Scribd
Upload
12 views15 pages

5 Esr

Uploaded by

joshuafadama62
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
12 views15 pages

5 Esr

Uploaded by

joshuafadama62
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 15

ERYTHROCYTE SEDIMENTATION

RATE

O. Addai-Mensah MD MSc. PhD.


ERYTHROCYTE SEDIMENTATION RATE

• Was first described in 1897 by Edmund


Biernacki and confirmed later by Farheus and
Westergreen in 1918.
• It is the rate of fall of RBCs in a tube over a
given period of time(1hr)
• Its is non specific, and is used for the
detection of inflammation and for monitoring
response to treatment in individuals with
certain conditions (TB autoimmune dx’s etc)
• It is easy to perform, widely available and
inexpensive, making it a widely used
screening test.
Principle

• It is determined by the interaction between


factors that promote, and those that resist
sedimentation
• Negatively charged sialic acid residues on the
red cell give the cell an overall negative
charge ( zeta potential)
• RBCs thus, have a general tendency to repel
from each other(like charges)
• Plasma proteins like fibrinogen and gamma
globulins decrease the zeta potential resulting
in rouleaux formation and a consequent
increase in the sedimentation rate
• This explains the increased ESR in some
disease states.
MEASUREMENT OF ESR

• Westergreen
• Modified westergreen
• Wintrobes
• Landau/microsedimentation method
WESTERGREEN METHOD

• The reference method


• Tube 30cm long with an internal diameter of
2.55mm calibrated from 0-200 with a capacity
of 1ml
Procedure

• 2ml of whole blood is added to 0.5ml of 3.8%


sodium citrate and mixed
• Pipette is placed in a vertical position at room
temperature.
• After an hour, the distance from the zero mark
to the top of the RBC column is recorded as
the ESR.
MODIFIED WESTERGREEN

• Here EDTA (2ml diluted with 0.5mls of 3.8%


sodium citrate is used as the anticoagulant.
• Diluted EDTA gives a more precise estimation
WINTROBES METHOD

• A wintrobes tube 110mm long with an internal


diameter of 3mm is used.
• Also graduated from 0-100
• Blood is carefully mixed with EDTA and the
tube filled to the zero mark
• The tube is placed in a vertical position and
the level of the RBcs read after an hour
• (0-9mm/hr,0-20mm/hr)
Landau

• A landau pipette, graduated from 0-55mm is


attached to a suction device.
• 5.0g/dl of citrate solution is pipetted up to the
first line of the stem and fasting capillary
blood drawn up to the 2nd mark
• The citrate/blood mixture is drawn into the
bulb and mixed thoroughly after which the
mixture is forced back into the stem
• Ensure that the upper level mark is set at
zero and the tube placed vertically.
• The reading after one hour is noted as the
ESR
• It is preferred in infants and in situations
where the blood is insufficent
• 0-5mm/hr, 0-8mm/hr
Sedimentation phases

• Lag phase- here little sedimentation occurs


.this occurs in the first 10mins
• Phase of rapid RBC falling- here settling
occurs at a constant rate. Occurs in the
following 40mins
• The packing phase- sedimentation slows as
cells pack at the bottom of the tube. Final
10mins
Normal ESR values

Men
• 17-50yrs 10mm/hr
• 51-60yrs 12mm/hr
• 61-70yrs 14mm/hr
• >70yrs about 30mmhr
Women
• 17-50yrs 12mm/hr
• 51-60yrs 19mm/hr
• >70yrs about 35mm/hr
Factors increasing ESR values
• Increasing age ,Female gender,Pregnancy,
Black population
• Anemia
• RBC abnormalities
• Macrocytosis
• Technical factors (pependicularity of
tube,temperature,vibrations, etc)
• Infection(TB)
• Connective tissue disorders, inflammatory
and autoimmune dx’s(RA,SLE)
• Malignancy(multiple myeloma)
• Drugs-dextran,methyldopa,penicillamine,Vit
A, oral contraceptives.
Factors decreasing ESR values

• Extreme leucocytosis
• Acanthocytosis
• Microcytosis
• Technical (short ESR tube,temperature,
inadequate mixing,dilution problems,etc)
• Hypofibrinoginaemia
• Clotted samples
• Dysproteinaemia
• Hypogammaglobulinaemia

You might also like