Skip to main content
UploadLanguage (EN)Support
BusinessMobileSocial MediaMarketingTechnologyArt & PhotosCareerDesignEducationPresentations & Public SpeakingGovernment & NonprofitHealthcareInternetLawLeadership & ManagementAutomotiveEngineeringSoftwareRecruiting & HRRetailSalesServicesScienceSmall Business & EntrepreneurshipFoodEnvironmentEconomy & FinanceData & AnalyticsInvestor RelationsSportsSpiritualNews & PoliticsTravelSelf ImprovementReal EstateEntertainment & HumorHealth & MedicineDevices & HardwareLifestyle
HA
Uploaded byHussein Al-tameemi
41,627 views

Erythrocyte Sedimentation Rate (ESR)

The erythrocyte sedimentation rate (ESR) is a non-specific test used to detect inflammation and monitor disease activity, measuring the rate at which red blood cells settle in a test tube. Factors such as plasma composition and red blood cell characteristics can affect ESR results, which must be interpreted cautiously as it is not diagnostic of specific conditions. Normal ranges vary by age and sex, while elevated or decreased ESR levels can be associated with various medical conditions.

Education◦
Related topics:
Laboratory Technology•
Erythrocyte Sedimentation Rate (ESR) Hussein A. Abid  Lecture: 04 Middle Technical University Technical Institute of Baquba Medical Laboratory Technology Department Academic year 2019-2020 – Spring semester Medical Laboratory Technology & Quality Control Applications Module code: MLT113 L.No.: MLT113-20-T-04
Erythrocyte Sedimentation Rate (ESR) • A nonspecific test for inflammatory and necrotic conditions. • May also be increased in situations of physiologic stress, such as pregnancy. • In these conditions, there is a change in blood proteins which leads to a clumping of red blood cells. • Measures the speed with which erythrocytes settle in a tube of blood which has been mixed with an anticoagulant. 01 Hussein Adil Abid - 2020
ESR • Cells which have clumped due to inflammatory and necrotic conditions settle more rapidly than single cells. • Expressed in mm/h. • There is a direct relationship between the ESR and the course of such diseases; as the disease improves, such as due to drug therapy, the ESR decreases. • Also called sedimentation sate and sed rate 02 Hussein Adil Abid - 2020
ESR • Easy to perform, widely available and inexpensive • Widely used as screening test • Also used as a monitoring tool for response to treatment in conditions in which it is raised (tuberculosis, autoimmune diseases ..etc.) • ESR is not diagnostic of any particular disease, but rather is an indication that a disease process is ongoing and must be investigated. • ESR is affected by three factors: erythrocytes, plasma composition, and mechanical/technical factors 03 Hussein Adil Abid - 2020
Methods 1. Westergren method 2. Wintrobe's method 3. Disposable ESR tubes (VES-MATIC 20) 04 Hussein Adil Abid - 2020
Principle • This test is based on the fact that inflammatory and necrotic processes cause an alteration in blood proteins, resulting in an aggregation of red cells, which make them heavier and more likely to fall rapidly when placed in a special vertical tube. 05 Hussein Adil Abid - 2020
Materials and consumables 1. Westergren tube and rack 2. Trisodium citrate (31.3 g/ 1000 ml D.W.) 3. Pipette and tips 4. Blood sample 5. Timer 06 Hussein Adil Abid - 2020
Procedure Notes:  Patient must fasting at least 4 hours before testing.  The blood sample must be mixed with anticoagulant trisodium citrate as (1 anticoagulant: 4 blood), e.g. 0.4 ml of sodium citrate should be mixed with 1.6 ml of blood. 07 Hussein Adil Abid - 2020
Procedure 1. Mix the diluted blood for at least 2 minutes on a rotator. (The blood should be at room temperature). Check the tube for clots using two applicator sticks. 2. Make certain the Westergren ESR rack is exactly level. 3. Fill the Westergren tube to exactly the 0 mark. Making certain there are no air bubbles in the blood. 4. Place the tube in the rack. Be certain the tube fits snugly and evenly into the grooves provided. 5. Allow the tube to stand for exactly 60 minutes. 6. At the end of 60 minutes records the number of millimeters the red blood cells have fallen. This result is the erythrocyte sedimentation rate in millimeters/hour. 08 Hussein Adil Abid - 2020
09 Normal ranges of ESR After 1 hour Adult male < 15 mm/h Adult female < 20 mm/h Children < 13 mm/h Or 𝑬𝑺𝑹(𝒎𝒎/𝒉) = 𝑨𝒈𝒆 𝒚𝒆𝒂𝒓𝒔 𝟐 + 𝟓 (𝒇𝒐𝒓 𝒇𝒆𝒎𝒂𝒍𝒆𝒔 𝒐𝒏𝒍𝒚) Hussein Adil Abid - 2020
Increased ESR • Multiple myeloma • Connective tissue disorders (rheumatoid arthritis, systemic lupus erythematosus and other autoimmune diseases) • Tuberculosis • Malignancies • Severe anemia • Menstruation N.B.: in many cases it could be higher than 100 mm/h. 10 Hussein Adil Abid - 2020
Decreased ESR • Polycythemia • Severe Leukocytosis • Sickle cell disease (anemia) • Hereditary spherocytosis • Congestive Cardiac Failure • Corticosteroid use • Hypofibrinogenemia 11 Hussein Adil Abid - 2020
Factors affecting ESR A) Effect of plasma protein: Increased in the concentration of fibrinogen and Immunoglobulins due to tissue injury will increase rouleaux formation and hence the rate of sedimentation. Plasma albumin retards sedimentation of RBCs. B) The RBC size and number: The size and number of RBCs that show alterations in their biconcavity, like spherocytes and sickle cells, usually do not exhibit increase rate, unless there is severe anemia. Increase red cell mass will retard the sedimentation rate e.g. polycythemia. C) Technical factors: 1) Perpendicularity of sedimentation tube, slight deviations from the absolute. Vertical can increase the result. 2) Temperature (RT 18-25 °C) higher temperature cause false high results due to reduction in plasma viscosity (direct sun light). 3) Vibration can reduce the ESR. 12 Hussein Adil Abid - 2020
NOTES  If the concentration of EDTA is greater than recommended, the ESR will be falsely low.  The anticoagulants sodium or potassium oxalate and heparin cause the RBCs to shrink and the ESR will be falsely high.  If the ESR stands for more than 60 minutes, the results will be falsely elevated. If the test is timed for less than 60 minutes, invalidly low values are obtained.  A marked increase (or decrease) in room temperature leads to increased (or decreased) ESR result.  Tilting of the ESR tube increases the ESR.  Bubbles in blood cause invalid results.  Fibrin clots present in the blood invalidate the test results.  The ESR should be set up within 2 hours of blood collection. If EDTA is used as the anticoagulant, the test may be set up within 6 hours if the blood has been refrigerated. 13 Hussein Adil Abid - 2020
NOTES  The ESR may be increased during menstruation, after the 12th week of pregnancy, and postpartum.  The ESR may be decreased in the presence of elevated white blood cell count, albumin, and lipids.  Drugs which may increase the ESR: dextran, heparin, oral contraceptives.  Drugs which may decrease the ESR: albumin, aspirin, corticotropin, cortisone, lecithin, steroids.  In polymyalgia rheumatica, the ESR is monitored frequently to guide the healthcare provider in determining dosage of prednisone needed for control of symptoms.  The ESR is usually very high (>55 mm/h) in patients with temporal arteritis. It is essential that steroids be initiated immediately to avoid complications such as blindness or stroke. 14 Hussein Adil Abid - 2020
Hussein Adil Abid - 2020