The document discusses the erythrocyte sedimentation rate (ESR), defining it as the rate at which red blood cells settle in anticoagulated blood. It covers the mechanisms, factors affecting ESR, and methods for detection, including the Westergren method, with normal ranges specified. Clinical significance is highlighted, emphasizing ESR's role in monitoring disease progression, but it is noted that changes in ESR are not specific to any particular disease.

1. ESR
Ms Ankita R Bhatiya
Assistant Professor
Shree P.M.Patel COLLEGE OF PARAMEDICAL
SCIENCE N TECHNOLOGY

2. It include:
 1.What is ESR?
 2.Mechanism of ESR.
 3.Factor affecting ESR.
 4. Method for detection of ESR

3. ESR
 INTRODUCTION :
 Definition:
 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.
 This process includes:
 Aggregation : All RBC are come together;
 Rouleaux formation: when red cells form Rouleaux (RBCs cling together like
coins in pile)

4. ESR
This process includes:
 Aggregation : All RBC are come together;
 Rouleaux formation: when red cells form Rouleaux (RBCs cling
together like coins in pile)
 Sedimentation in which the falling of red cells takes place The
larger the aggregation in first stages the faster the rate of fall.

5. Patho-physiological factors affecting the
ESR value
 1. High blood counts tend to lower the sedimentation rate, while
low blood count tends to accelerate the rate of fall.
 2. In sickle cell anaemia the shape of the cells tends to prevent
Rouleau formation & hence sedimentation is low.
 3.In hypochromic anaemia the microcytes resist Rouleau
formation & sedimentation is retarded.
 4. ESR is grater in women than in men & it is related to the
difference in PCV.

6. Patho-physiological factors affecting the
ESR value
 5. During pregnancy ESR increases after 3rd month & returns to
normal in about 3 to 4 weeks after delivery.
 6. ESR is low in infants & gradually increases up to puberty.
 7.The changed levels of plasma protein such as fibrinogen &
globulins, which accompany most of the acute & chronic
infections, tend to increase Rouleaux formation. ESR is therefore
increased in any condition causing increase in fibrinogen or

7. Laboratory Factors Which Influence ESR:
 Time: There is progressive decreases in
sedimentation in first 4 hrs & after that there is rapid
decreases.
 Length of ESR Tube: ESR is greater with longer tube
than with shorter tube.
 Temperature: The red cell sedimentation is increases

8. ESR can be done by three methods:
 1. Westergren method - Male 0-15 mm/hr, Female
0-20 mm/hr
 2. Wintrobe's method - Male 0-9 mm/hr, Female 0-
20 mm/hr
 3. Landau's method - Male 0-5 mm/hr, Female 0-8
mm/hr

9. ESR can be done by three methods:
 Westergren Method: In this method Westergren tube is used. It is open at
both the ends & is about 30 cm or 300 mm long with a bore diameter of about
2:5 mm with graduation from to 200 mm.
 Wintrobe’s Method: In this method Wintrobe’s tube is used. It is open at one
end & is about 11 cm or 110 mm long with a bore diameter 2.5 or 3 mm &
graduated from 0 up to 10 cm with the graduations both in ascending &
descending, order. The scale with the markings in ascending order from the top
is used in ESR determination while the scale with descending order is used for
haematocrit determination. It holds about 1 ml of whole blood.
 Landau’s Method: In this method landau's pipette is used. It is graduated from

10. Westergrn Method
 Aim: Determination of ESR by Westergren method.
 Clinical Significance: ESR is increases in all condition where
there is tissue break down or where there is entry of foreign
proteins in the blood. The determination is useful to check the
progress of the disease. If the patient is improving the ESR
tends to fall. If the patient's condition is getting worse the ESR
tend to rise. The changes of ESR are however not diagnostic of
any specific disease.
 Method: Westergren method

11. Westergren Method
 Normal Range: Male - 0 to 15 min/hr
 Female - 0 to 20 min/hr
 Principle: Anticoagulated blood is taken in a tube & left
undisturbed in a vertical position. The level of the column of red
cells is noted in the beginning & after 1 hr. Temperature &
slanting of tube affect the ESR. Hence always work in a quiet
area of the lab, & away from the window in order to avoid temp.
variation. Also make sure that the tubes are vertical during the
ESR measurement.

12. Westergren Method
 Requirements:
 1.Westergren ESR tube
 2.Westergren ESR stand
 3.Timer or watch &Sodium citrate
 specimen: EDTA blood sample

13. 1. Identify the right patient.
2. Collect all the requirements.
3. Do the labelling.
4. Collect require amount of blood by vein puncture.
5. In a labelled test tube take 0.4 ml sodium citrate & 1.6 ml
blood & mix well.
6. Fill the
Westergren tube exactly up to zero mark making certain that
there is no air bubble in the blood column drawn through the

14. 7. Place the tube upright in the stand. It should fit evenly into the
groove of the stand.
8. Note the time. Allow the tube to stand for exactly one hour.
9. Exactly after one hour note the level to which the red cell column
has fallen.
10. Report the result in terms of mm/hr.
11. Put all the requirements back to its place.
12. Clean the working area.
13. Wash the hands.

16. Precaution:
 1.Wash the tubes as early as possible under running tap water. Rinse in
deionised water & dry in the incubator between 40 to 50 degree.
 2.Do not take the reading after half an hour & report a 1 hr. reading after
multiplying by 2. The rate is slow in the beginning & fast after about 45 min.
 3.Temp. Directly affects the ESR. High temp. leads to false high values &
conversely for low temp. The specimen must be brought to room temp.
before setting up the test.
 4. Tilting of the tube increase the ESR rate.
 5.Do not use haemolysed blood.