erythocyte sedimentation rate , factors affecting stages westegrens method wintrobrs method zeta sedimentation method landaue method capillary tube method micro esr method automated method increasing and decreasing conditions

2. • Erythrocyte sedimentation rate (ESR) is a non-specific test
for inflammation.
• It is easy to perform, widely available,
• Inexpensive making it a widely used screening test.
• It is also used a monitoring tool for response to treatment in
conditions in which it is raised (tuberculosis, autoimmune
diseases etc).
• Basics:
• The ESR test in performed in the laboratory by placing
anticoagulated blood in an upright tube (Westegren's most
often).
• At the end of one hour, the rate of the RBC sedimentation
is measured.

3.  When whole blood is allowed to settle
sedimentation of erythrocyte will occur.
 The rate at which red cell fall is known as ESR.
 The column of red cell is settle by rbc.

4.  Physiological factor
 Red cell factor
 Lab factors

5. A- Effect of plasma protein (α 2 , β , gamma)
Increased in the concentration of fibrinogen and
Immunoglobulin's 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
bioconcavity, like spherocyte and sickle cells, usually do not
exhibit increase rate, unless there is severe anemia. (dec
ESR)
• Increase red cell mass will retard the sedimentation rate e.g.
polycythemia.
• SEDIMENTATION RATE α WEIGHT OF CELL,
• INVERSILY PROPTN…………. SURFACE AREA
•

6. C- Technical factors
• Perpendicularity of sedimentation tube, slight deviations
from the absolute. Vertical can increase the result.
• Temperature (RT 18-25 C) higher temperature cause false
high results due to reduction in plasma viscosity
• Vibration can reduce the ESR.
• Time
• Length of tube
• AC
•

7. • The initial lag phase (10m)( aggregation)
• The phase of rapid RBC falling (40m)
(sedimentation)
• The packing phase (10m) .(complete packing)
•Normal value: ESR values tend to rise with age and are generally
higher in women. ESR is also elevated in the black population and
those with anemia .

11. • Wintrobe method ; male:0-9 mm/hr
• ; female:0-20 mm/hr
• Westergrens method; male 5-15 mm/hr
• ; females 5-20 mm/hr
• Landau method ; male 0-5 mm/hr
• ; female 0-8 mm/hr

12. • ESR is determined by the interaction between factors that
promote (fibrinogen) and resist (negative charge of RBCs -
that repel each other) sedimentation.
• Normal RBCs settle slowly as they do not form rouleaux or
aggragate together. Instead, they gently repel each other due
to the negative charge on their surfaces.
• Increased rouleaux formation contributes to high ESR.
• Rouleaux are stacks of many RBCs that become heavier and
sediment faster.
• Plasma proteins, especially fibrinogen, adhere to the red cell
membranes and neutralize the surface negative charges,
promoting cell adherence and rouleaux formation

13. • Put 0.4 ml sodium citrate + 1.6 ml blood . OR put
0.2 ml sodium citrate + 0.8 ml blood .
Alternatively, 3ml whole blood anticoagulated with
EDTA. (If this specimen type is used the whole
blood [2.0ml] must be diluted with 0.85% w/v
sodium chloride [0.5ml] prior testing).

14. 1) 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) 2-Make certain the Westergren ESR rack is exactly level.
3) 3- Fill the Westergren pipette to exactly the 0 mark.
Making certain there are no air bubbles in the blood.
4) 4-Place the pipette in the rack. Be certain the pipette fits
snugly and evenly into the grooves provided.
5) 5-Allow the pipette to stand for exactly 60 minutes.
6) 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

15. The aggregated RBCs in the rouleaux formation have a higher ratio of 'mass to
surface area' as compared to single RBCs and hence sink faster in plasma .

16. • ESR of more than 100 mm/hr is strongly
associated with serious underlying disorders
like connective tissue disease, infections and
malignancies.
• ESR is helpful in diagnosing two specific
inflammatory diseases ,temporal arteritis
and polymyalgia rheumatica.

17. • Multiple myeloma.
• Connective tissue disorders - SLE, RA and other
autoimmune diseases.
• Tuberculosis.
• Malignancies.
• Severe anemia.
• Drugs such as dextran, methyldopa (Aldomet), oral contraceptives,
penicillamine procainamide, theophylline, and vitamin A can increase
ESR, while aspirin, cortisone, and quinine may decrease it .

18. • Polycythemia
• Severe Leukocytosis
• Sickle cell disease (anemia(
• Hereditary spherocytosis
• Congestive cardiac failure
• Corticosteroid use
• Hypofibrinogenemia
• Note that sickle cell anemia and spherocytosis have low ESR
unlike other anemia's.
• This is due to reduced rouleaux formation owing to the
abnormally shaped RBCs in this condition.

19. • Erythrocyte sedimentation rate is a non-specific test and is
not diagnostic of any particular disease. It has a high
sensitivity but low specificity. Never base a diagnosis
solely on an ESR value, either normal or high.
• Interpretation of the result should always be along with
the patient's clinical history, examination findings and
results of other tests done.
• If high ESR is encountered without any obvious reasons,
patient should be reassured and the test repeated after a
reasonable amount of time (a couple of months).

20. • ESR and C-reactive protein (CRP) are both markers of
inflammation .
• Generally, ESR does not change as rapidly as does
CRP, either at the start of inflammation or as it goes
away.
• CRP is not affected by as many other factors as is ESR,
making it a better marker of inflammation.
• However, because ESR is an easily performed test,
many doctors still use ESR as an initial test when they
think a patient has inflammation .

22. . Westergrens method
• modified westegrens method
. Wintrobe method
• capillary method
• microESR method
. Landau-microsedimentation method
• zeta sedimentation rate
• automated method

23.  MODIFIED WESTEGRENS MTD :
EDTA used, dilute with0.5 ml normal saline
 Wintrobe method
 capillary method :
 microESR method : 0.2 ml bld ,230 mm long ,
1mm bore size ……pediatric patients
 Landaue mtd