esrpcvbloodindices-copy-170305110725.pptx

ESR, PCV, MCV,MCHC,MCH, COLOR INDEX

1. ESR, PCV AND BLOOD INDICES

2. OBJECTIVES OF THIS CLASS To perform and interpret ESR To perform and interpret PCV To perform and interpret Blood Indices

3. ERYTHROCYTE SEDIMENTATION RATE (ESR) ESR is the measurement of the rate of sedimentation of red cells in anti-coagulated blood. Blood is allowed to stand for 1 hr in an open-ended glass tube mounted vertically on a stand Length of column of plasma above the red cells is measured in mm.

4. An ticoagulated blood is drawn up into a tube of standardi zed dimensions and left in a vertical position for exactly one hour By that time, the red cells would have separated and settled from the plasma. Upper plasma column is recorded by reading from the scale on the side of the tube. Measures the distance that RBCs will fall in a vertical tube over a given time period Initial screening tool and also as a follow-up test – monitor therapy and progression or remission of disease

5. Three definite phases: First or Lag Phase (10mins) – red cells form a characteristic rouleaux pattern (aggregation) and sedimentation is generally slow. (Pack of coins) Decantation Phase (40mins) – The rate accelerates in this phase; fast settling or sinking of RBCs Final Packing Phase (last 10mins) – slows again as red cell aggregates pile up at the base of the tube. There is slow sedimentation.

6. FACTORS AFFECTING ESR Plasma factor RBC factor Technical factor

7. PLASMA FACTORS Increased fibrinogen increases rouleaux formation thereby increasing ESR S. haptoglobulin , C - reactive protein & cholesterol also increases ESR Albumin and lecithin decreases sedimentation i.e. decreasing ESR

8. RBC FACTORS Primarily through changes in number and/or shape Anemia responsible for increased ESR Microcytes – sediment more slowly Macrocytes – sediment faster

9. Poikilocytosis retards ESR because abnormal shape hampers rouleaux formation Anticoagulants – Sodium citrate & EDTA doesnot affect ESR oxalates & heparin may affect

10. T E CHN I CA L F A C T O R S Poor temperature control Length and bore of the tube Vibration Verticality

11. MET H O D S Westergren’s method Wintrobe’s method Micro - ESR Automated systems Zeta sedimentation

12. The method for measuring the ESR recommended by the International Council for Standardization in Haematology (ICSH) Based on that of Westergren, who developed the test in 1921 for studying patients with pulmonary tuberculosis.

13. CONVENTIONAL WESTERGREN METHOD The recommended tube is a straight glass or rigid transparent plastic tube 30 cm in length 2.55 mm in diameter. Bore must be uniform A s c a l e g r ad u a t e d i n mm ex t en d s over the lower 20 cm.

14. For the diluent, 3.8 g/dl Trisodium citrate used Dilution – 1:4 0.25ml trisodium citrate : 1ml blood Mix the blood sample thoroughly and then draw it up into the Westergren tube to the 200 mm mark by means of a rubber teat or a mechanical device

15. Place the tube exactly vertical ex a c t ly 60 m in, f ree and lea v e u ndi st urbed for from vibra t i o ns a n d dra u gh t s a n d n o t e xp ose d t o d i r e c t sunlight. Then read to the nearest 1 mm the height of the clear plasma above the upper limit of the column of sedimenting cells. Westergren pipette filled with blood and placed vertically on the rubber cork in the rack

16. ERYTHROCYTE SEDIMENTATION RATE Average ESR value by Westergren Method: Male – 3-5mm Female – 4-7mm

17. PROCEDURE – WINTROBE METHOD Add well mixed double oxalate / EDTA blood to the zero mark of the Wintrobe tube, using a pipette Avoid air bubbles Place in vertical position in a rack and let sit for 60 minutes Read and record results in millimeter (distance which the cells have settled)

18. Average ESR value by Wintrobe’s Method: Males: – 9mm/hr Females: – 20mm/hr Children: – 13mm/hr

19. Increased ESR Chronic infections e.g. Tuberculosis Extensive/ Chronic inflammation Collagen vascular disorders o o o Systemic Lupus Erythromatosus Rheumatoid asthritis Systemic Sclerosis Shock Active syphilis Active infectious infections

20. Decreased ESR Newborns Congestive heart failure Polycythemia Marked leukocytosis Allergic states Sickle cell anemia

21. Ratio of volume of RBCs to that of whole blood It indicates relative proportion of red cells to plasma Expressed in percentage. Also called hematocrit or erythrocyte volume fraction PACKED CELL VOLUME

22. Methods: Macrohematocrit method (Wintrobe Method) Microhematocrit method Electronic Method

23. WINTROBES METHOD Wintrobe’s tube – 110mm long, internal bore 2.5mm & a flat inner base. Graded 0-10 on both sides.

24. Method: 1. Mix the anticoagulant blood sample thoroughly 2. Draw blood in a Pasteur pipette Fill the tube upto 10 mark Ce n tr i fug e t h e sa m p l e at 2 00 - 2 3 r p m f o r 30mins Take t h e r e ad i n g of t h e leng t h o f t h e c o l u m n of red cells

25. Buffy coat- WBC& PLATELETS. UPPER MOST LAYER – PLASMA Yellowish-Jaundice Pink-haemolysis Milky-hyperlipidemia

26. PCV reading

27. PRECAUTIONS Use recommended amount of EDTA Test done with in 6-8 hours Wintrobe tube should be filled from below upwards so that no air bubble is trapped.

28. INCREASED PCV Polycythemia -Newborns, High altitude, Hypoxia due to lung and heart diseases. Congestive Heart failure, Burns (loss of plasma), Dehydration, Severe Exercise, Emotional stress DECREASED PCV Anaemia Pregnancy ( H e m o di lu t i o n )

29. RED BLOOD CELL INDICES: 1. Mean corpuscular volume(MCV) 2. Mean corpuscular hemoglobin(MCH) 3. Mean corpuscular hemoglobin concentration(MCHC) 4. Red cell distribution width (RDW)

30. Mean Corpuscular V o lum e (MCV) Average or mean volume of a single red blood cell Expressed in femto liter (fl)

31. Calculation Formula: M CV = PCV in per c en t age X 10 RBC count per cmm Normal range : 80-100 fl

32. INCREASED Megaloblastic anaemia Chronic alcoholism Liver disease newborns DECREASED Microcytic hypochromic anaemia

33. Mean Corpuscular H em og l o bi n ( M CH) Average hemoglobin content (weight of Hb) in a single red blood cell Expressed in picograms(pg).

34. Calculation: Formula: M CH = H b in g m /dl X 10 RBC count per cmm Normal range : 27 – 32 pg

35. I N C RE A S E D Macrocytic anaemia Newborns DECREASED Microcytic anaemia

36. Mean Corpuscular Hemoglobin Concentration(MCHC) Concentration of haemoglobin in 1 dl or 1 liter of packed red cells

37. Calculation Formula: MC H C = H b in g m /dl X 1 00 PCV in % Normal range : 30 – 35 g/dl

38. I N C R E A S ED Hereditary spherocytosis DECREASED Hypochromic anaemia

39. CLINICAL SIGNIFICANCE Macrocytic anaemia: M CV slightly increased upto 150 fl MCH is slightly increased MCHC is normal or diminished Microcytic anaemia: MCV is diminished up to 50 fl or lower MCH is diminished to 15 pg or lower MCHC is diminished to 20% or less Spherocytosis: MCV is diminished MCHC is elevated

40. RED CELL DISTRIBUTION WIDTH Measures the degree of variation of red cell size in a blood sample. Increased in iron deficiency anaemia Decreased in beta- thalassemia trait Normal value: 9.0-14.5