This presentation is focused on diagnostic utility of Red blood cell indices which will be very useful for undergraduate and postgraduate of medical field.
I have listed out the LE cells structure and Microscopical examinaton of LE CELLS, Difference between tart cells and le cells, clinical symptoms and diagnostic procedure.
Erythrocyte Sedimentation Rate (ESR), a lecture for medical lab technicians at Baquba Technical Institute, Middle Technical University. All theoretical and practical notes about the test.
This presentation is focused on diagnostic utility of Red blood cell indices which will be very useful for undergraduate and postgraduate of medical field.
I have listed out the LE cells structure and Microscopical examinaton of LE CELLS, Difference between tart cells and le cells, clinical symptoms and diagnostic procedure.
Erythrocyte Sedimentation Rate (ESR), a lecture for medical lab technicians at Baquba Technical Institute, Middle Technical University. All theoretical and practical notes about the test.
ESR IS ERYTHROCYTE SEDIMATATION RATE.When anticoag ulated blood is allowed to stand in an undisturbed condition for a period of time the erythrocyte tends to sink to the bottom. Two layers are formed, the upper plasma layer & lower one of red cells. The rate at which the red cells fall is known as the erythrocyte sedimentation rate.
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June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
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- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
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2. OBJECTIVES
What is ESR?
Principle of ESR
Mechanism of ESR
Factors affecting ESR
Different methods of estimating ESR
Clinical significance of ESR
Errors
4. Introduction
Non specific test indicative of inflammation.
It is used an initial screening tool and also as a follow up test to
monitor therapy and progression or remission of disease.
Easy to perform.
Inexpensive.
Unit – measured in mm/hr.
5. What are the other acute phase reactants that you know of?
6. ESR is determined by the interaction between
factors that promote (fibrinogen) and factors that
resist (negative charge of RBC) 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.
Mechanism
7. 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.
It is inversely proportional to the surface area
Mechanism
8. Stages of Erythrocyte Sedimentation
Stage of rouleaux formation/aggregation 10 minutes
Stage of sedimentation/settling 40 minutes
Stage of packing 10 minutes
9. Factors That Increase ESR
Old age
Female
Pregnancy
Anemia
RBC abnormalities
Macrocytosis
Technical factors
Dilution problems
Increased temperature of
specimen
Tilted ESR tube
Elevated fibrinogen levels
Infection
Inflammation
malignancy
13. Reference method when undiluted blood is used.
Requirements:
Westergren pipette
Westergren stand
Anticoagulant diluent solution
Trisodium citrate (4:1)
EDTA
Westergren Method
14. Mix anticoagulated blood sample thoroughly. The
Westergren tube is filled with blood sample up to the “0”
mark. A rubber bulb or a mechanical device should be
used for filling. There should be no air bubbles in the
blood.
The tube is placed in a strictly vertical position in the ESR
stand and left undisturbed for 1 hr.
After exactly 1 hr, read the height of the column of
plasma above the red cell column in mm.
ESR is expressed in mm/hr.
Westergren Method
15. Male < 50 years: 0-15mm/hr
Male >50 years: 0-20mm/hr
Female <50 years: 0-20mm/hr
Female >50 years: 0-30mm/hr
Children: 0-10mm/hr
Reference Range By Westergren Method.
16. Advantages:
More reliable and gives accurate result.
Disadvantages:
More blood is required.
Difficult to fill blood in the tube.
PCV cannot be done.
Mouth pipetting can be hazardous.
17. Used to estimate both ESR and PCV
Requirement:
Wintrobe’s pipette
Wintrobe’s stand
Anticoagulated blood
EDTA
Double oxalate
Wintrobe’s Method
18. Mix the anticoagulated blood thoroughly.
Fill the wintrobe’s tube by using Pasteur pipette
upto the “0” mark.
Place the tube vertically in the stand.
Note the ESR at the end of 1hr.
Wintrobe’s Method
19. Males: 0-9mm/hr
Female: 0-20mm/hr
Children: 0-13mm/hr
Reference Range By Wintrobe’s Method.
20. EDTA blood is used instead of citrate.
2ml of EDTA blood is diluted with 0.5ml of 3.8% TSC or
0.85% NaCl.
Modified Westergren Method
21. Used in case of infants and if the blood is inadequate.
Requirement:
Fasting Capillary Blood (heel/finger tip/toe)
5.0gm/dl Tri Sodium Citrate solution
Landau Pipette (0-50mm)
Pipette stand
Suction device for drawing blood in the pipette
Capillaries for blood collection.
Micro Sedimentation Method
(Landau Method)
22. Attach landau pipette to suction device.
Draw 5.0gm/dl citrate upto the first line of the stem.
Draw blood upto the second line of the stem.
Draw the citrate+blood into the bulb and mix thoroughly.
Force back the mixture into the stem.
Set the upper level to the “0” mark at the top.
Place it vertically in the stand.
Note reading after 1 hour.
Micro Sedimentation Method
(Landau Method)
23. Male: 0-5mm/hr
Female: 0-8mm/hr
Newborn: 0-2mm/hr
Neonate to puberty: 3-13mm/hr
Reference Range by
Micro Sedimentation Method
(Landau Method)
25. Automated bench top analyser to measure ESR.
Blood collected in cuvets.
Sample is left to sediment.
18 degree slanting of the tubes causes
acceleration of the ESR.
Designed to measure 20 blood samples.
Results are comparable to Westergren method.
Results are available in approximately 25 minutes.
VES-MATIC 20
32. The filled Sedimat Westergren pipette is placed in the
SEDIMAT 15 automated ESR reader, which accelerates
the sedimentation under controlled conditions.
Based on the ability of blood to block the transmission
of infrared light
The reader displays the results of each sample on an
LCD display after 15 minutes.
The results are also stored in memory and can be
printed out.
SEDIMAT 15
33.
34. Zeta potential is a measure of the magnitude of the
electrostatic or charge repulsion/attraction between
particles
The Zeta potential results from negatively charged sialic
acid groups on the red cell membrane.
Fibrinogen and gammaglobulins decrease the Zeta
potential.
Decreased Zeta potential increases the rouleaux
formation.
This results in increasing ESR.
Thus explaining the mechanism behind raised ESR in
diseases.
Zeta Potential
35. It is the measurement of the ease with which RBCs will
pack under a standardised compaction – dispersion stress.
It is inversely proportional to the Zeta potential of these
cells when suspended in a particular plasma under
consideration.
Requires a Zetafuge.
Zeta Sedimentation Ratio
36. Zetafuge is a centrifuge which requires spin capillary
tubes in vertical position in four 45 seconds cycles.
Rouleaux formation and sedimentation in just 3 minutes.
Reading is called as ZETACRAT.
Zeta sedimentation ratio = (True Hct/Zetacrat) X100
Normal value is 51 – 54% for both sexes.
Zetafuge
37. A blood sample of 100ul contained in a vertical tube is
spun at 400rpm for 45 seconds.
The resultant force causes RBCs to travel outward until
they approach the outer edge of the tube.
The capillary tubes are rotated 180 degrees and
centrifuge is restarted.
As the centrifuge head regains its operating speed the
clumped RBCs now travel from the inner wall of the tube.
They are partially dispersed during the initial phases of
this journey before being deposited once more in the
outer wall.
Zeta Sedimentation Ratio
38. In the process they are exposed to the normal downward
gravitational forces and thus come to rest upon outer
edge of the tube at a point somewhat lower than the
starting point.
This process is repeated 4 times.
This causes the RBCs to travel in a zig-zag path in the
capillary tube and become more densely packed.
Four 45 seconds cycle of compaction, dispersion and
recompaction is employed.
At the conclusion of these 3 minutes, the degree of
compaction achieved by the RBCs is measured.
Zeta Sedimentation Ratio
39. To measure the ZSR, a capillary tube is read after the
compaction – dispersion cycles.
ZSR corresponds with the upper meniscus of the red cell
column.
The meniscus of the zetacrit is not completely horizontal.
The tail of the RBC rises above it on one side and a small
wedge of plasma depresses it on the other.
Zetacrit is marked at the knee of the curve between the
red cells and the meniscus.
Zeta Sedimentation Ratio
40.
41. Capillary tubes are easier and faster to fill.
Requires less sample.
Capillary tubes are cheaper than the regular ESR tubes.
ZSR is unaffected by the degree of anemia.
Advantages of ZSR
42. Results are expressed in % rather than in mm/hr.
Need to purchase specific capillary tubes and a Zetafuge.
Disadvantages of ZSR
43. All the situations where ESR is already used.
Anaemic patients.
Multiphasic health screening centers.
Blood bank donors.
Application of ZSR
46. Saves technician time.
Provides increased safety because the need for
sample manipulation is decreased.
Interface with the Laboratory Information System
(LIS).
Uses smaller volumes of sample.
Provides more rapid results.
Advantages of Automated Methods
47. Improper ratio of blood and anticoagulant.
Haemolysed blood sample.
Clotted blood.
Presence of air bubble.
Error due to sunlight, vibration, small bore size,
dirty and wet tube.
Delay in performing the test.
Sources of Error
49. Conditions Associated With
Very High ESR >100 mm/hr
1. Multiple myeloma
2. Connective tissue disorders - SLE, RA and
other autoimmune diseases
3. Tuberculosis
4. Malignancies
5. Severe anemia
50. Some Conditions With Low ESR
1. Polycythemia
2. Severe Leukocytosis
3. Sickle cell anemia
4. Hereditary spherocytosis
5. Congestive cardiac failure
6. Corticosteroid use
7. Hypofibrinogenemia
51. To eliminate the influence of anemia on ESR.
Corrected according to the volume of Red cells.
Corrected ESR
52. Find the horizontal line which represent the ESR at the
end of 1st hour.
Follow this across the chart till it intersects the vertical
line.
Vertical line represents the blood cell volume.
Follow the nearest curved line till it intersects the heavy
line at;
1. 42% per 100ml for females.
2. 47% per 100ml for males.
At the point of intersection read the value on the
horizontal line for the corrected ESR.
Correction of ESR
54. ESR is a non specific phenomenon and reflects
only change in plasma protein pattern and the
variation in RBC volume.
Cannot be used as a diagnostic tool.
Does not indicate the nature of the disease.
Limitations of ESR
55. To follow the course of the disease.
To establish the prognosis in certain chronic
diseases.
Increase in two or more consecutive tests
indicates continuation of the increased activity.
To distinguish between organic and non-organic
disorders.
To support the diagnosis.
Clinical Significance of ESR
56. 1. Henry’s Clinical Diagnosis And Management Of
Laboratory 22/E.
2. Dacie And Lewis Practical Hematology 10/E.
3. Textbook Of Medical Laboratory Technology –
Godkar 2/E.
4. Internet Sources.
References
Increase: dextran, methyldopa (Aldomet), oral contraceptives, penicillamine procainamide, theophylline, albumin and vitamin A.
Decrease: aspirin, cortisone, and quinine.
Formula to convert between diluted blood esr and undiluted blood esr:
Diluted blood esr = (undiluted blood esr x 0.86) – 12
Westergren pipette – 30cms length, 2.5mm diameter, 0-200 caliberation
Landau pipette 50cm in length….1mm inner bore…..0-50 markings
Pitfalls: correlation with the reference westergren method, prone to human error (mixing atleast 15 times followed by 5 mins limit before drawing blood into capillary tube).