Erythrocyte sedimentation rate

HEALTH SCIENCE STUDENTS WILL BE BENEFITED

1. ERYTHROCYTE SEDIMENTATION RATE 06-Nov-17 G.KALAIVANI 1

2. ERYTHROCYTE SEDIMENTATION RATE COMMONLY USED NON SPECIFIC TEST IN ROUTINE CLINICAL PRACTICE OTHER HIGH SENSITIVITY INFLAMMATORY MARKERS ( EG. C-REACTIVE PROTEIN) ARE PRESENTLY USED TO DETECT OR MONITOR DISEASE ( EG. CARDIOVASCULAR DISEASE AND METABOLIC SYNDROME ) 06-Nov-17 G.KALAIVANI 2

3. ERYTHROCYTE SEDIMENTAION RATE PRINCIPLE WHEN ANTICOAGULATED BLOOD IS PLACED IN A VERTICAL TUBE AND IS ALLOWED TO STAND,RBCS SETTLE TOWARDS THE BOTTOM OF THE TUBE SPEED OF SEDIMENTATION OF RED CELLS IN PLASMA OVER A PERIOD OF 1 HOUR IS MEASURED BY THE LENGTH OF THE SEDIMENT RBC COLUMN AND IS EXPRESSED IN MILLIMETERS 06-Nov-17 G.KALAIVANI 3

4. ERYTHROCYTE SEDIMENTAION RATE RBCS HAVE NET NEGATIVE CHARGE ON THEIR SURFACE AND TEND TO REPEL EACH OTHER .THE REPULSIVE FORCES ARE PARTIALLY OR TOTALLY COUNTERACTED IF THERE IS AN INCREASE IN THE POSITIVELY CHARGED PLASMA PROTEINS THIS PROCESS IS CALLED “SEDIMENTATION” OVER A PERIOD OF 1 HOUR IS MEASURED BY THE LENGTH OF THE SEDIMENT RBC COLUMN EXPRESSED IN MILLIMETERS 06-Nov-17 G.KALAIVANI 4

5. STAGES OF ESR SEDIMENTATION OCCUR IN 3 STAGES STAGE OF AGGREGATION (FORMATION OF A NUMBER OF THINGS INTO A CLUSTER)/ROULEAUX FORMATION : IN THE INITIAL 10 MINUTES, THERE IS LITTLE SEDIMENTATION AS ROULEAUX FORM AND THE SIZE OF THE ROULEAUX FORMED INFLUENCED THE SPEED OF SEDIMENTAION STAGE OF SETTLING: FOR 40 MINUTES ,SETTLING OCCURS AT A CONSTANT RATE STAGE OF PACKING: PACKING OF RBCs OCCURS IN THE FINAL 10 MINUTES 06-Nov-17 G.KALAIVANI 5

6. ERYTHROCYTE SEDIMENTATION RATE 06-Nov-17 G.KALAIVANI 6

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12. WINTROBE ESR - PROCEDURE WHOLE BLOOD COLLECTED IN WINTROBE,S” BALANCED OXALATE “ OR EDTA USING THE SPECIAL PIPETTE,TRANSFER WELL MIXED BLOOD FROM THE SAMPLE BOTTLE FILL THE SPECIAL WINTROBE TUBE TO THE 0.0 MARK NEAR THE TOP OF THE TUBE (THE TUBE CONTAIN ABOUT 1ml OF BLOOD) 06-Nov-17 G.KALAIVANI 12

13. WINTROBE ESR – PROCEDURE PLACE IT VERTICALLY IN THE STAND & NOTE THE TIME EXACTLY AFTER 1 HOUR,EXAMINE THE TUBE NOTE THE READING OF THE LEVEL OF THE TOP OF THE RBC COLUMN THIS READING IN mm CORRESPONDS TO THE ESR 06-Nov-17 G.KALAIVANI 13

14. ADVANTAGES SIMPLE REQUIRES SMALL AMOUNT OF BLOOD SAME TUBE CAN BE USED FOR BOTH ESR AND PCV BUFFY COAT SMEAR IS USEFUL IN CASES OF LEUKOPENIA 06-Nov-17 G.KALAIVANI 14

15. DISADVANTAGE ESR VALUE HIGHER THAN PCV WHICH CAN NOT BE OBTAINED BY THIS METHOD 06-Nov-17 G.KALAIVANI 15

16. ALTERNATIVELY METHODS CAPILLARY METHOD (MICRO ESR METHOD): REQUIRES ONLY O.2 ml OF BLOOD USEFUL IN PEDIATRIC PATIENTS ZETA SEDIMENTATION RATE : SPECIAL DEVICE ZETAFUGE IS USED AUTOMATED ESR : RESULTS ARE OBTAINED WITHIN 30 MINUTES AND ARE COMPARABLE WITH WESTERGREN 1 HOUR READING ESR STAT PLUS : CENTRIFUGATION –BASED METHOD 06-Nov-17 G.KALAIVANI 16

17. WESTERGREN METHOD VERY SIMPLE COMMONLY USED METHOD 06-Nov-17 G.KALAIVANI 17

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19. WESTERGREN METHOD 06-Nov-17 G.KALAIVANI 19

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21. WESTERGREN ESR – PROCEDURE A WESTERGREN PIPETTE IS FILLED UP TO THE “ZERO” MARK PLACED VERTICALLY IN THE WESTERGREN RACK AT ROOM TEMPERATURE AFTER 60 MINUTES,THE DISTANCE BETWEEN THE TOP OF THE RED CELL COLUMN “ZERO “ MARK IS NOTED IN MILLIMETERRS AS ESR READINGS RESULT: ESR IS EXPRESSED AS mm AT THE END OF ONE HOUR 06-Nov-17 G.KALAIVANI 21

22. ADVANTAGE MORE SENSITIVE ACCURATE METHOD WHEN COMPARED TO THE WINTROBE METHOD BECAUSE THE COLUMN IS LONGER , i.e 200 mm 06-Nov-17 G.KALAIVANI 22

23. MODIFIED WESTERGREN METHOD USES BLOOD WITH ANTICOAGULATED WITH EDTA RATHER THAN WITH CITRATE PRODUCES THE SAME RESULTS ADVANTAGES – MORE CONVENIENT ESR CAN BE PERFORMED FROM THE SAME TUBE OF BLOOD COLLECTED FOR OTHER HAEMATOLOGIC STUDIES ESR CAN BE TWO MILLIMETERS OF WELL –MIXED EDTA –BLOOD IS DILUTED WITH 0.5 ml OF 3.8%SODIUM CITRATE OR WITH 0.5 ml of 0.85% SODIUM CHLORIDE 06-Nov-17 G.KALAIVANI 23

24. Revised normal range for ESR AGE MEN WOMEN Below 50 years 15mm/ hour 20mm/hour Above 50 years 20mm/hour 30mm/hour Above age 85 years 30mm/hour 42mm/hour 06-Nov-17 G.KALAIVANI 24

25. SIGNIFICANCE OF ESR PROGNOSTIC TEST RATHER THAN A DIAGNOSTIC TEST ESR IS ONE OF THE JONES MINOR CRITERIA FOR THE DIAGNOSIS OF RHEUMATIC FEVER 06-Nov-17 G.KALAIVANI 25

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27. PHYSIOLOGICAL FACTORS INFLUENCING THE RATE OF SEDIMENTAION 06-Nov-17 G.KALAIVANI 27

28. APPLICATION OF ESR & CLINICAL SIGNIFICANCE SICKLE CELL DISEASE: LOW ESR IN THE ABSENCE OF PAINFUL CRISIS AND MODERATELY RAISED 1 WEEK INTO THE CRISIS OSTEOMYELITIS: ELEVATED AND USEFUL IN FOLLOW UP STROKE: ESR≥28MM/HOUR IS POOR DIAGNOSTIC FEATURE 06-Nov-17 G.KALAIVANI 28

29. PHYSIOLOGICAL FACTORS INFLUENCING THE RATE OF SEDIMENTAION 1.PLASMA FACTORS – AN ACCELERATED ESR IS FAVOURED BY ELEVATED LEVELS GLOBULINS ,FIBROGEN AND CHOLESTEROL 2.NUMBER OF CELLS – INCREASES IN ANEMIA DECREASES IN POLYCYTHEMIA 3.AGE - ESR IS LOW – CHILDHOOD ELDER PEOPLE SLIGHTLY INCREASED 4.GENDER – ESR IS SLIGHTLY HIGHER IN WOMEN THAN MEN DUE TO THE FACT THAT WOMEN TEND TO HAVE SLIGHTLY LOWER PCV VALUES 5.PREGNANCY – ESR BEGINS TO INCREASE IN THIRD MONTH OF PREGNANCY RETURNS TO NORMAL 3-4 WEEKS AFTER DELIVERY 06-Nov-17 G.KALAIVANI 29

30. APPLICATION OF ESR & CLINICAL SIGNIFICANCE CANCER OF PROSTATE: ESR ≥ 37mm/ hr IS ASSOCIATED WITH HIGHER INCIDENCE OF DISEASE ( PROGRESSION AND DEATH ) PREGNANCY : ESR MODERATELY INCREASES BEGINNING AT THE 10 TH -12 TH WEEK AND RETURN TO NORMAL ABOUT 1 MONTH POSTPARTUM 06-Nov-17 G.KALAIVANI 30

31. LABORATORY FACTORS INFLUENCING THE ESR 1.TEMPERATURE – SEDIMENTATION RATE IS INCREASED AT HIGHER TEMPERATURE NORMALLY PEOPLE HAVE A SLIGHTLY HIGHER ESR ESR IS ALWAYS DONE AT ROOM TEMPERATURE CARE SHOULD BE TAKEN THAT THE APPARATUS IS NOT EXPOSED TO THE DIRECT RAYS OF THE SUN COMING THROUGH A WINDOW OR TO SOME OTHER SOURCE OF HEAT 06-Nov-17 G.KALAIVANI 31

32. 2.TIME PROGRESSIVE BLOOD HAS BEEN STANDING FOR MORE THAN 4 HOURS ESR WILL DECREASE CONSIDERABLY 06-Nov-17 G.KALAIVANI 32

33. 3.ANTICOAGULANTS INFLUENCE SEDIMENTATION POTASSIUM OXALATE – SHRINKS THE CELL AMMONIUM OXALATE – SWELLS THE CELLS IF OXALATED BLOOD IS USED FOR THE ESR,IT SHOULD ONLY BE BALANCED OXALATE OR WINTROBE,S MIXTURE 06-Nov-17 G.KALAIVANI 33

34. 4.THE LENGTH OF THE TUBE ESR IS GREATER WITH LONGER TUBE 5.INCINATION OF THE TUBE IF THE TUBE IS PLACED IN A RACK IN WHICH IT IS SLANTED OR DEVIATED FROM THE VERTICAL THE RATE OF SEDIMENTATION WILL BE INCREASED ENSURE THAT THE TUBES ARE HELD EXACTLY VERTICALLY 06-Nov-17 G.KALAIVANI 34

35. 6.MOVEMENT OR AGITATION OF THE TUBE TUBE SHOULD BE HELD ON A TABLE WHICH IS NOT BEING BUMPED OR VIBRATED SUCH EQUIPMENT AS CENTRIFUGES OR SHAKERS AS AGITATION OF THE BLOOD DURING THE PERIOD OF THE TEST 06-Nov-17 G.KALAIVANI 35

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37. LUPUS ERYTHEMATOUS CELL TEST IN AUTOIMMUNE DISEASES (E.G.SLE, RHEUMATOID ARTHRITIS) VARIETY OF ANTIBODIES ARE FOUND ONE OF THEM IS AN ANTINUCLEAR ANTIBODY (ANA) WHICH CANNOT PENETRATE INTACT CELLS ANAS CAN REACT WITH NUCLEI OF DAMAGED CELLS & CONVERT NUCLEAR CHROMATIN INTO HOMOGENOUS MATERIAL 06-Nov-17 G.KALAIVANI 37

38. LUPUS ERYTHEMATOUS CELL TEST IN VIVO, ANAS ACT ON THE NUCLEI OF DAMAGED CELLS AND DENATURES IT INTO HOMOGENOUS MATERIAL THIS NUCLEAR MATERIAL IS PHAGOCYTOSED IN THE PRESENCE OF COMPLEMENTARY BY PHAGOCYTIC LEUKOCYTE (NEUTROPHIL OR MACROPHAGES) LE CELL IS ANY PHAGOCYTIC LEUKOCYTE TISSUE THEY ARE KNOWN AS LE BODIES OR HEMATOXYLIN BODIES . 06-Nov-17 G.KALAIVANI 38

39. LUPUS ERYTHEMATOUS CELL TEST Tart cell : LE cell has to be differentiated from a tart cell It is a monocyte/neutrophil containing a phagocytosed nucleus of another cell The nuclear material is not homogeneous and it retains its chromatin pattern It may be found in healthy individuals 06-Nov-17 G.KALAIVANI 39

40. PREVIOUS YEAR QUESTIONS ESR (5 MARKS) APRIL 2017 ,FEB/MARCH 2011 FACTORS AFFECTING E.S.R (5 MARKS) FEB/MARCH 2012 E.S.R ESTIMATION BY WINTROBE’S METHOD (5 MARKS) FEB 2010 DEFINE ESR.DISCUSS VARIOUS METHODS OF ESR ESTIMATION AND FACTORS INFLUENCING ESR .(AUGUST 2010 ) ESR – WHAT IS THE NAME OF THE INSTRUMENTS AND ANTICOAGULANTS USED IN ESTIMATION OF E.S.R AND ITS NORMAL VALUES IN MALES AND FEMALES? (3 MARKS) AUG/SEP 2011 06-Nov-17 G.KALAIVANI 40

41. PREVIOUS YEAR QUESTIONS NAME THE ANTICOAGULANT USED IN ESR AND ITS CONCENTRATION?(3 MARKS) SEP 2012 ESTIMATION OF ESR (5 MARKS)MARCH 2013 06-Nov-17 G.KALAIVANI 41

42. COMPLETED ESR 06-Nov-17 G.KALAIVANI 42