ESR

1. ERYTHROCYTE SEDIMENTATION
RATE (ESR)
P SUNIL KUMAR
Haematology & Transfusion Medicine
St.John’s Medical College
Bangalore
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2. • - Definition
• -Methods
• Principle
• Normal ranges
• Procedure
• Advantages
• Increased and decreased conditions
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3. Definition
• The rate at which erythrocytes settle down at
the bottom of the tube at 1st one hour is
regarded as erythrocyte sedimentation rate.
• ESR is a commonly used nonspecific test in
routine clinical practice
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4. METHODS
• Wintrobes Method
• Westergren's Method
• Microsedimentation ( Landau) method
• Capillary method (Micro ESR method)
• Automated method ( Analysers)
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5. DETERMINATION OF ESR BY
(WESTERGEN’S METHOD)
• Method : Westergren's Method
• It has been proved as the international
reference method.
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6. Westergren's tube Description
• It is a straight glass tube
30cm in length
• and 2.5mm in a diameter
with a capacity of 1ml.
• A scale graduated in mm
from (0-200mm).
• Specially made racks with
adjustable leveling screws
are available for holding the
sedimentation tube in
vertical position.
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7. Normal Range / Biological Reference Range :
– Male : 0 – 10 mm after 1hour
– Female : 0 – 20mm after 1 hour
– Children : 0- 10mm after 1 hour
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8. PRINCIPLE
• When a anticoagulated blood is placed in a
vertical tube and is allowed to stand, RBCs
settle towards the bottom of the tube. The
speed of sedimentation of red cells in plasma
over a period of 1 hour is measured by the
length of the sedimented RBC column and is
expressed in milimeters.
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9. • RBCs have net negative charge on their
surface and tend to repeal each other. The
repulsive forces are partially or totally
counteracted if there is an increase in the
positively charged plasma proteins
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10. Factors affecting ESR
• Plasma factors : Eg, Fibrinogen , Globulins.
• Red Cell factors :
• A. Number- Eg Anaemia Polycythemia
• B.Size
• C.Rouleaux formation
• D.abnormal or irregular shape
• Technical factors : ESR tube must be kept in
vertical, other wise it results inaccurate ESR
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11. Requirements
• ESR vacutainer tubes
• Westergren's tube
• ESR stand
• Suction device
• Sodium Citrated blood sample
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14. Specimen Required
• 1.6 ml of blood + 0.4 ml of 3.8% sodium
citrate
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15. Specimen collection & Storage
• Test should be set up within 2 hrs after
collection
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16. procedure
• 1.Fill the Westergren's tube exactly up to Zero mark by
means of rubber bulb ( avoid air bubbles).
• 2. Place the tube upright in the stand. It should fit evenly
into the groove of the stand
• 3.Note the time. Allow the tube to stand for exactly one
hour
• 4.Exactly after one hour, note the level to which the red cell
column has fallen.
• 5.Report the result in terms of mm/after 1 hour.
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17. Phases of ESR
• Phase of rouleaux formation- 10 min
• Phase of sinking - 40 min
• Phase of packing - 10 min
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18. Westergren’s method
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19. DETERMINATION OF ESR BY
WINTROBE METHOD
• Wintrobe’s Method: ESR is estimated on
anticoagulated blood in a Haematocrit tube
which is also used for PCV estimation.
• Advantage of this method is that same tube is
used for PCV and ESR.
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20. Normal range:
• 0-9 mm fall at 1hr in males
• 0-20 mm fall at 1 hr in females.
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21. Requirements
• Wintrobes tube
• Wintrobes tube stand
• Pasteur pipette or 2 ML syringe with needle
• Timer or watch
• Sodium citrate blood sample (3.8%)
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22. Procedure
• 1. Mix the blood carefully
• 2.Fill the Wintrobes tube zero mark by using a
Pasteur pipette or by using a syringe
• 3.place the tube in exact vertical position in the
stand . Set the timer for one hour
• 4.At the end of one hour note the level of
erythrocyte count in terms of mm after 1 hour
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23. Wintrobes method …..
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24. INCREASED ESR VALUES SEEN IN
• Infections
• Inflammation
• Hyper fibrinogenemia
• Hyper gammaglobenemia
• Multiple myeloma
• SLE, RA
• Malignancy
• Old age
• Pregnancy
• Tuberculosis
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25. DECREASED VALUES SEEN IN….
• Extreme leukocytosis
• RBC abnormalities
• Sickle cell anemia
• Protein abnormalities
• Hypo fibrinogenemia
• Hypo gammaglobenemia
• Hereditary spherocytosis
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27. • Q : Define ESR; discuss Wintrobes method of
ESR estimation and factors influencing ESR,
normal ranges. ( 5 Marks)
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