[3s] esr Flashcards
_____ refers to the speed of the settling of RBCs in anticoagulated blood.
Erythrocyte Sedimentation Rate (ESR)
t/f ESR measures the distance in mm that RBCs fall in one hour
t
What are the most important plasma proteins that influence ESR?
Fibrinogen, B-globulins, and pathological immunoglobulins (antibodies)
Select: Commonly monitored using ESR
A) Rheumatoid arthritis
B) Temporal arteritis
C) Polymyalgia rheumatica
D) Inflammatory bowel disease
A B C
OOO: Inflammatory condition for which ESR is used to monitor
A) Infection
B) Malignancies
C) Heart failure
D) Temporal arteritis
C
T/F Due to its high specificity and sensitivity, ESR is an excellent standalone test for detecting inflammation.
F - ESR has low specificity and sensitivity and is used for monitoring, not diagnosis.
A more reliable alternative to ESR for monitoring inflammation is ______.
C-reactive protein (CRP) (↑ CRP)
T/F ESR is directly proportional to RBC mass and inversely proportional to plasma viscosity.
T
The natural ______ charge of RBCs prevents them from forming rouleaux.
Negative (zeta potential)
What happens to RBCs during inflammatory conditions that increase ESR?
Increased plasma proteins, such as fibrinogen and antibodies, neutralize the negative charge of RBCs, leading to rouleaux formation.
OOO: directly proportional to ESR
A) Plasma protein concentration
B) RBC mass
C) Plasma viscosity
D) Rouleaux formation
C
t/f Rouleaux formation occurs when positively charged plasma proteins bridge RBCs, forming a stack of coins appearance.
T
The initial period of aggregation during ESR lasts ______ minutes and is also known as the ______ phase.
10; Lag
During which stage of ESR is sedimentation the fastest?
Period of Fast Settling
total duration of the ESR process
60 mins (1 hr)
t/f final period of packing during ESR is also called the decantation phase
f - Period of Fast Settling is called the decantation phase.
The final period of packing in ESR lasts ______ minutes, during which sedimentation slows down.
10
T/F Stack of coin (rouleaux formation) is directly proportional ESR
t
ESR relies on the principle that when anticoagulated blood is allowed to stand ______ at ______ temperature, RBCs settle at the bottom of the tube in an hour.
perpendicular (90°); room
Select: Increases the fall of RBCs in ESR during inflammatory conditions
A) Decreased plasma viscosity
B) Increased plasma proteins
C) Lower RBC mass
D) Higher zeta potential
B
T/F RBCs settle in ESR due to the formation of rouleaux, which is a stack-like arrangement caused by interlinking plasma proteins.
T
Very low sedimentation, positively charged proteins interlink RBCs
Lag Phase
Constant sedimentation of RBCs, lasts 40 minutes
Decantation Phase
RBCs sedimentation slows down significantly in the last 10 minutes
Final Sedimentation
The total duration of the ESR process is ______ minutes, comprising three stages: Lag Phase (), Period of Fast Settling (), and Final Packing (______ minutes).
60; 10; 40; 10
The lag phase in ESR is characterized by significant sedimentation of RBCs.
f - Sedimentation is very low during the lag phase.
What is another name for the Period of Fast Settling?
decantation phase
During which stage of ESR does rouleaux formation primarily occur?
Lag Phase
ESR can indicate the presence of an active infection because inflammation often causes an increase in ________, ________, and other plasma proteins
Fibrinogen, globulin
OOO: Use of ESR
A) Index of active infection
B) Measurement of suspension stability of RBCs
C) Diagnosis of specific diseases
D) Indication of abnormal plasma protein concentrations
C
t/f The Westergren rack ensures that ESR tubes are placed at a perfect 90° angle, as any tilting could falsely increase the results.
t
Measures time elapsed during ESR process
Timer
Holds blood sample for ESR determination with dual calibration
Wintrobe tube
Allows precise blood transfer to the ESR tube
Rubber aspirator
The Wintrobe-Landsberg method uses a tube that is ______ cm in length and ______ mm in bore diameter.
11.5 ; 3.0
T/F In the Wintrobe-Landsberg method, anticoagulated blood treated with oxalate, EDTA, or citrate can be used.
T
*Initially: oxalate
*Small tubes: EDTA / CITRATED
anticoagulant in WINTROBE-LANDSBERG METHOD
double oxalate
Why do females typically have higher ESR reference values than males?
Elevated fibrinogen due to menstruation
Situation: You have measured the ESR using the Wintrobe-Landsberg method. After one hour, the RBCs have settled to the 15 mm mark. What is the result, and is it within the normal range for a male patient?
15 mm/hr; Not within the normal range (male normal: 0-10 mm/hr).
Normal Reference Value of WINTROBE-LANDSBERG METHOD
Male: _____
Female: _____
M: 0-10 mm/hr
F: 0-20 mm/hr
Why is the Westergren method considered the most sensitive for ESR determination?
The tube is longer and narrower, which enhances accuracy
The Westergren method uses a ______ cm tube with a bore diameter of ______ mm
30; 2.5
t/f The Westergren method is recommended by the Clinical and Laboratory Standards Institute (CLSI) and the International Council for Standardization of Hematology (ICSH).
t
Westergren method uses a tube that is ___ in length and ____ in bore size for ESR determination?
30 cm ; 2.5 mm
T/F The Westergren method is the most sensitive method for ESR determination.
T
The Westergren method uses an anticoagulant in a ________ ratio, where the blood to anticoagulant is ________.
1:4; citrate
OOO: Characteristic of the Westergren method
A) Length of 30 cm
B) Bore size of 2.5 mm
C) Anticoagulant: EDTA
D) Rubber aspirator used for blood transfer
C
Sequence: Westergren ESR method
1) Let the tube stand vertically on the rack.
2) Fill the Westergren tube with blood using a rubber aspirator.
3) Record the ESR after one hour.
2-1-3
Select: Advantages of the Westergren method
A) Recommended by CLSI and ICSH
B) It is sensitive for ESR determination
C) Can only be used for acute inflammatory conditions
D) It is commonly used for chronic disease monitoring like tuberculosis
A B D
T/F: The Westergren method uses an anticoagulant ratio of 1:5 (anticoagulant to blood)
F - 1:4
In the modified Westergren method, the length of the tube is ______ mm and the bore size is ______ mm
200; 2.55
What method is most recommended for ESR and uses a modified tube with a length of 200 mm and a bore of 2.55 mm?
Modified Westergren method
OOO: Difference between the Wintrobe and Westergren methods
A) Westergren tube has a rubber stopper, while Wintrobe tube does not
B) Westergren method uses a narrower tube diameter
C) Wintrobe method requires pipetting, while Westergren method does not
D) Wintrobe tube is typically used for shorter lengths than Westergren tube
B
Advantage: Smaller amount of blood is needed,
other tests can be performed after ESR determination (hematocrit and LE cell preparation)
WINTROBE
The female ESR range for the Graphic or Cutler method is 5-6 mm/hr on average.
T
WESTERGREN vs WINTROBE
Length of tube:
Diameter of bore:
Bottom of tube:
Calibration:
Anticoagulant of choice:
Length of Tube: 30 cm & 11.5 cm
Diameter of bore: 2.5 mm & 3 mm
Bottom of Tube: Open Flat & closed
Calibration: 0-200 nm & 0-100 nm
Anticoagulant: 3.8% trisodium citrate & Hellen and Paul’s double oxalate
Advantage: Most sensitive method for serial
study of chronic diseases
WESTERGREN
Disadvantage: Less sensitive due to a shorter
column
WINTROBE
Disadvantage: Large amount of blood is necessary
WESTERGREN
T/F The Graphic or Cutler method requires blood to be mixed with 3.8% sodium citrate at a 1:1 ratio.
F - 0.8 mL of blood to 0.5 mL of 3.8% sodium citrate
anticoagulant of choice for the Graphic or Cutler method
3.8% sodium citrate
Wintrobe vs Westergren: Length & Width
Wintrobe: _______
Westergren: ______
Wintrobe: shorter and wider
Westergren: longer and narrower (higher reference value)
Select : Graphic or Cutler method
A) The tube is closed with a paraffin-coated cork
B) The tube is observed every 5 minutes
C) It is widely used in hospitals today
D) The anticoagulant used is 3.8% sodium citrate
A B D
capacity of the tube used in the Graphic or Cutler method
5 mL
What is the normal male ESR range for the Graphic or Cutler method?
0-8 mm/hr
OOO: Graphic or Cutler method
A) Requires observation every 5 minutes
B) Anticoagulant of choice is 3.8% sodium citrate
C) Uses a 30 cm tube
D) Tube capacity is 5 mL
C - Westergren method
T/F The Graphic or Cutler method is still commonly performed in modern hospitals.
F - historical and barely used
How long should the tube in the Graphic or Cutler method stand before the results are recorded?
1 hr
T/F The Graphic or Cutler method requires constant observation every 5 minutes for 1 hour.
t
Select: Results of the Graphic or Cutler method
A) Normal male reference value is 0-8 mm/hr
B) Normal female reference value is 0-10 mm/hr
C) Female values increase during menstruation due to fibrinogen production
D) The test is performed every 10 minutes during menstruation
A B C
OOO: Graphic or Cutler method
A) Sedimentation chart
B) 3.8% sodium citrate anticoagulant
C) Observation every 5 minutes
D) Uses a 30 cm tube
D - westergren
T/F The ESR for females increases during menstruation due to a decrease in fibrinogen.
F - ESR increases due to increased fibrinogen production
What is the anticoagulant of choice for the Linzenmeier method?
3% sodium citrate
t/f The Linzenmeier method uses a tube that is 65 mm in length and has a capacity of 1 mL.
t
OOO: Linzenmeier method
A) Anticoagulant is 3% sodium citrate
B) The tube is 65 mm in length
C) The tube has a flat bottom
D) The tube has a mark at 18 mm
C - bray
Select: Linzenmeier method?
A) The RBCs settle at the 18 mm mark
B) The time to fall to the 18 mm mark is recorded
C) The method is used for pediatric patients with tuberculosis
D) The tube capacity is 5 mL
A B C
Select: Micro Landau method
A) The tube has a bulb similar to RBC and WBC pipettes
B) The ESR is measured at the end of one hour
C) The method uses 1.3% sodium citrate as the anticoagulant
D) It is a modification of the Linzenmeier-Raunert method
A B D
OOO: does not belong
A) Linzenmeier method
B) Bray’s method
C) ESR is measured in minutes
D) Uses capillary blood
D - more relevant to the Smith Micro method
anticoagulant of choice for Bray’s method
1.3% sodium citrate
t/f The normal range for male ESR in the Linzenmeier method is 350-600 minutes.
t
The normal range for female ESR in the Linzenmeier method is ____
300-600 minutes.
Select : Bray’s method
A) Uses a flat-bottomed tube
B) The results are recorded after 1 hour
C) Blood is mixed with 3.8% sodium citrate
D) Measures ESR every 5 minutes for 30 minutes
A B C
