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The recent “Best Practice” article by Dr Cruickshank1 does not mention pseudoxanthochromia caused by contamination of the cerebrospinal fluid (CSF) with iodine solution at the time of sample collection. The problem seems to occur when iodine solution is applied to the patient's skin and the operator's glove, and then the specimen is contaminated. When combined with a traumatic tap in a normal patient, this technique can mimic the appearance of subarachnoid haemorrhage. Clues to the presence of pseudoxanthochromia are iodine staining around the outside of the specimen container, and the absorbance maximum of iodine is typically 445 nm compared with bilirubin at 450–460 nm. Preparation of the skin with chlorhexidine instead of iodine avoids this source of potential confusion.
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