MODULE 5 UNIT 1: ERYTHROCYTE SEDIMENTATION RATE (ESR)

Question 1

An (?) will be allowed to stand at room temperature undisturbed for a period of time.

Answer 1

anticoagulated blood

Question 2

(?) settles at the bottom of the ESR tube.

Answer 2

Erythrocytes

Question 3

The (?) is the distance in millimeters that the red blood cells fall in 1 hour.

Answer 3

ESR

Question 4

The ESR is affected by several factors including

[?] - tend to repel to one another due to its negative surface charge

Answer 4

red blood cells

Question 5

ESR may also be affected by

[?] - contain fibrinogen, albumin, globulin, etc., [?].

Answer 5

plasma factors
mechanical and technical factors

Question 6

(?) is a non-specific marker of inflammation.

Answer 6

Erythrocyte sedimentation rate (ESR)

Question 7

ESR is performed to detect and monitor [?] together with other [?] such as C-Reactive protein which is more reliable.

Answer 7

inflammation
inflammatory markers

Question 8

ESR is elevated in many other conditions such as

Answer 8

plasma cell myeloma
pregnancy
anemia
older age

Question 9

Due to its [?], ESR is also prone to several technical errors that can cause false elevation or decrease in the sedimentation rate.

Answer 9

sensitivity

Question 10

ESR has low [?] to inflammation, which makes it less recommended as [?] in detecting such inflammatory conditions among individual with asymptomatic state.

Answer 10

specificity and sensitivity
screening test

Question 11

ERTHROCYTES Increase

Answer 11

Macrocytes
Anemia

Question 12

Erythrocytes Decrease

Answer 12

Microcytes
Poikilocytes
Polycythemia
Spherocytes

Question 13

Plasma Composition Increase

Answer 13

Fibrinogen
Alpha-1- Globulin
Alpha-2- Globulin
Lipids

Question 14

Plasma Composition Decrease

Answer 14

Albumin
Lecithin

Question 15

Technical/Mechanical Factors Increase

Answer 15

Tilting
Increased Temperature
Vibration

Question 16

Technical/Mechanical Factors Decrease

Answer 16

Low Temperature
Over anticoagulant

Question 17

3 Factors that Influence ESR

Answer 17

Erythrocytes
Plasma Composition
Technical/Mechanical Factors

Question 18

3 Stages of ESR

Answer 18

1. Initial rouleaux formation
2. Rapid Settling
3. Final Sedimentation of RBCs

Question 19

In the initial [?], little sedimentation occurs as rouleaux formation starts.

Should there be an increase in quantities of [?], the repulsive forces are partially or totally counteracted.

Under these conditions, [?] may tend to settle more rapidly as a result of the rouleaux formation.

Answer 19

10 minutes

positively charged plasma proteins

erythrocytes

Question 20

For about [?], settling occurs at a constant rate.

[?] settle slowly since these cells have a small mass however, alteration of the [?] that are present in plasma is also possible to happen in certain diseases and can cause rouleaux formation.

The alteration that may occur can change the surface of the erythrocyte leading to [?] of the red blood cells, [?] of erythrocytes, and a [?] ESR.

Answer 20

40 minutes

Normal erythrocytes

fibrinogen globulins

-stacking
-increase mass
-more rapid

Question 21

[?] slows as cells pack at the bottom of the tube in the final [?].

Answer 21

Sedimentation

10 minutes

Question 22

This method uses an oxalate-anticoagulated whole blood however, EDTA or citrated whole blood may also be used with the shorter column.

Answer 22

Wintrobe and Landsberg Method

Question 23

Wintrobe and Landsberg Method
 Length: ?
 Bore: ?

Answer 23

 Length: 11.5cm
 Bore: 3.0mm

Question 24

Procedures
1. Use fresh blood collected in EDTA anticoagulant. A minimum of 2 mL of whole blood is needed.
2. After mixing the blood thoroughly, fill a Pasteur pipette using a rubber pipette bulb. 3. Place the filled pipette into the Wintrobe tube until the tip reaches the bottom of the tube.
4. Carefully squeeze the bulb and expel the blood into the Wintrobe tube while pulling the Pasteur pipette up from the bottom of the tube. There must be steady, even pressure on the bulb to expel blood into the tube as well as continuous movement of the pipette up the tube to prevent the introduction of air bubbles into the column of blood.
5. Fill the Wintrobe tube to the 0 mark.
6. Place the tube into a Wintrobe rack (tube holder) and allow to stand undisturbed
for 1 hour at room temperature. The rack must be perfectly level and placed in a draft-free room.
7. Record the number of millimeters the red blood cells have fallen. Read the tube from the bottom of the plasma meniscus

Answer 24

Wintrobe and Landsberg Method

Question 25

Wintrobe and Landsberg Method
Normal Value:
Male: ?
Female: ?
Children: ?

Answer 25

Male: 0-9MM
Female: 0-20MM
Children: 0-13MM

Question 26

This method has been recommended as the reference method when undiluted whole blood is used. Hematocrit should not exceed 35% since it may be poorer for the reproducibility of the sedimentation in narrow tubes.

Answer 26

Standard Westergren Method

Question 27

Conversion of diluted blood ESR and undiluted is as follows:

o Diluted blood ESR Undiluted
ESR = ?
o Length: ?
Bore: ?
o Calibrated in millimeters from

Answer 27

(Undiluted ESR × 0 86) – 12
30cm
2.5mm
0-200

Question 28

Procedures
1. Two milliliters of whole blood are added to 0.5 mL of sodium citrate and mixed by inversion.
2. A Westergren pipet is filled to the 0 mark and is placed exactly vertical in the rack at room temperature without vibration or exposure to direct sunlight.
3. After exactly 60 minutes, the distance from the 0 mark to the top of the column of red cells is recorded in millimeters as the ESR value. If the demarcation between plasma and the red cell column is hazy, the level is taken where the full density is first apparent.

Answer 28

Standard Westergren Method

Question 29

Standard Westergren Method
Below age 50
Above age 50
Children

Answer 29

0-15mm/hr; 0-20mm/hr
0-20mm/hr; 0-30mm/hr
0-10mm/hr; 0-10mm/hr

Question 30

This method uses blood that EDTA anticoagulated rather than with citrate. This also allows the ESR to be performed from the same tube of blood used for other hematologic studies.

Answer 30

Modified Westergren Method

Question 31

Procedures
1. Use well-mixed blood collected in EDTA and dilute at four parts blood to one part 3.8% sodium citrate or 0.85% sodium chloride (e.g., 2 mL blood and 0.5 mL diluent). Alternatively, blood can be collected directly into special sedimentation test tubes containing sodium citrate. Standard coagulation test tubes are not acceptable, because the dilution is nine parts blood to one-part sodium citrate. 2. Place the diluted sample in a 200-mm column with an internal diameter of 2.55 mm or more.
3. Place the column into the rack and allow to stand undisturbed for 60 minutes at room temperature (18 to 25° C). Ensure that the rack is level.
4. Record the number of millimeters the red blood cells have fallen in 1 hour. The buffy coat should not be included in the reading. Read the tube from the bottom of the plasma layer to the top of the sedimented red blood cells.

Answer 31

Modified Westergren Method

Question 32

Modified Westergren Method
Wintrobe; Westergren
Bore:
Graduation:
Anticoagulant:
Amount of blood:

Answer 32

Bore: 3 mm; 2.5 mm
Graduation: Upto 200 mm; Upto 300 mm
Anticoagulant: Double oxalate/ EDTA; Sodium Citrate/ EDTA
Amount of blood: 1 ml; 2.4 ml

Question 33

Conditions with Increase ESR

Answer 33

Inflammatory condition
Acute and Chronic Infections
Rheumatic fever
Rheumatoid Arthritis
Myocardial infarction
Nephrosis
Tuberculosis
Multiple myeloma
Waldenstrom’s macroglobulinemia Subacute bacterial endocarditis
Hepatitis
Menstruation
Pregnancy

Question 34

Conditions with Decrease ESR

Answer 34

Spherocytosis
Poikilocytosis
Sickle cell anemia
Hemolytic jaundice
Severe Iron Deficiency
Thalassemia

Question 35

Conditions with Markedly Increase (100mm or more per hour)

Answer 35

Multiple myeloma
Waldenstrom’s macroglobulinemia
Malignant lymphoma
Leukemia
Acute and Severe bacterial infection
Severe anemia
Carcinoma
Collagen diseases
Sarcoma
Portal or Biliary cirrhosis
Ulcerative colitis
Severe renal disease

Question 36

Conditions with Moderately Increase

Answer 36

Acute and Chronic Infectious diseases
Acute localized infections
Reactivation of a chronic infection
Rheumatic fever
Rheumatoid arthritis
Myocardial infarction
Malignant tumors with necrosis
Hyperthyroidism
Hypothyroidism
Lead and arsenic intoxication
Nephrosis
Internal hemorrhage
Acute hepatitis
Unruptured ectopic pregnancy after third month
Ruptured ectopic pregnancy
Menstruation
Normal pregnancy after third month
Tuberculosis
Ingestion of oral contraceptives
Intravenous dextran
Post-commissurotomy syndrome

Question 37

Conditions with Decrease ESR

Answer 37

• Early acute appendicitis (within 24 hours)
• Early unruptured ectopic pregnancy
• Malarial paroxysm
• Cirrhosis of the liver
• Degenerative arthritis
• Infectious mononucleosis
• Acute allergies
• Uncomplicated virus diseases
• Peptic ulcer, Typhoid fever
• Undulant fever, Pertussis
• Rheumatic carditis with cardiac failure

Question 38

The (?) may cause erroneous reading of ESR, if the (?) is higher than recommended, it may cause elevation. However, if used in the proper concentration, Sodium citrate or EDTA does not affect the rate of sedimentation.

Answer 38

concentration of the anticoagulant

Question 39

Alteration of the (?) is possible with the use of Heparin. It can also cause increase ESR when used as a medication in vivo.

Answer 39

membrane zeta potential

Question 40

(?) may cause false interpretation since hemolysis may modify the sedimentation.

Answer 40

Bubbles and Hemolysis

Question 41

(?) accelerates the ESR, on standing, erythrocytes tend to become spherical and less readily form rouleaux.

Answer 41

Tilting the tube

Question 42

The (?) aggregate along the lower side while the plasma rises along the upper side.

Answer 42

red cells

Question 43

The red cells aggregate along the lower side while the (?) rises along the upper side.

Answer 43

plasma

Question 44

An angle of even (?) from the vertical may accelerate the ESR by as much as 30%.

Answer 44

3 degrees

Question 45

(?) have slightly higher (1–2 mm/hour) values than glass pipets.

Answer 45

Plastic ESR pipets

Question 46

Temperature should be within the range of (?) C. Lower or higher temperatures in some cases alter the ESR.

Answer 46

20°–25°

Question 47

If the blood has been kept refrigerated, it should be permitted to reach room temperature and be mixed by inversion a minimum of (?) before the test is performed.

Answer 47

eight times

Question 48

The test should be set up within (?) after the blood sample is obtained (or within 12 hours if EDTA is used as the anticoagulant and the blood is kept at 4° C); otherwise, some samples with elevated ESRs will be falsely low (Morris, 1975).

Answer 48

2 hours

Question 49

The test should be set up within 2 hours after the blood sample is obtained (or within (?) if EDTA is used as the anticoagulant and the blood is kept at 4° C); otherwise, some samples with elevated ESRs will be falsely low (Morris, 1975).

Answer 49

12 hours