positif : terlihat kekeruhan yang jelas 
+1 : opalescent (kekeruhan ringan seperti kabut)
+2 : keruh 
+3 : sangat keruh
+4 : Kekeruhan seperti susu

• Nilai normal   : (-) / (+1)

 NONNE APELT
• Prinsip : reagen Nonne memberikan reaksi terhadap protein globulin dalam bentuk
kekeruhan yang berupa cincin. Ketebalan cincin  berhubungan dengan kadar globulin,
makin tinggi kadarnya maka cincin yang terbentuk semakin tebal.

• Alat dan reagen yang dipakai :

- Tabung serologi (garis tengah 7 mm)
- Reagen Nonne (larutan ammonium sulfat jenuh dalam air) 

• Cara pemeriksaan :
- Ke dalam tabung serologi dimasukkan 1 ml reagen Nonne
- Tambahkan 1 ml LCS dengan cara pelan-pelan sehingga terbentuk 2 lapisan,dimana
lapisan atas adalah LCS
- Diamkan selama 3 menit.
- Kemudian dilihat pada perbatasan kedua lapisan dengan latar belakang gelap
 
• Interprestasi hasil :
Negatif : tidak terbentuk cincin antara kedua lapisan
+1 : cincin yang terbentuk menghilang setelah dikocok (tidak ada bekasnya).
+2 : setelah dikocok terjadi opalesensi
+3 : mengawan setelah dikocok
• Normal : (-) 
 PROTEIN KUANTITATIF
• Metode : Biuret

• Prinsip :
Protein dalam sampel bereaksi dengan ion cupri (II) dalam medium alkali membentuk
komplek warna yang dapat diukur dengan spektrofotometer 

• Tujuan : Untuk menetapkan kadar protein dalam LCS.

• Alat :
- Tabung reaksi
- Mikropipet  20 µLdan 1000 µL.
- Tip kuning dan biru.
- Fotometer

• Reagensia :
- Reagen Kerja:  Cupri (II) asetat 6 mmol/L, Kalium Iodida 12 mmol/L, NaOH 1,15
mol/L, deterjen.
- Reagen standard : 8,0 g/dL 
- Stabilitas : Reagensia stabil setelah dibuka sampai kadaluarsa bila disimpan pada
suhu ruang.
• Cara Kerja :
-Masukkan ke dalam tabung berlabel
Blanko Standar Sampel

Standar - 20 µl  -

Serum - - 20 µl

Reagen kerja 1000 µl 1000 µl 1000 µl

- Campur dan inkubasi selama 10 menit pada suhu ruang.

- Diukur absorben standar dan sampel pada Photometer dengan Panjang
gelombang 578 nm terhadap blanko reagent.

• Perhitungan :
Total Protein   = 
Absorben  sampel     x konsentrasi standar (8,0 g/dL)
                                Absorben standard 
     = ………………..g/dL  x 1000
   = …………mg/dL

• Nilai Normal   : 15 – 45 mg/dl

 GLUKOSA KUANTITATIF
• Menyusutnya kadar glukosa dalam LCS meningitis purulenta
(metabolisme leukosit & bakteri ↓ kadar glukosa 0).

• Semua mikroorganisme menggunakan glukosa pe↓ kadar glukosa

dapat disebabkan oleh : fungi, protozoa, bakteri tuberculosis, dan
bakteri piogen.

• Meningitis oleh virus  sedikit me↓ kadar glukosa dalam LCS.

• Metode                :            GOD-PAP
• Prinsip                  :
Glukosa dioksidasi oleh glukosa oksidase menghasilkan hidrogen peroksida yang
bereaksi dengn 4-aminoantipirin dan fenol dengan pengaruh katalis peroksidase
menghasilkan quinoneimine yang berwarna merah.

• Tujuan                  :Untuk menentukan kadar glukosa dalam LCS

• Reaksi                 : 
Glukosa + ½  O2  + 2 H2O  glukosa oxidase      Glukonate + H2O2.
2 H2O2 + 4-Aminoantipyrine + Phenol  POD  Quinoneimine + 4 H2O 

• Alat                      :
-     Tabung reaksi kecil                               - Timer
-     Mikropipet 10 dan 1000 µl                    - Tissue
-     Tip kuning dan biru                                - Rak Tabung
-     Fotometer

• Reagensia :
-     Reagen kerja Glukosa
-     Reagen standar  Glukosa 100 mg/dl
-     Stabilitas : Reagensia stabil setelah dibuka sampai kadaluarsa bila disimpan pada
suhu 2-8°C.
• Cara kerja: Blanko Standar Sampel
-    Dipipet ke dalam tabung :
Standar - 10 µl -

Serum - - 10 µl

Reagen Kerja 1000 µl 1000 µl 1000 µl

-   Dicampur dan diinkubasi pada suhu ruang selama 10 menit.

-   Diukur absorben standar dan sampel pada Photometer terhadap blanko dengan
panjang gelombang 546 nm.
 
• Pengamatan dan Pembacaan :
-   Absorben blanko aquabidest  : 0,000
-   Dicatat Absorben pengukuran reagent blanko, standar dan sampel 

• Perhitungan :
Glukosa          = 
Absorben  sampel     x konsentrasi standard (100 mg/dL)
                           Absorben standard     
=………………. mg/dL

• Nilai Normal : 45 – 70 mg/dL

 CHLORIDA KUANTITATIF
• Metode : TPTZ

• Prinsip :
Ion Chlorida bereaksi dengan Mercury (II), 2,4,4-tri-(2 pyridil)-S-triazide
kompleks (TPTZ) membentuk merkuri (II) chlorida. TPTZ bebas
bereaksi dengan ion besi (II) menghasilkan warna biru kompleks.
Perubahan absorben pada 578 nm sebanding dengan kadar chlorida. 
• Cara Kerja           :

Blanko Standar Sampel

Standar - 10 µl -

Serum - - 10 µl

Reagen Kerja 1000 µl 1000 µl 1000 µl

- Dipipet ke dalam tabung:

- Dicampur dan diinkubasi pada suhu ruang selama 10 menit.
- Diukur absorben standar dan sampel pada Photometer terhadap blanko dengan
panjang gelombang 546 nm.

• Perhitungan :
  Chlorida  =
  Absorben  sampel     x konsentrasi standard (100 mmol/L)               
                     Absorben standard
      =………………. mmol/L

• Nilai Normal : 98 - 106 mmol/L

TERIMA KASIH
 01
Information
You can enter a subtitle here if you need it
What is a laboratory?
Do you know what helps you make your point
crystal clear? Lists like this one:
● They’re simple
● You can organize your ideas clearly
● You’ll never forget to buy milk!
And the most important thing: the audience
won’t miss the point of your presentation
 Laboratory financing

Public funding Private funding

Mercury is the closest planet Venus has a beautiful name
to the Sun and the smallest and is the second planet from
one in the Solar System—it’s the Sun. It’s hot and has a
only a bit larger than the Moon poisonous atmosphere
 Types of laboratories

Medicinal Biological Chemical

Mercury is the Venus has a Despite being red,
closest planet to the beautiful name and Mars is actually a
Sun and the smallest is the second planet cold place. It’s full of
of them all from the Sun iron oxide dust
 Laboratory characteristics

Staff Equipment
Mars is actually a very Venus has extremely
cold place high temperatures

Research Results
Jupiter is the biggest Saturn is a gas giant
planet of them all and has several rings
 Skills of laboratory staff
Chemical Physics Mathematical
knowledge knowledge knowledge
Mars is actually a very Venus has extremely Neptune is very far
cold place high temperatures away from the Sun

Biological Equipment Methodological

knowledge skills character
Mercury is the closest Saturn is a gas giant Jupiter is the biggest
planet to the Sun with several rings planet of them all
Awesome
Words
“This is a quote, words full of
wisdom that someone
important said and that can
inspire the reader.”
—Someone Famous
A picture is worth a
thousand words
Meet the
laboratory staff
Images reveal large amounts of
data, so remember: use an
image instead of a long text.
Your audience will appreciate it
 1791
The year in which the physician and chemist Antoine
Francois Four proposed the creation of laboratories in
hospitals for chemical analysis
 9h 55m 23s
Jupiter's rotation period

333,000
The Sun’s mass compared to Earth’s

386,000 km
Distance between Earth and the Moon
 Most analyzed samples
20% 30% 50%

Synovial fluid Urine Blood

Neptune is the fourth- Mercury is the closest Saturn is the second-
largest planet in the planet to the Sun and largest planet in the
Solar System the smallest of them all Solar System
 Learn more on the website

You can replace the image on the screen with your own
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 Interact from
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You can replace the image on
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and select “Replace image”
Download our
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Laboratorium highlights
United States
Jupiter is the biggest
planet of them all

India
Mercury is the closest
planet to the Sun
 Laboratory history

1XX 1XX 1XX 2XX

X X X X

First lab Institution Quality Actuality

Mercury is the Venus has a Earth is the third Jupiter is the
closest planet to beautiful name planet from the biggest planet of
the Sun and is very hot Sun and has life them all
 Organization of a laboratory
Directors

Plant A Plant B Plant C

Staff Staff Staff

Clients Clients Clients

 Duties of laboratory personnel

Staff 1 Staff 2 Staff 3

Mercury is the closest Venus is the second Ceres is located in the
Function 1 planet to the Sun planet from the Sun main asteroid belt

Jupiter is the biggest Saturn is composed of Neptune is the farthest

Function 2 planet of them all hydrogen and helium planet from the Sun

Pluto is now
Earth is the only planet The Moon is Earth’s
Function 3 that harbors life
considered a dwarf
only natural satellite
planet
 Percentage of labs in the world
35% Asia
Venus is a hot planet

25% America
Mercury is very small

20% Europe
Mars is a cold planet

20% Others
Follow the link in the graph to modify its data and then
Saturn is a gas giant paste the new one here. For more info, click here
 Our staff

Jenna Hills Susan Bones John Doe

You can speak a bit You can speak a bit You can speak a bit
about this person here about this person here about this person here
 True or false
Select the correct answer from the following table

Statement False True

Laboratories do not need staff X
The USA have the most laboratories in the world X
Antoine Francois proposed laboratories in hospitals X
Blood is the most studied liquid X
The first laboratory was created in 2022 X
 Select the correct answer
Write the correct answer

Laboratory Elements of a Types of

characteristics laboratory laboratories

Staff Pipettes Medicinal

Research Telescope Musical

No research Mortar Biological

 Connect the columns
Correctly relates the information in the columns

Year in which hospital labs are proposed Asia

The largest laboratories are in 1791

It has the highest percentage of labs Staff

It is essential for laboratory operation The blood

It is the most chemically tested fluid the United States & India

It was he who proposed hospital labs Antoine Francois Four

 Laboratory crossword puzzle
Find the words and highlight them

s a f h s u g c g e p o f r b f

t t l a b o r a t o r y x o a q

a i a w j v f s a m p l e s e a

f l s o t s i r a h w l n a o j

f y k d p p m i c r o s c o p e

a b l o o d e d j i s v m k t c

Laboratory Staff Blood Microscope Samples Flask

 Questions and Answers
When were laboratories invented?
1
You can write your answer here

What are the characteristics of laboratories?

2
You can write your answer here

What is studied in laboratories?

3
You can write your answer here
Getting to know laboratories
Describe what you see in the laboratory

● Write here what you see

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 Elements of laboratories
Color the elements that belong to a laboratory in yellow

Telescopes Microscopes Fire

Flasks Powder Test tubes

Pipettes Rocks Satellites

Robots Mortar Micropipettes

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