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Questions and Answers
What effect does polycythemia have on the erythrocyte sedimentation rate (ESR)?
Which of the following factors negatively affects ESR due to increased RBC repulsion?
What is the primary anticoagulant used in the ESR test?
In which condition would a patient's ESR most likely be increased?
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Which of the following conditions would likely decrease the weight of the red blood cells and subsequently lower the ESR?
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What is the expected ESR range for adult males during the first hour?
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What effect does a higher temperature have on the ESR test results?
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What is the significance of achieving a vertical position during the ESR test?
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Study Notes
Erythrocyte Sedimentation Rate (ESR) Test
- ESR measures the rate at which red blood cells (RBCs) settle in a vertical tube.
- RBCs sediment faster when they clump together (rouleaux formation).
- A faster sedimentation rate often indicates inflammation or infection in the body.
- Normal sedimentation rate varies based on sex and is a prognostic, not diagnostic test
Factors Affecting ESR
Red Blood Cells (RBCs)
- Number: ESR is inversely proportional to the number of RBCs. More RBCs (polycythemia) result in a lower ESR, and fewer RBCs (anemia) result in a higher ESR.
- Size: Larger RBCs (macrocytes) lead to a higher ESR, while smaller RBCs (microcytes) lead to a lower ESR.
- Shape: Abnormal RBC shapes (like spherocytosis or sickle cell anemia) can affect ESR.
Plasma
- Proteins: Plasma proteins like fibrinogen and globulins, especially IgM, increase the tendency for rouleaux formation and consequently a higher ESR. Inflammation increases this.
- Albumin: Albumin has a negative charge, which opposes the clumping of RBCs leading to a slower sedimentation rate and resultant lower ESR. High levels of albumin (hyperalbuminemia) associate with a low ESR.
Tools and Steps for ESR Test
- Tools: Westergren tubes and a metal holder are used.
- Steps: Fill the tube with blood to the 0 mark, add sodium citrate (anticoagulant) in a 1:4 ratio, let it sit for 1h then measure the plasma column, let sit for a second hour and re-measure the plasma column.
- Important Note: EDTA is not recommended as an anticoagulant because it causes hemolysis.
Normal Ranges
- Male: 1st hour: 7-9 mm/h; 2nd hour: 9-11 mm/h
- Female: 1st hour: 11-13 mm/h; 2nd hour: 13-15 mm/h
Physiological and Pathological Causes of Elevated ESR
Physiological Causes
- Menstruation
- Pregnancy
- Lactation
- Muscular exercise
- High temperature
Pathological Causes
- Inflammation
- Infection
- Tissue damage (trauma)
- Tuberculosis (TB)
- Cancer
- Rheumatic diseases
Low ESR
- Hyperalbuminemia
- Polycythemia
- Microcytosis
- Spherocytosis
- Sickle cell anemia
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Description
Test your knowledge on the Erythrocyte Sedimentation Rate (ESR) test and the factors that affect it. Understand how RBC count, size, shape, and plasma proteins influence ESR readings. This quiz explores the implications of ESR in diagnosing inflammation and infection.
