This document discusses erythrocyte sedimentation rate (ESR), packed cell volume (PCV), and blood indices. It provides details on performing and interpreting ESR using the Westergren and Wintrobe methods. Average ESR values are 3-5 mm/hr for males and 4-7 mm/hr for females using Westergren method. For Wintrobe method values are 0-9 mm/hr for males and 0-20 mm/hr for females. PCV is measured using the Wintrobe method and expressed as a percentage. Blood indices - MCV, MCH, MCHC are also discussed along with their clinical significance.

1. ESR, PCV AND BLOOD
INDICES
DR. MOHAN SINGH DHAKAD

2. OBJECTIVES OF THIS
CLASS
Toperform and interpret ESR
Toperform and interpret PCV
Toperform and interpret Blood Indices

3. ERYTHROCYTE
SEDIMENTATION RATE (ESR)
ESRis the measurement of the rate of
sedimentation of red cells in anti -
coagulated blood.
Blood is allowed to stand for 1 hr in an
open-ended glass tube mounted vertically
on astand
Length of column of plasma above the red
cells is measured in mm.

4. Three definite phases:
•Stage of rouleaux formation (10mins) – red cells
form a characteristic rouleaux pattern
(aggregation) and sedimentation is generally
slow. (Pack of coins)
•Stage of sedimentation (40mins) – The rate
accelerates in this phase; fast settling or sinking
ofRBCs
•Stage of Packing of rouleaux (last 10mins) –
slows again as red cell aggregates pile up at the
base of the tube. There is slow sedimentation.

5. FACTORS AFFECTING
ESR
1. Plasma factor
2. RBCfactor
3. Technical factor

6. PLASMA FACTORS
*Increased fibrinogen increases rouleaux
formation thereby increasing ESR
*S. haptoglobulin , C - reactive protein &
cholesterol also increases ESR
*Albumin and lecithin decreases
sedimentation i.e. decreasing ESR

7. RBC FACTORS
Primarily through changes in number
and/or shape
Anemia responsible for increasedESR
◦Microcytes – sediment more slowly
◦Macrocytes – sediment faster

8. Poikilocytosis retards ESRbecause
abnormal shape
hampers rouleaux formation
Anti coagulants – Sodium citrate & EDTA
does not affect ESR
oxalates & heparin mayaffect

9. TECHNICAL FACTORS
Poor temperature control
Length and bore of the tube
Vibration
Verticality

10. METHODS
Westergren’s method
Wintrobe’s method

11. WESTERGREN METHOD
The recommended tube is a straight
glass or rigid transparent plastic tube
30 cm in length
2.55 mm in diameter.
Bore must be uniform
A scale graduated in mm
extends over the lower 20cm.

12. For the diluent, 3.8 g/dl Trisodium citrateused
Dilution –1:4
0.25ml trisodium citrate : 1mlblood
Mix the blood sample thoroughly and then draw it into
the Westergren tube up to the 200 mm mark by means
of a rubber teat or amechanical device

13. Placethe tube exactlyvertical
exactly 60 min, free
and leave undisturbed for
from
vibrations and draughts and
not exposed to direct
sunlight.
Then read to the nearest 1
mm the height of the clear
plasma above the upper limit
of the column of sedimenting
cells.
Westergren pipette filled with blood
and placed vertically on the rubber
cork in the rack

14. ERYTHROCYTE SEDIMENTATION
RATE
Average ESRvalue by Westergren Method:
Male –3-5mm in first 1hour
Female – 4-7mm in first1 hour

15. PROCEDURE – WINTROBE METHOD
1.Add well mixed double oxalate / EDTAblood to the zero mark of
the Wintrobe tube, usingapipette
Avoid air bubbles
2. Place in vertical position in arack and left for 60 minutes
3.Readand record results in millimeter (distance which thecells
have settled)

16. AverageESRvalue byWintrobe’s Method:
◦ Males: 0 –9mm/hr
◦ Females:0 –20mm/hr
◦ Children: 0 –13mm/hr

17. IncreasedESR
•Chronic infections e.g.Tuberculosis
•Extensive/ Chronic inflammation
•Collagen vascular disorders
o
o
o
Systemic LupusErythromatosus
Rheumatoid arthritis
Systemic Sclerosis
•Shock
•Active syphilis
•Active infectious infections

18. DecreasedESR
•Newborns
•Congestive heart failure
•Polycythemia
•Marked leukocytosis
•Allergic states
•Sicklecell anemia

19. Ratio of volume of RBCsto that of whole blood
It indicates relative proportion of red cells to plasma
Expressedin percentage.
Also called hematocrit or erythrocyte volume fraction
PACKED CELL VOLUME

20. Methods:
1. Macrohematocrit method (Wintrobe Method)
2. Microhematocrit method

21. WINTROBES METHOD
•Wintrobe’s tube – 110mmlong,
internal bore 2.5mm&
aflat inner base.
Graded 0-10 on both sides.

23. Method:
1.Mix the anticoagulant blood samplethoroughly
2.Draw blood in aPasteurpipette
3.Fill the tube upto 10mark
4
..Centrifuge the sample at 2000-3000 rpm for
30mins
5.Takethe reading of the length of the column of
red cells

25. Buffy coat- WBC& PLATELETS.
UPPERMOSTLAYER– PLASMA
•Yellowish-Jaundice
•Pink-haemolysis
•Milky-hyperlipidemia

27. PCV reading

28. PRECAUTIONS
Use recommended amount of EDTA
Test done within 6-8 hours
Wintrobe tube should be filled from
below upwards so that no air bubble
istrapped.

29. INCREASED PCV
Polycythemia
-Newborns, Highaltitude,
Hypoxia due to lung and
heart diseases.
Congestive Heart failure,
Burns (loss of plasma),
Dehydration, Severe
Exercise,Emotional stress
DECREASED PCV
Anaemia
Pregnancy
(Hemodilution)

30. RED BLOODCELL INDICES:
1.Mean corpuscular volume(MCV)
2.Mean corpuscular
hemoglobin(MCH)
3.Mean corpuscular hemoglobin
concentration(MCHC)

31. Mean Corpuscular
Volume(MCV)
Average or mean volume of a single red
bloodcell Expressed in femto liter (fl)

32. Calculation
Formula:
MCV = PCV in percentage X10
RBCcount per cmm
Normal range:
80-100fl

33. INCREASED
Megaloblastic anaemia
Chronic alcoholism
Liver disease
newborns
DECREAS
ED
Microcytic hypochromic
anaemia

34. Mean Corpuscular
Hemoglobin(MCH)
Averagehemoglobin content (weight of Hb) ina
single red bloodcell
Expressedin picograms(pg).

35. Calculation:
Formula:
MCH = Hb in gm/dl X 10
RBCcount per cmm
Normal range: 27 – 32pg

36. INCREASED
Macrocytic anaemia
Newborns
DECREASED
Microcytic anaemia

37. Mean Corpuscular Hemoglobin
Concentration(MCHC)
Average of red cells containing hemoglobin.

38. Calculation
Formula:
MCHC = Hb X 100
PCV
Normal range: 30 – 35 (%)

39. INCREASED
Hereditary spherocytosis
DECREASED
Hypochromic anaemia

40. CLINICAL SIGNIFICANCE
A)Macrocytic anaemia:
◦ MCVslightly increased upto 150 fl
◦ MCHis slightly increased
◦ MCHCis normal ordiminished
B)Microcytic anaemia:
◦ MCVis diminished up to 50 fl orlower
◦ MCHis diminished to 15 pg or lower
◦ MCHCis diminished to 20%orless
C)Spherocytosis:
◦ MCVis diminished
◦ MCHC iselevated

41. Thank you