ESR

Question 1

Erythrocyte Sedimentation Rate (ESR) measures

Answer 1

Rate of fall of RBCs settling in 1 hour (distance in mm).

Question 2

ESR indication

Answer 2

Detect and monitor inflammatory conditions (e.g., rheumatoid arthritis).

Question 3

ESR in sickle cell disease (SCD) - absence of crisis

Answer 3

Low ESR.

Question 4

ESR in sickle cell disease (SCD) - during crisis

Answer 4

Moderately increased ESR (1 week into crisis).

Question 5

ESR in osteomyelitis

Answer 5

Elevated, helpful in monitoring therapy.

Question 6

ESR in stroke

Answer 6

> 28 mm/h indicates poorer prognosis.

Question 7

ESR in prostate cancer

Answer 7

> 37 mm/h indicates higher incidence of progression and death.

Question 8

ESR in coronary artery disease (CAD)

Answer 8

> 22 mm/h in white men indicates higher risk of CAD.

Question 9

ESR in cancer patients

Answer 9

> 100 mm/h usually indicates metastases.

Question 10

ESR in polymyalgia rheumatica and temporal arteritis

Answer 10

> 90 mm/h typical.

Question 11

Moderate ESR elevations

Answer 11

Common in inflammatory diseases, chronic infections, collagen disease, neoplastic disease.

Question 12

ESR diagnostic value

Answer 12

Limited diagnostic value in inflammatory disorders, useful for monitoring disease activity.

Question 13

ESR limitations

Answer 13

Prone to technical errors, low specificity and sensitivity, not recommended as a screening test in asymptomatic individuals.

Question 14

ESR technical limitations

Answer 14

Prone to errors, low specificity, low sensitivity, not recommended for asymptomatic individuals.

Question 15

Westergren method

Answer 15

Results determined after 1 hr. & 2 hrs.

Question 16

Westergren anticoagulant

Answer 16

3.8% Na citrate (4:1 ratio).

Question 17

Modified Westergren method

Answer 17

Results determined after 1 hr., most commonly used.

Question 18

Modified Westergren anticoagulant

Answer 18

EDTA.

Question 19

Modified Westergren diluents

Answer 19

0.85% NaCl or 3.8% Na citrate.

Question 20

Modified Westergren column size

Answer 20

200-mm column with 2.55 mm or more internal diameter.

Question 21

ICSH

Answer 21

International Council for Standardization in Hematology.

Question 22

CLSI

Answer 22

Clinical and Laboratory Standards Institute.

Question 23

Wintrobe method

Answer 23

Results determined after 1 hr.

Question 24

Wintrobe anticoagulant

Answer 24

Double oxalate or EDTA.

Question 25

Wintrobe tube dimensions

Answer 25

Left side (red): 0 (top) and 10 cm (bottom) for ESR; Right side (white): 10 cm (top) and 0 (bottom) for Macro-hematocrit.

Question 26

VES-MATIC 20 Instrument

Answer 26

Bench top analyzer for measuring ESR in 20 samples.

Question 27

VES-MATIC 20 blood sample collection

Answer 27

Blood obtained in special cuvets and mixed by the instrument.

Question 28

VES-MATIC 20 sedimentation time

Answer 28

Comparable to Westergren in 25 minutes for 1st hour, 45 minutes for 2nd hour.

Question 29

VES-MATIC 20 tube slant

Answer 29

18-degree slant accelerates sedimentation.

Question 30

VES-MATIC 20 sensors

Answer 30

Optoelectric sensors automatically read RBC sedimentation level.

Question 31

Modified Westergren ESR reference range for adult males

Answer 31

0 to 10 mm/hour.

Question 32

Modified Westergren ESR reference range for adult females

Answer 32

0 to 15 mm/hour.

Question 33

Wintrobe ESR reference range for adult males

Answer 33

0 to 9 mm/hour.

Question 34

Wintrobe ESR reference range for adult females

Answer 34

0 to 20 mm/hour.

Question 35

Factors influencing ESR increase

Answer 35

↑ cholesterol, ↑ fibrinogen, ↑ gamma globulins, ↑ albumin, ↑ glucose, ↑ bile salts, ↑ phospholipids, Leukemia, Leukocytosis, Inflammatory conditions, Infections, Subacute bacterial endocarditis, Acute heavy metal poisoning, Collagen vascular diseases, Diabetes mellitus, End-stage renal failure, Hepatitis, Gout, Malignancy, Menstruation, Multiple Myeloma, Waldenstrom’s macroglobulinemia, Myocardial infarction, Rheumatic fever, Rheumatoid arthritis, Syphilis, Temporal arteritis, Nephrosis, Tuberculosis, Pregnancy, Cachexia, Congestive heart failure, Adults over 60 years of age.

Question 36

Factors influencing ESR decrease

Answer 36

↓ albumin, ↓ fibrinogen, ↓ gamma globulins, Microcytosis, Acanthocytosis, Hemoglobin C, Sickle cells, Spherocytosis, Thalassemia, Refrigerated sample NOT returned to room temperature, Low room temperature, Narrow ESR column diameter.

Question 37

RBC conditions increasing ESR

Answer 37

Anemia, Macrocytosis, Polycythemia, Anisocytosis (marked), Microcytosis, Acanthocytosis, Hemoglobin C, Sickle cells, Spherocytosis, Thalassemia.

Question 38

Drugs that increase ESR

Answer 38

Dextran, Heparin, Penicillamine, Procainamide, Theophylline, Vitamin A, Adrenocorticotropic hormone (corticotropin), Cortisone, Ethambutol, Quinine, Salicylates.

Question 39

Clinical conditions increasing ESR

Answer 39

Inflammatory conditions, Infections (acute and chronic), Subacute bacterial endocarditis, Acute heavy metal poisoning, Collagen vascular diseases, Diabetes mellitus, End-stage renal failure, Hepatitis, Gout, Malignancy, Menstruation, Multiple Myeloma, Waldenstrom’s macroglobulinemia, Myocardial infarction, Rheumatic fever, Rheumatoid arthritis, Syphilis, Temporal arteritis, Nephrosis, Tuberculosis, Pregnancy, Cachexia, Congestive heart failure, Adults over 60 years.

Question 40

ESR error causes

Answer 40

Tilted ESR tube, Clotted blood sample, Delay in testing, Bubbles in ESR column, Vibration, High room temperature, Low room temperature.

Question 41

ESR tilt error

Answer 41

A tilt of 30° from the vertical can cause error of up to 30%.