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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
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