ESR

1. A TECHNICAL REPORT
ON
STUDENTS’ INDUSTRIAL WORK EXPERIENCE SCHEME
(SIWES)
BY
AISHAT OLUWAPELUMI LAWAL
MATRIC NO: 19/57BC/00914
BIOCHEMSITRY DEPARTMENT
SCHOOL: BASIC MEDICAL SCIENCES
FACULTY: PURE AND APPLIED SCIENCES
COMPLETED
AT
NOVA DIAGNOSTICS LIMITED
(GOMOLA HOUSE, UNITY ROAD, ILORIN, KWARA STATE)

2. OUTLINE
 INTRODUCTION
• SIWES
• BACKGROUND OF ESTABLISHMENT
• UNITS AND ORGANOGRAM
 TOPIC: ERYTHROCYTE SEDIMENTATION RATE (ESR) BY WESTERGREN METHOD
• INTRODUCTION
• MECHANISM OF ESR
• PRINCIPLE OF ESR
• STAGES OF ESR
• FACTORS AFFECTING ESR
• MATERIALS AND EQUIPMENTS NEEDED
• CLINICAL SIGNIFICANCE OF ESR
• PROCEDURE AND CAUSES OF ERRORS
• NORMAL RANGE/CLINICAL REFERENCE
 CHALLENGES FACED AND RECOMMENDATION
 CONCLUSION

3. INTRODUCTION TO SIWES
 Students’ Industrial Work Experience Scheme (SIWES) was established by ITF in 1973
to ensure that graduates of Nigeria tertiary institutions get enough practical skills in
their respective fields of study in order to prepare them for the working industry
after the completion of their degree programs.
 Roles of SIWES include: -
I. To provide opportunities for students, in higher institutions of learning, to acquire
industrial skills and experience during their course of study.
II. To prepare students for the work economy they are likely to meet after graduation.
III. To expose students to work methods and techniques in handling equipment and
machineries that may not be available in their institutions of choice.
IV. To allow the transition phase from school to the world of working environment
easier and to also facilitate students’ contact for later job placements.
V. To provide students opportunities to apply theoretical knowledge into real work
situations and thereby bridging the gap between theory and practice.

4. BACKGROUND OF ESTABLISHMENT
 NOVA DIAGNOSTIC LTD was established on the 15th of March, 2015 with its location
at Ibrahim Taiwo Area of Ilorin. The establishment started with two departments;
Scan & Imaging Unit and Phlebotomy Unit before further expansion into other
departments.
 Years later, NOVA DIAGNOSTIC LTD moved to its present location on the first floor of
the popular Gomola House at Unity axis in Ilorin, Kwara state.
 The organization has a highly skilled and motivated team in its provision of
comprehensive, accurate and reliable testing with quick turn-around time and
innovative solutions.
UNITS of establishment
 PHLEBOTOMY
 CLINICAL CHEMISTRY
 HAEMATOLOGY
 MEDICAL MICROBIOLOGY
 SCAN & IMAGING
 BLOOD BANKING

5. ORGANIZATIONAL STRUCTURE
CEO
RADIOLOGY
MANAGER
X RAY
ULTRASOUND
LABORATORY
MANAGER
CHIEF
LABORATORY
SCIENTIST
LABORATORY
SCIENTISTS
PHLEBOTOMISTS
ACCOUNTANT
MARKETERS
CASHIERS
JANITORS
GENERAL
MANAGER

6. TOPIC
ERYTHROCYTE SEDIMENTATION RATE (ESR)
BY
WESTERGREN’SMETHOD

7. INTRODUCTION TO ESR
 Erythrocyte sedimentation rate is the measurement of the rate at which the erythrocytes settle
from the plasma in anticoagulated blood.
 ESR is a simple non-specific screening test that indirectly measures the presence of
inflammation in the body as it reflects the tendency of red blood cells to settle more rapidly in
the face of certain disease states.
 The tendency of red cells to sediment is usually due to increases in plasma fibrinogen,
immunoglobulins and other acute-phase reaction proteins. Changes in red cell shape or
numbers may also affect ESR value.
 It is measured in mm/hr as a standard version of the test is left to stand for 1 hour.
 There are two main methods of performing ESR; Westergren’s and Wintrobe’s methods.
 Westergren’s is the preferred method at NOVA Diagnostics.

8. CLINICAL SIGNIFICANCE OF ESR
 The ESR represents a nonspecific response to tissue damage and inflammation.
 It primarily reflects changes in the plasma proteins that accompany most the acute
and chronic infections, tumors, and degenerative diseases.
 It is also used an initial screening tool for presence of diseases.
 It is also used as a follow up test to monitor therapy and progression or remission of
certain diseases such as tuberculosis and rheumatoid arthritis.
 Important criterion in establishing the diagnosis of temporal arteritis and
polymyalgia rheumatica.

9. MECHANISM OF ESR
 ESR is determined by the interaction between factors that promote (like fibrinogen)
and factors that resist (like negative charge of RBCs) sedimentation.
 Normally, RBCs settle down slowly as they do not form rouleaux. Instead, they gently
repel each other due to the negative charge on their surface.
 Rouleaux are stacks of many RBCs that become heavier and settle down faster.
 Plasma proteins, especially fibrinogen, adhere to the red cell membranes and
neutralize the surface negative charges, promoting cell adherence and rouleaux
formation.
 ESR is directly proportional to the weight of the cell aggregates but inversely
proportional to the surface area

10. PRINCIPLE OF ESR
 When anticoagulated whole blood is allowed to stand in a narrow vertical tube for a
period of time, the RBCs – under the influence of gravity - settle out from the
plasma. The rate at which they settle is measured as the number of millimeters of
clear plasma present at the top of the column after one hour (mm/hr).
STAGES OF ESR
 Rouleaux formation/aggregation 10 minutes
Red cells stack together like pairs of coin
 Sedimentation/settling of rouleaux 40 minutes
 Cell packing 10 minutes
This is why ESR tests is made to stand for 1 hour

11. FACTORS AFFECTING ESR
 The ESR is affected by three factors: erythrocytes, plasma composition and mechanical/technical
factors.
 ERYTHROCYTES
 Macrocytes tend to sediment rapidly than microcytes
 Alterations of ratio of red cells to plasma
 Decreased red cell mass in anemia increases ESR
 Increased red cell mass in polycythemia decreases ESR
 Sickle cells and spherocytes are unable to form rouleaux and therefore ESR is low.
 PLASMA COMPOSITION
 In normal blood, the RBCs remain more or less separated. They are negatively charged and therefore repel each
other.
 Increased plasma protein concentration, notably fibrinogen, immunoglobulins and acute phase proteins (C-
reactive protein, ceruloplasmin, -1-globulins), cause a reduction in the negative charge of the RBCs and
facilitates formation of rouleaux.
 Removal of fibrinogen by defibrination and increase in the albumin reduces ESR
 TECHNICAL FACTORS
 It is important that the ESR tube be exactly perpendicular/upright. A tilt of 30⁰ can cause errors up to 30%.
 The rack holding the tubes should not be subject to any movement or vibration.
 The sedimentation rate increases as the temperature increases.
 ESR tubes with a narrower than standard bore will generally yield lower sedimentation rates.

12. ELEVATED ESR
 THE FOLLOWING FACTORS INCREASE ESR:
 Old age (Adults over 60 years of age frequently have a slightly higher ESR value primarily
due to decreased concentrations of plasma albumin).
 Females because of Menstrual Cycle
 Pregnancy
 Anemia
 RBC abnormalities
 Elevated fibrinogen levels
 Inflammation malignancy
 Pregnancy (especially after the third month).
 Acute and chronic infections.
 Rheumatic arthritis and fever.
 Myocardial infarction.
 Acute hepatitis.
 Hypothyroidism.
 Hyperthyroidism.

13. DECREASED ESR
 THESE FACTORS CAUSE A DECREASE IN ESR VALUE
 Extreme leukocytosis
 Polycythemia
 The presence of red blood cell abnormalities (poikilocytosis, spherocytes, and sickle
cells).
 Protein abnormalities
 Hypofibrogenemia
 Polycythemia.
 Congestive heart failure.

14. MATERIALS AND EQUIPMENTS FOR ESR
 Westergren pipette (30 cm in length, 2.5 mm internal diameter with marking on the tube
from 0 – 200 mm).
 Westergren stand/rack
 Leveling plate for stabilizing the rack
 Vacutainer tube with anticoagulant diluent solution (Trisodium citrate) to be mixed with
blood in ratio 1:4
 EDTA sample tube for sample collection
Vacutainer tube
Westergren tube/pipette

15. PROCEDURE FOR ESR
 Test should be carried out within four hours of blood collection if specimen is kept at
room temperature
 The Westergren method requires collecting 2 ml of venous blood into the vacutainer
tube containing 0 .5 ml of sodium citrate as anticoagulant.
 Mix the blood and anticoagulant thoroughly.
 There should be no clots and air bubbles in the blood.
 The Westergren pipette/tube is then filled to the 200 mm mark by inserting into the
vacutainer tube. The tube is placed in a rack in a strictly vertical position for 1 hour at
room temperature after which the distance from the lowest point of the surface
meniscus to the upper limit of the red cell sediment is measured.
 The pipette is kept upright in the ESR stand/rack lying on the leveled surface
 Read the upper level of RBC column exactly after one hour.

16. CLINICAL RANGES FOR ESR
 Male < 50 years: 0 – 10 mm/hr
 Male >50 years: 0 – 15 mm/hr
 Female <50 years: 0 – 20 mm/hr
 Female >50 years: 0 – 30 mm/hr
 Children: 0 – 10 mm/hr
 No vibrations or movement must occur from the start of the test to its completion
for accurate result.
 Improper ratio of blood and anticoagulant.
 Hemolysed sample
 Clotted blood
 Air bubbles
 Dirty and wet tubes
 Delay in performing the test
 Using undiluted blood sample
CAUSES OF ERRORS IN ESR

17. CHALLENGES FACED FOR SIWES
 Major challenge was inability to secure place of attachment very fast
CONCLUSION
In conclusion, the SIWES program serves as a very good opportunity for students to unite their
theoretical classes with the practical and applied aspects of their course of study.
I gained a lot of knowledge and exposure as regards various equipment and their operations.
This scheme also exposed me to the inner workings of a standard job setting, allowing me to
sharpen my work ethic and professionalism.
This program also gave exposure as regards interactions with students from various
departments and institutions of learning.
RECOMMENDATIONS
 Institutions of learning should work in conjunction with ITF and various organizations
to make securing placements easier and faster
 Payments of stipends should be made and integral part of the SIWES posting.
 Orientation on SIWES and industrial training attachments should be encouraged for
organizations and parastatals by the government.

18. REFERENCES
 Erythrocyte Sedimentation Rate presentation by Dr. Hajra K. Mehdi (slideshare.com)
 Erythrocyte Sedimentation Rate presentation by Rashida Ansari
 In house laboratory manual NOVA Diagnostics

19. THANK YOU ALL
FOR LISTENING