*CMPH* TEST: Role of insects & their vectors

1. Presented to: Mam Shazra
Presented by: Group 1 (A) Boys

2. The erythrocyte sedimentation rate
(ESR) is a non-specific test. It is raised in a wide
range of infectious, inflammatory, degenerative, and
malignant conditions associated with changes in
plasma proteins, particularly increases in fibrinogen,
immunoglobulins, and C-reactive protein.
Also affected by many other factors including
anaemia, pregnancy, haemoglobinopathies,
haemoconcentration
and treatment with anti-inflammatory drugs.

3. ESR can be performed either by Wintrobe's
Method or by Westergren's Method.
--The Westergren Method is recommended by the
ICSH. In this method, properly diluted blood
sediments in an open-ended glass tube
mounted vertically on a stand.
The Westergren
Method can be performed on blood that has
been collected either directly in liquid Tri-Sodium
Citrate anticoagulant or in powdered EDTA.

4. 1. A Westergren Tube is an open-ended tube,
30 cm in length and has a diameter of 2.55 mm. It is
marked
from the bottom in mm up
to 20 cm length. The bore must be uniform
and smoot
2. A Westergren Stand
3. A rubber teat or a mechanical device for
filling the tube.

5. Tri-Sodium citrate, 32
g/l Reagent No. 73
(3.2% W/v)
anticoagulant
•
Store the reagent
at 4–8 C. Renew if
it becomes cloudy
Either venous blood collected
directly
into sodium citrate and tested
within 2 hours, or
EDTA anticoagulated blood
diluted in sodium citrate
can be used. If EDTA blood is
used and kept refrigerated at
4–8 C, citrate dilution of the
blood and
testing can be delayed for up to
6 hours.

6. 1. Take a Westergren tube and fill it with
diluted blood to the zero mark with suction
applied by a teat or mechanical device.
2. Place a finger tip over the upper end of the
Westergren tube to hold the column of blood
in the tube.
3. Fix the tube in the Westergren Stand and
allow it to stand there for exactly 1 hour.
4. At the end of the one hour, read the height
of the clear plasma to the nearest one mm

7. Westergren tubes must be scrupulously
clean and dry. After use, these should be
thoroughly washed with tap water, then
rinsed with acetone and allowed to dry.
The surface of the table on which the stand is placed, must
be level and vibration-free.
The test should be protected from draught and direct
sunlight.
The test should be carried out at room temperature (18-25°C).
Sedimentation is accelerated at high
temperatures.

8. • Females: (17-50 years) - up to 12 mm in 1 hour
• Males: (17-50 years) - up to 10 mm in 1 hour
• Newborns: their ESR is usually low
Note: Higher values are obtained during
menstruation, pregnancy, puerperium.
Because of the many factors that affect red
cell sedimentation, slightly and moderately
raised values
may not be significant, particularly in
tropical countries. Markedly raised values
should be investigated

9. Anaemia due to any cause
Acute and chronic inflammatory conditions and
infections including:
– HIV disease
– Tuberculosis*
– Acute viral hepatitis
– Arthritis
– Bacterial endocarditis
– Pelvic inflammatory disease
– Ruptured ectopic pregnancy
ESR values do not fall when a patient with
tuberculosis is also co-infected with HIV

10. In polycythaemia, dehydration, dengue
haemorrhagic fever, and other conditions
associated with haemoconcentration.
Abnormally shaped red cells as in sickle cell
disease also lower sedimentation rate.
Other situations in which sedimentation is
reduced
include DIC (fibrinogen is consumed) and
treatment with anti-inflammatory drugs.

11. Nonspecificity
Affected by Multiple Factors
Interference with Impurities
Nonspecific Inflammation Detection
Inexpensive and Simple
Quick to Perform