Esr

ESR IS ERYTHROCYTE SEDIMATATION RATE.When anticoag ulated blood is allowed to stand in an undisturbed condition for a period of time the erythrocyte tends to sink to the bottom. Two layers are formed, the upper plasma layer & lower one of red cells. The rate at which the red cells fall is known as the erythrocyte sedimentation rate.

1. ESR Ms Ankita R Bhatiya Assistant Professor Shree P.M.Patel COLLEGE OF PARAMEDICAL SCIENCE N TECHNOLOGY

2. It include: 1.What is ESR ? 2.Mechanism of ESR. 3.Factor affecting ESR . 4. Method for detection of ESR

3. ESR INTRODUCTION : Definition : When anticoag ulated blood is allowed to stand in an undisturbed condition for a period of time the erythrocyte tends to sink to the bottom. Two layers are formed, the upper plasma layer & lower one of red cells. The rate at which the red cells fall is known as the erythrocyte sedimentation rate. This process includes : Aggregation : All RBC are come together; Rouleaux formation: when red cells form Rouleaux (RBCs cling together like coins in pile) Sedimentation in which the falling of red cells takes place The larger the aggregation in first stages the faster the rate of fall.  

4. ESR This process includes : Aggregation : All RBC are come together; Rouleaux formation: when red cells form Rouleaux (RBCs cling together like coins in pile) Sedimentation in which the falling of red cells takes place The larger the aggregation in first stages the faster the rate of fall.

5. Patho -physiological factors affecting the ESR value 1. High blood counts tend to lower the sedimentation rate, while low blood count tends to accelerate the rate of fall. 2. In sickle cell anaemia the shape of the cells tends to prevent Rouleau formation & hence sedimentation is low. 3.In hypochromic anaemia the microcytes resist Rouleau formation & sedimentation is retarded. 4. ESR is grater in women than in men & it is related to the difference in PCV.

6. Patho -physiological factors affecting the ESR value 5. During pregnancy ESR increases after 3rd month & returns to normal in about 3 to 4 weeks after delivery. 6. ESR is low in infants & gradually increases up to puberty. 7.The changed levels of plasma protein such as fibrinogen & globulins, which accompany most of the acute & chronic infections, tend to increase Rouleaux formation. ESR is therefore increased in any condition causing increase in fibrinogen or globulin.

7. Laboratory Factors Which Influence ESR : Time: There is progressive decreases in sedimentation in first 4 hrs & after that there is rapid decreases. Length of ESR Tube : ESR is greater with longer tube than with shorter tube. Temperature: The red cell sedimentation is increases at higher temperature.

8. ESR can be done by three methods: 1. Westergren method - Male 0-15 mm/hr, Female 0-20 mm/hr 2. Wintrobe's method - Male 0-9 mm/hr, Female 0-20 mm/hr 3. Landau's method - Male 0-5 mm/hr, Female 0-8 mm/hr Each has its own advantages & disadvantages. The Westergren sedimentation method gives more accurate results & is widely used.

9. ESR can be done by three methods: Westergren Method : In this method Westergren tube is used. It is open at both the ends & is about 30 cm or 300 mm long with a bore diameter of about 2:5 mm with graduation from to 200 mm. Wintrobe’s Method: In this method Wintrobe’s tube is used. It is open at one end & is about 11 cm or 110 mm long with a bore diameter 2.5 or 3 mm & graduated from 0 up to 10 cm with the graduations both in ascending & descending, order. The scale with the markings in ascending order from the top is used in ESR determination while the scale with descending order is used for haematocrit determination. It holds about 1 ml of whole blood. Landau’s Method: In this method landau's pipette is used. It is graduated from 0 to 50 mm. This method is also known as micro sedimentation method & it is used in infants & if blood quantity is insufficient.

10. Westergrn Method Aim: Determination of ESR by Westergren method. Clinical Significance: ESR is increases in all condition where there is tissue break down or where there is entry of foreign proteins in the blood. The determination is useful to check the progress of the disease. If the patient is improving the ESR tends to fall. If the patient's condition is getting worse the ESR tend to rise. The changes of ESR are however not diagnostic of any specific disease. Method : Westergren method

11. Westergren Method Normal Range: Male - 0 to 15 min/hr Female - 0 to 20 min/hr Principle: Anticoagulated blood is taken in a tube & left undisturbed in a vertical position. The level of the column of red cells is noted in the beginning & after 1 hr. Temperature & slanting of tube affect the ESR. Hence always work in a quiet area of the lab, & away from the window in order to avoid temp. variation. Also make sure that the tubes are vertical during the ESR measurement.

12. Westergren Method Requirements: 1.Westergren ESR tube 2.Westergren ESR stand 3.Timer or watch &Sodium citrate specimen: EDTA blood sample

13. Procedure: 1. Identify the right patient. 2. Collect all the requirements. 3. Do the labelling . 4. Collect require amount of blood by vein puncture. 5. In a labelled test tube take 0.4 ml sodium citrate & 1.6 ml blood & mix well. 6. Fill the Westergren tube exactly up to zero mark making certain that there is no air bubble in the blood column drawn through the tube.

14. 7. Place the tube upright in the stand. It should fit evenly into the groove of the stand. 8. Note the time. Allow the tube to stand for exactly one hour. 9. Exactly after one hour note the level to which the red cell column has fallen. 10. Report the result in terms of mm/hr. 11. Put all the requirements back to its place. 12. Clean the working area. 13. Wash the hands.

15. Precaution: 1.Wash the tubes as early as possible under running tap water. Rinse in deionised water & dry in the incubator between 40 to 50 degree. 2.Do not take the reading after half an hour & report a 1 hr. reading after multiplying by 2. The rate is slow in the beginning & fast after about 45 min. 3.Temp. Directly affects the ESR. High temp. leads to false high values & conversely for low temp. The specimen must be brought to room temp. before setting up the test. 4. Tilting of the tube increase the ESR rate. 5.Do not use haemolysed blood.