ESR(Erythrocyte Sedime - uCoz

ESR(Erythrocyte Sedimentation rate)
Introduction:whene an anticoagulant blood is allowed to stand vertically sedimentation
of erythrocytes occurs. the rate at which erythrocytes fall down is known as erythrocyte
sedimentation rate.
Principle : anticoagulant blood is taken in a tube and kept undisturbed in vertical
position in a rack. This will allow the sedimentation of erythrocytes, after the specific
time .generally 1 hr .the level of red cell is noted the distance travelled by erythrocytes in
1 hr . Is called as erythrocyte sedimentation rate (ESR)
Methods : there are two methods of determination of ESR :
1- Westergren method
2- Wintrobe method by hawre mlt.ucoz.com

Westergren method
Requirement :
1- Westergren Pipette . 2- Westergren rack. 3- Anticoagulant
Westergren pipette is open in both end , its 30cm in length and 2.5 mm in diameter . The
lower 20cm are marked with 0 at top and 200 at bottom .
The anticoagulant is used in this method is 3.8% trisodium citrate solution . 0.4ml of
trisodium is added to 1.6 ml of blood or 0.5 ml to 2ml of blood
PROCEDURE: fill the pipette by sucking blood up to 0 mark and fix it vertically in
westergren stand (rack). Read the upper level of RBC column exactly after 1 hr
Normal values :
.for male 0-15mm/hr
.for female 0-20 mm/hr

Wintrobe method
• Requirement :
1- Wintrobe pipette . 2- Wintrobe stand . 3- Anticoagulant
Wintrobe tube is open at one side only. The length of Wintrobe tube is 11cm and the diameter is 2.5 mm . The
lower 10cm are marked .the marking is 0 at top and 100 at bottom for ESR and its also used for PCV . the
anticoagulant is used in this method is EDTA 0.4 of EDTA add to 1.6 ML of blood or 0.5 to 2 ml of blood
PROCEDURE: with the help of long necked pasture pipette or special syringe , fill Wintrobe tube up to 0
mark . Place the tube exactly in vertical position in a Wintrobe rack read the upper level of RBC
column exactly after 1 hr
Normal values .
In males : 0-9 mm/hr
.in female : 0-20 mm /hr
The Wintrobe method is commonly and more advantages than westergren method because by Wintrobe
method we can find PCV in addition to ESR

Possible errors in ESR
•improper anticoagulant
•The tube is not vertical in position , the stand should not be kept on vibrating surface .
•Dirty tube
•Bubble caused by too vigorous mixing of blood and anticoagulant
•Hemolysis may modify ESR
•Blood should be tested with in 3 hr of collection
•The reading should be taken after 1 hr exactly .
•The stand should be kept away from sun light or high temperature
FACTOR AFFECTING ESR :
1- plasma .2- RBC .3- Anticoagulant

Plasma :increase level of fibrinogen and globulin accelerate ESR albumin retards ESR ,increase in plasma
viscosity slow down ESR ,cholesterol accelerates ESR
RBC :change in erythrocyte plasma ratio affect ESR . Anemia is responsible for accelerate ESR . Microcyte
sediment slowly ,the macrocyte sedimentation rapidly
Important note:
ESR is no diagnostic test (specific test )for any particular disease , the rapid increase of ESR is found in any
chronic infection like tuberculosis ,lymphatic fever toxemia .and in pregnancy after second month and also
increase in liver disease and malignant tumor
The slow ESR is found in :
1- newborn infants . 2- polycythaemia . 3- allergic condition .4- heart frailer
Relation to C-reactive protein
C-reactive protein is an acute phase protein produced by the liver during an inflammatory reaction.
Since C-reactive protein levels in the blood rise more quickly after the inflammatory or infective
process begins, ESR is often replaced with C-reactive protein measurement. There are specific
drawbacks, however: for example, both tests for ESR and CRP were found to be independently
associated with a diagnosis of acute maxillary sinusitis [17] so in some cases the combination of the
two measurements may improve diagnostic sensitivity and specificity.
by hawre mlt.ucoz.com