HEMA ESR Flashcards
ERYTHROCYTE SEDIMENTATION RATE
Refers to the speed of the settling of RBC in ___.
Measures the ___ and ____ of RBCs in plasma in a tube of a standard bore and length after standing ___
ERYTHROCYTE SEDIMENTATION
RATE
- anticoagulated blood
-distance and speed of fall
-perpendicularly
____ are the most important factor
influencing ESR
Plasma proteins
STAGES OF ESR
- Initial period of aggregation or rouleaux formation - 10 mins
2.Period of fast settling - 40 mins
3.Final period of packing - 10 mins
IMPORTANCE OF ESR
- Indirectly measures inflammation in the body
- Used as an index of the presence of active infection
- Measures the suspension stability of RBCs
- Indicates abnormal concentration of fibrinogen,
globulin, and other plasma proteins
METHODS OF ESR
DETERMINATION
1.Wintrobe-Landsberg Method
2.Westergren Method
ESR MATERIALS
EDTA anticoagulated blood
Wintrobe tube
Pasteur pipette
Timer
Westergren tube
Westergren rack
Test tube rack
Quite accurate
Utilizes Wintrobe tube which contains ____
WINTROBE-LANDSBERG
METHOD
-two calibrations
WINTROBE-LANDSBERG
METHOD (procedure)
- Fill the Wintrobe tube with blood using the Pasteur
pipette.
2.Place the tube in a vertical position on a rack. - After letting the tube stand for one hour, record the ESR in millimeters.
WINTROBE-LANDSBERG
METHOD (Normal Values)
Male: 0-10 mm/hr
Female: 0-20 mm/hr
WINTROBE-LANDSBERG
METHOD
Has 2 calibrations
⚬0-10 (Red) is used for ________
⚬10-0 (White) is used for ________
ESR
HEMATOCRIT
The most sensitive for ESR determination
Can be used for the serial study of ____ like _____ and _____
WESTERGREN METHOD
chronic diseases like tuberculosis, carcinoma and others
WESTERGREN METHOD procedure
1.Fill the Westergren tube with blood
2.Let the tube stand vertically on a Westergren rack.
3.Record the ESR in millimeters after an hour.
WESTERGREN METHOD Normal values
Male: 0-15 mm/hr
Female: 0-17 mm/hr
COMPARISON BET. WINTROBE AND WESTERGREN METHODS
LENGTH
DIAMETER OF BORE
BOTTOM OF TUBE
CALIBRATION
ANTICOAG OF CHOICE
ADV
DISADV
WESTERGREN
30CM
2.5MM
OPEN
0-200 mm
3.8% trisodium citrate
most sensitive method for serial study of chronic dses.
Large amnt of blood is necessary
WINTROBE
11.5 cm
3mm
Flat and closed
0-100mm
Hellen and Paul’s double oxalate
Smaller amnt of blood is needed, other test can be performed after ESR determination (hematocrit and LE cell prep)
Less senstive due to a shorter column
CLINICAL SIGNIFICANCE
Increased ESR
Chronic inflammatory conditions including rheumatoid arthritis
Pregnancy (increased fibrinogen)
Bacterial infection
Malignancy
Tissue damage
Multiple myeloma
Waldenstrom macroglobulinemia
Severe anemia
CLINICAL SIGNIFICANCE
Normal to Decreased ESR
Polycythemia
Sickle cell anemia
Spherocytosis and other conditions with poikilocytosis (prevents rouleaux formation)
Viscosity of plasma lessens ESR (More viscous = Decreased ESR)
SOURCES OF ERROR
Falsely increased results
Tilted column
Hemolysis
Increased room temperature
SOURCES OF ERROR
Falsely decreased results
Clotted sample
Excess anticoagulant
Old blood (spherocytes form)
FACTORS AFFECTONG ESR
- Blood proteins and lipids
- Red blood cells
- WBC
- Drugs
- Clinical conditions
- Specimen handling
- Technique
Blood protein and Lipids Increased ESR
Hypercholesterolemia
Hyperfibrinogenemia
Hypergammaglobulinemia
Hypoalbuminemia
Blood protein and Lipids decreased ESR
Hyperalbuminemia
Hyperglycemia
Hypofibrinogenemia
Hypogammaglobulinemia
Increased bile salts
Increased phospholipids
RBC Increased ESR
Anemia macrocytosis
RBC Decreased ESR
Acanthocytosis
Anisocytosis(marked)
Hemoglobin C
Microcytosis
Polycythemia
Sickle cells
Spherocytosis
Thalassemia
WBC Increased ESR
Leukemia
WBC decreased ESR
Leukocytosis (marked)
DRUGS Increased ESR
Dextran heparin
Penicillamine
Procainamide
Theophylline
Vitamin A
Drug decreased ESR
Adrenocorticotropic hormone (corticotropin)
Cortisone
Ethambutol
Quinine
Salicylates
Clinical conditions
Increased ESR
Acute heavy metal poisoning
Acute bacterial infections
Collagen vascular dses
Diabete mellitus
End-stage renal failure
Gout
Malignancy
Menstruation
Multiple myeloma
Myocardial infarction
Pregnancy
Rheumatic fever
Rheumatoid Arthritis
Syphilis
Temporal arteritis
Clinical conditions
Decreased ESR
Cachexia
Congestive heart failure
Newborn status
Specimen handling Increased ESR
Refrigerated specimen not returned to room temp
Specimen handling Decreased ESR
Clotted blood specimen
Delay in testing
Technique Increased ESR
High room temp
Tilted ESR tube
Vibration
Technique decreased ESR
Bubbles in ESR column
Low room temperaure
Narrow ESR Column diameter
