This document provides information about the erythrocyte sedimentation rate (ESR) test. It describes how the test works by allowing anticoagulated blood to stand vertically undisturbed for 1 hour, then measuring the distance the erythrocytes have settled. There are three stages of sedimentation over this time period. Two common methods for performing the ESR test are described - the Westergren and Wintrobe methods. Reference ranges for ESR are provided. Potential sources of error and limitations of the test are also outlined.

1. ERYTHROCYTE SEDIMENTATION
RATE
PREPARED BY PUNAM SAHOO

2. INTRODUCTION
• When an anticoagulated blood is allowed to stand vertically , sedimentation of
erythrocyte occurs. The rate at which erythrocytes fall down, is known as
erythrocyte sedimentation rate (ESR).
• ESR is relatively simple , inexpensive, non specific test that has been used for
detect and monitor inflammation of various infections, cancers and autoimmune
disease .

3. PRINCIPLE
• Anticoagulated blood is taken in a tube and kept undisturbed in vertical position in
a stand . This will allow the sedimentation of erythrocytes . After a specific time,
generally 1 hour, the level of red cell is noted. The distance traveled by
erythrocytes in 1 hour is called as erythrocytes sedimentation rate (ESR).

4. STAGES OF ESR
There are 3 stages in erythrocyte
sedimentation
1) Stage 1 : Rouleaux formation -
First 10 minutes
2) Stage 2 : Stage of sedimentation
or settling - 40 mins
3) Stage 3 : Stage of packing - 10
minutes

5. METHODS OF ESR
• There are two methods of determination of ESR :-
1. WESRWEGEN METHOD
2. WINTROBE METHOD

6. WESTERGREN METHOD
REQUIREMENTS
• Westergren pipette
• Westergren stand
• Anticoagulant ( 3.8% trisodium citrate )
PROCEDURE
Fill the pipette by sucking blood up to 0 mark and fix it vertically in Westergren stand.
Read the upper level of RBC column exactly after 1 hour.
NORMAL RANGE –
Male – 0 to 5 mm/hr
Female – 0 to 7 mm/hr

8. WINTROBE METHOD
REQUIREMENTS
• Wintrobe pipette
• Wintrobe stand
• Anticoagulant (EDTA)
PROCEDURE
With the help of long necked Pasteur pipette or a special syringe , fill the
wintrobe tube up to 0 mark . Place the tube in an exactly vertical position in a
wintrobe stand. Read of RBC column exactly after 1 hour .
NORMAL RANGE
Male – 0 to 9 mm/hr
Female – 0 to 20 mm/hr

9. POSSIBLE ERRORS IN ESR
• The value of ESR can be affected by following errors:.
• Improper anticoagulant.
• The tube is not exactly vertical in position. Slight inclination may result in great difference in ESR
value. Three degrees angle of inclination may raise ESR up to 30%.
• Dirty tube.
• Bubble caused by too vigorous mixing of blood and anticoagulant.
• Hemolysis may modify ESR.
• Blood should be tested within 3 hours of collection. The prolonged storage may modify ESR.
• The stand should not be kept on vibrating surface.
• The reading should be taken exactly after1 hour.
• The stand should be kept away from window to avoid temperature variations.

10. limitation
Rapid ESR is found in :
chronic infection like tuberculosis, lymphatic fever . Myocardial infraction,
anemia, syphilis, malignant tumor, menstruation, liver disease etc. In pregnancy,
after second month, ESR is increased.
Slow ESR is found in :
Newborn infants, polycythemia, allergic conditions, heart failure etc.