Erythrocyte Sedimentation Rate (ESR)

ESR

1. ERYTHROCYTE SEDIMENTATION RATE (ESR)   P SUNIL KUMAR Haematology & Transfusion Medicine St.John’s Medical College Bangalore 13-Oct-18 1 SUNIL KUMAR. P

2. - Definition -Methods Principle Normal ranges Procedure Advantages Increased and decreased conditions 13-Oct-18 2 SUNIL KUMAR. P

3. Definition The rate at which erythrocytes settle down at the bottom of the tube at 1 st one hour is regarded as erythrocyte sedimentation rate. ESR is a commonly used nonspecific test in routine clinical practice 13-Oct-18 3 SUNIL KUMAR. P

4. METHODS Wintrobes Method Westergren's Method Microsedimentation ( Landau) method Capillary method (Micro ESR method) Automated method ( Analysers ) 13-Oct-18 4 SUNIL KUMAR. P

5. DETERMINATION OF ESR BY (WESTERGEN’S METHOD) Method : Westergren's Method It has been proved as the international reference method . 13-Oct-18 5 SUNIL KUMAR. P

6. Westergren's tube Description It is a straight glass tube 30cm in length and 2.5mm in a diameter with a capacity of 1ml. A scale graduated in mm from (0-200mm). Specially made racks with adjustable leveling screws are available for holding the sedimentation tube in vertical position. 13-Oct-18 6 SUNIL KUMAR. P

7. Normal Range / Biological Reference Range : Male : 0 – 10 mm after 1hour Female : 0 – 20mm after 1 hour Children : 0- 10mm after 1 hour 13-Oct-18 7 SUNIL KUMAR. P

8. PRINCIPLE When a anticoagulated blood is placed in a vertical tube and is allowed to stand, RBCs settle towards the bottom of the tube. The speed of sedimentation of red cells in plasma over a period of 1 hour is measured by the length of the sedimented RBC column and is expressed in milimeters . 13-Oct-18 8 SUNIL KUMAR. P

9. RBCs have net negative charge on their surface and tend to repeal each other. The repulsive forces are partially or totally counteracted if there is an increase in the positively charged plasma proteins 13-Oct-18 9 SUNIL KUMAR. P

10. Factors affecting ESR Plasma factors : Eg, Fibrinogen , Globulins. Red Cell factors : A. Number- Eg Anaemia Polycythemia B.Size C.Rouleaux formation D.abnormal or irregular shape Technical factors : ESR tube must be kept in vertical, other wise it results inaccurate ESR 13-Oct-18 10 SUNIL KUMAR. P

11. Requirements ESR vacutainer tubes Westergren's tube ESR stand Suction device Sodium Citrated blood sample 13-Oct-18 11 SUNIL KUMAR. P

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14. Specimen Required 1.6 ml of blood + 0.4 ml of 3.8% sodium citrate 13-Oct-18 14 SUNIL KUMAR. P

15. Specimen collection & Storage Test should be set up within 2 hrs after collection 13-Oct-18 15 SUNIL KUMAR. P

16. procedure 1.Fill the Westergren's tube exactly up to Zero mark by means of rubber bulb ( avoid air bubbles). 2. Place the tube upright in the stand. It should fit evenly into the groove of the stand 3.Note the time. Allow the tube to stand for exactly one hour 4.Exactly after one hour, note the level to which the red cell column has fallen. 5.Report the result in terms of mm/after 1 hour. 13-Oct-18 16 SUNIL KUMAR. P

17. Phases of ESR Phase of rouleaux formation- 10 min Phase of sinking - 40 min Phase of packing - 10 min 13-Oct-18 17 SUNIL KUMAR. P

18. Westergren’s method 13-Oct-18 18 SUNIL KUMAR. P

19. DETERMINATION OF ESR BY WINTROBE METHOD Wintrobe’s Method: ESR is estimated on anticoagulated blood in a Haematocrit tube which is also used for PCV estimation. A dvantage of this method is that same tube is used for PCV and ESR. 13-Oct-18 19 SUNIL KUMAR. P

20. Normal range: 0-9 mm fall at 1hr in males 0-20 mm fall at 1 hr in females. 13-Oct-18 20 SUNIL KUMAR. P

21. Requirements Wintrobes tube Wintrobes tube stand Pasteur pipette or 2 ML syringe with needle Timer or watch Sodium citrate blood sample (3.8%) 13-Oct-18 21 SUNIL KUMAR. P

22. Procedure 1. Mix the blood carefully 2.Fill the Wintrobes tube zero mark by using a Pasteur pipette or by using a syringe 3.place the tube in exact vertical position in the stand . Set the timer for one hour 4.At the end of one hour note the level of erythrocyte count in terms of mm after 1 hour 13-Oct-18 22 SUNIL KUMAR. P

23. Wintrobes method ….. 13-Oct-18 23 SUNIL KUMAR. P

24. INCREASED ESR VALUES SEEN IN Infections Inflammation Hyper fibrinogenemia Hyper gammaglobenemia Multiple myeloma SLE, RA Malignancy Old age Pregnancy Tuberculosis 13-Oct-18 24 SUNIL KUMAR. P

25. DECREASED VALUES SEEN IN…. Extreme leukocytosis RBC abnormalities Sickle cell anemia Protein abnormalities Hypo fibrinogenemia Hypo gammaglobenemia Hereditary spherocytosis 13-Oct-18 25 SUNIL KUMAR. P

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27. Q : Define ESR; discuss Wintrobes method of ESR estimation and factors influencing ESR, normal ranges. ( 5 Marks) 13-Oct-18 27 SUNIL KUMAR. P

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