ESR (sed rate)

Question 1

The erythrocyte sedimentation rate is a nonspecific test used to detect and monitor any ____________ response to tissue injury. Aka an acute phase response 

Answer 1

Inflammatory

Question 2

What are the units for the ESR test?

Answer 2

mm/hr.

The test is performed in a one hour period 

Question 3

What factors affect ESR?

Answer 3

-size and shape of RBCs
-The plasma protein composition
-The total RBC concentration
-Other mechanical and technical factors

Question 4

RBCs fall because they lineup in __________ formation. 

Answer 4

Rouleaux

Question 5

Anything that overcomes the ________ potential will increase the chances that rouleaux will form and thus increase the ESR. 

Answer 5

Zeta

Question 6

The measurable charge of RBCs, innate repulsion from each other, caused by electrostatic forces

Answer 6

Zeta potential

Question 7

Increased Rouleaux = ___________ ESR

Answer 7

Increased

Question 8

What can significantly alter the ESR up or down?

Answer 8

Plasma protein ratio

Question 9

Conditions which increase plasma viscosity _________ the ESR. 

Answer 9

Increase

*BUT Increased whole blood viscosity decreases the ESR

Question 10



Question 11

When reading an ESR, what do you not include in the reading?

Answer 11

Do not include the whitish buffy coat (Leukocytes and platelets)

Question 12

What is the Westergren ESR reference ranges for males and females? 

Answer 12

Males 0-15mm/hr
Females 0-20 mm/hr

Question 13

The ESR is an extremely ____________ indicator of inflammation. It is increased in almost any type of infection or inflammation due to the rise in acute phase reactants. 

Answer 13

Nonspecific

Question 14

ESR can sometimes be associated with what conditions?

Answer 14

-autoimmune conditions such as lupus and RA
-Increase plasma proteins or plasma viscosity conditions

Question 15

What conditions can cause a decreased ESR?

Answer 15

-polycythemia
-Congestive heart failure
-hypofibrinogenenemia
-And severe RBC morphological abnormalities

Question 16

The larger the cell the _________ its rate of fall.

Answer 16

Faster

• Macrocytes tend to fall more rapidly than microcytes

Question 17

Why is ESR decreased in conditions such as sickle cells or spherocytes?

Answer 17

Where are unable to form rouleaux readily 

Question 18

Can severe anemia cause an increase or decrease ESR?

Answer 18

Increased

• Think of trying to line up three people in an elevator versus a large group

Question 19

Does polycythemia increase or decrease ESR?

Answer 19

Decrease

 * Think of trying to line up three people in an elevator versus a large group

Question 20

Is ESR In Polycythemia vera increased or decreased?

Answer 20

May be normal or decreased depending on the severity of the condition

Question 21

Every degree off from vertical during the ESR test can increase the rate by _____%

Answer 21

10

Question 22

What are the two standardized methods used for ESR?

Answer 22

-Westergren
-Wintrobe

Question 23

How long do the newest rapid optical ESRs take? 

Answer 23

20 min

They are semi-automated instruments that tilt the ESR tubes at a slight angle

Question 24

What are the three stages of ESR for the new rapid optical methodologies? 

Answer 24

1. Initial aggregation- Sedimentation is minimal, Rouleaux begins
2.  fast settling- Constant rate of settling for about 40 minutes
3. Final packing- Occurs mainly at the bottom of tube (last 10 min) 

Question 25

What do the newest rapid optical ESR measure?

Answer 25

The change in Turbidy of the blood as sedimentation progresses