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Erythrocyte Sedimentation Rate (ESR)

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0% found this document useful (0 votes)
3 views13 pages

Erythrocyte Sedimentation Rate (ESR)

Uploaded by

thanaa.mokhtar55
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We take content rights seriously. If you suspect this is your content, claim it here.
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Erythrocyte Sedimentation Rate

(ESR)

Diagnostic Hematology Department


Clinical Laboratory Sciences Program
Umm al Qura University
What is ESR?

 ESR is the measurement of the sedimentation (settling) of RBCs in


anticoagulated blood after standing for 1 hour.
 It is a non-specific test but indicative of inflammation.
 Used as initial screening and a follow up test to monitor therapy and
progression of a disease.
 Easy to perform and inexpensive.
ESR is determined by the interaction
between factors that promote (fibrinogen)
and factors that resist sedimentation
(negative charge of RBC).

Mechanism Normally, RBCs settle down slowly without


of ESR rouleaux due to repulsion by the negative
charges.

Plasma proteins ( fibrinogen) adhere to the


RBC membrane and neutralize the negative
charges, promoting adherence and
rouleaux formation.
Reagents & Equipment

 Westergren Disposable sedimentation tube (0–180mm length).


 Westergren sedimentation rack.
 Plastic disposable Pasteur pipettes.
 Timer.

Sample: Venous blood collected in 3.8% (0.25ml) Sodium Citrate


anticoagulant (4:1 ratio).
Procedure

i. Mix the blood sample thoroughly.


ii. Gently, insert the Westergren
pipette into the tube.
iii. Place the tube vertical in the rack
and let it stand for 60 minutes.
iv. Read to the nearest 1mm height of
the clear plasma .
v. The reading is expressed as
ESR = …. mm/ hour.
Reference Ranges

<50 0-15 mm/h <50 0-20 mm/h 0-10 mm/h

>65 0-38 mm/h >65 0-53 mm/h


Factors that affect ESR:

 Plasma factors (viscosity of plasma).


 Red cell factors (size, shape, rouleaux formation).
 Anti-coagulants (Na & K oxalates cause shrinkage of RBCs).
 Mechanical factors.
Rouleaux formation
(Multiple Myeloma)
Clinical Significance

Moderate elevated ESR Marked elevated ESR

Viral hepatitis Aplastic anemia.


Pregnancy Infections (Tuberculosis).
Lead poisoning Collagen disease, Rheumatoid arthritis
Myocardial infarction Ulcerative colitis.
Malignant tumors, Multiple Myeloma, Lymphoma
& Leukemia
ESR Result Interpretation

 ESR is directly proportional to the weight of the cell aggregate, and inversely
proportional to the surface area.

Microcytes, Sickle cells and spherocytes lower the ESR

Rouleaux formation, immunoglobulins, increase fibrinogen elevate ESR


Factors & conditions affecting ESR

False ESR ESR


 Tilted ESR tube  Sickle cells
 Vibrations  Microcytes
 Elevation of RT  Polycythemia
 Anisocytosis  Hypofibrinogenemia
 Old sample
Quality Control

 Because anisocytosis and poikilocytosis can affect the values of ESR,


abnormal values should be checked by measuring hematocrit and
examining peripheral smears.
 Duplicate sample run (internal quality control).

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