Erythrocyte Sedimentation Rate Overview

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Questions and Answers

What does the erythrocyte sedimentation rate (ESR) primarily reflect?

  • Changes in white blood cell count
  • Changes in platelet aggregation
  • Changes in plasma protein concentrations (correct)
  • Changes in blood volume

During which phase of the ESR do RBCs undergo rapid packing?

  • Lag phase
  • Decantation phase (correct)
  • Final settling phase
  • All of the above

How do larger RBCs (macrocytes) affect the sedimentation rate?

  • They stabilize the sedimentation rate
  • They increase the sedimentation rate (correct)
  • They have no effect on the sedimentation rate
  • They decrease the sedimentation rate

What effect does anemia have on the erythrocyte sedimentation rate?

<p>Increases the sedimentation rate (A)</p> Signup and view all the answers

What is the effect of increased plasma viscosity on erythrocyte sedimentation rate?

<p>It increases the ESR (D)</p> Signup and view all the answers

Which of the following conditions typically leads to a decreased ESR?

<p>Polycythemia (A)</p> Signup and view all the answers

What role does rouleaux formation play in the sedimentation of red blood cells?

<p>It leads to a larger mass and increased sedimentation velocity (B)</p> Signup and view all the answers

Which factor does NOT influence the erythrocyte sedimentation rate?

<p>Temperature of the sample (A)</p> Signup and view all the answers

What is the primary effect of increased plasma proteins on the erythrocyte sedimentation rate (ESR)?

<p>It increases ESR more than plasma viscosity. (C)</p> Signup and view all the answers

Which method of ESR uses a tube length of 30 cm?

<p>Original Westergren method (B)</p> Signup and view all the answers

What effect does tilting the tube have on the ESR measurement?

<p>It increases the ESR. (A)</p> Signup and view all the answers

Which anticoagulant is used in the Original Westergren method?

<p>Sodium citrate (C)</p> Signup and view all the answers

In the Wintrobe method, what is the necessary step to ensure accurate measurements?

<p>Avoiding bubble formation and vibration. (A)</p> Signup and view all the answers

What is the reference ESR value for males using the Wintrobe method?

<p>0-9 mm/hr (C)</p> Signup and view all the answers

Which method is known to be the most sensitive due to its longer tube requirement?

<p>Original Westergren method (C)</p> Signup and view all the answers

When performing a hematocrit alongside ESR using the Wintrobe method, what should be done after reading the ESR?

<p>Centrifuge the tube for 15 minutes. (C)</p> Signup and view all the answers

Which method requires a smaller amount of blood and does not involve dilution?

<p>Wintrobe method (D)</p> Signup and view all the answers

What happens to the ESR if the concentration of EDTA is greater than recommended?

<p>ESR will be falsely low (C)</p> Signup and view all the answers

How long can blood specimens be stored at 4°C before testing?

<p>24 hours (C)</p> Signup and view all the answers

Which of the following factors can falsely elevate the ESR?

<p>Heparin anticoagulant (D)</p> Signup and view all the answers

What effect does tilting the ESR tube have on the sedimentation rate?

<p>Increases the sedimentation rate (D)</p> Signup and view all the answers

Increased ESR can be observed in which of the following conditions?

<p>Rheumatic arthritis (D)</p> Signup and view all the answers

What is the consequence of allowing an ESR specimen to sit at room temperature for more than 4 hours?

<p>The red blood cells will become spherical (D)</p> Signup and view all the answers

Which component can invalidate the results of an ESR test?

<p>Bubbles in the blood (B)</p> Signup and view all the answers

What is the anticoagulant of choice for the Linzenmeier method?

<p>3% sodium citrate (D)</p> Signup and view all the answers

What is the normal sedimentation rate range for females during menstruation?

<p>12 mm/hr (C)</p> Signup and view all the answers

How long is the Micro-Landau tube calibrated for sedimentation in millimeters?

<p>0-50 mm (B)</p> Signup and view all the answers

What feature distinguishes Bray’s tube from other methods?

<p>Flat-bottomed design and dual calibration (C)</p> Signup and view all the answers

Which automated system allows for the simultaneous processing of multiple samples at one time?

<p>Ves-matic (A), Mini-Ves (B)</p> Signup and view all the answers

What is the maximum sedimentation reading time for the Linzenmeier method?

<p>60 minutes (D)</p> Signup and view all the answers

What is the main purpose of using the 3% sodium citrate in the Graphic or Cutler procedure?

<p>Prevent coagulation (D)</p> Signup and view all the answers

Which of the following methods is primarily suited for infants and children?

<p>Smith Micro (D)</p> Signup and view all the answers

Flashcards

Erythrocyte Sedimentation Rate (ESR)

A test measuring the rate at which red blood cells settle in a blood sample over an hour. It indicates inflammation.

Rouleaux formation

Stacking of red blood cells like coins due to changes in plasma proteins; increases ESR.

Increased ESR

A faster rate of red blood cell settling, often associated with inflammation or disease.

Plasma proteins

Proteins in blood plasma that influence ESR by affecting red blood cell stacking.

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Agglutination

Clumping of red blood cells due to changes in their surface; increases ESR.

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Macrocytes

Large red blood cells, which may lead to increased ESR.

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ESR stages

Series of phases in ESR test: initial, rapid, and settling phases.

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Viscosity of plasma

Thickness of blood plasma, influenced by protein concentrations. Increased viscosity increases ESR.

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Westergren Method

The standardized method for measuring Erythrocyte Sedimentation Rate (ESR) by the International Committee for Standardization in Hematology.

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Wintrobe Method

A method to measure ESR with a smaller blood volume and no dilution, resulting in higher sensitivity for mild elevations.

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EDTA Concentration Impact

An excess of EDTA in the blood sample can lead to artificially low ESR results.

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Anticoagulant Impact

Anticoagulants like sodium or potassium oxalate, and heparin can shrink red blood cells, causing a falsely elevated ESR.

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ESR Storage Time Impact

Leaving the blood sample for over 60 minutes leads to a falsely elevated ESR.

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Temperature Impact on ESR

A higher room temperature results in a higher ESR, while a lower temperature results in a lower ESR.

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ESR Tube Tilt Impact

Tilting the ESR tube during the test increases the sedimentation rate, affecting the results.

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Bubbles and Fibrin Clots

Bubbles in the blood sample or fibrin clots can invalidate the ESR test results.

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Acute Phase Proteins

Proteins in the blood that increase during inflammation, causing red blood cells to stack (rouleaux formation) and increasing ESR.

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ESR and Viscosity

Increased plasma viscosity (thickness) makes red blood cells fall slower, but it's less impactful than increased acute phase proteins on ESR.

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ESR: Tube Tilt

Tilting the tube during ESR measurement will cause the red blood cells to settle faster, resulting in a falsely elevated ESR.

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ESR: Temperature

Increased temperature speeds up the rate at which red blood cells settle, leading to a higher ESR reading.

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ESR: Vibration

Shaking or vibrating the ESR tube can disrupt the settling pattern of red blood cells, resulting in a false ESR.

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ESR: Tube Size

The length and diameter of the ESR tube influence the settling rate of red blood cells. Longer tubes or narrower tubes result in higher ESR values.

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GRAPHIC OR CUTLER METHOD

A method for determining the rate at which red blood cells settle in a blood sample over an hour. Uses a special tube with a 5ml capacity and 0-50 mm graduation. The tube is allowed to stand for 1 hour, observing every 5 minutes.

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CUTLER TUBE

A tube used in the GRAPHIC OR CUTLER method to measure the erythrocyte sedimentation rate. It has a 5ml capacity and is graduated from 0 to 50 mm.

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LINZENMEIER METHOD

A method for measuring Erythrocyte Sedimentation Rate (ESR) that uses a tube with a specific length, diameter, and capacity. The tube is allowed to stand until the red blood cells settle at a specific mark.

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BRAY'S METHOD

A method for measuring the Erythrocyte Sedimentation Rate (ESR) that uses a flat-bottomed tube calibrated on both sides. Red blood cells sedimentation is observed at intervals for 1 hour, and a graph may be plotted to visualize the rate.

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MICRO LANDAU METHOD

A modification of the Linzenmeier-Raunert method to measure ESR in smaller volumes. Uses a special tube calibrated 0-50mm with two specific marks and a small bulb.

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SMITH MICRO METHOD

A method for measuring ESR in infants and children when venipuncture might not be practical.

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AUTOMATED ESR SYSTEM BY VEGA BIOMEDICAL

A fully automated system for measuring ESR. Uses automated mixing, settling, and reading of samples. Results are comparable to the Westergren method and are obtained quickly.

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MINI-VES AND VES-MATIC

Two automated ESR systems by Vega Biomedical that offer varying sample capacities. MINI-VES handles 4 samples at a time, while VES-MATIC manages 20 samples and prints results.

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Study Notes

Erythrocyte Sedimentation Rate (ESR)

  • ESR is a nonspecific measurement used to detect and monitor inflammatory responses to tissue injury.
  • It reflects changes in plasma proteins that accompany acute and chronic infections, tumors, and degenerative diseases.
  • The principle is the rate of settling of red blood cells (RBCs) in anticoagulated blood, measured by the distance travelled by RBCs in one hour.

Stages of ESR

  • Lag/Agglomeration Phase: Initial stage (approx. 10 minutes), characterized by rouleaux formation.
  • Decantation Phase: Constant sedimentation and rapid packing of RBCs (approx. 40 minutes), influenced by tube length—longer tubes result in higher ESR.
  • Final Settling Phase: Further packing (approx.10 minutes) and slower rate of fall.

Factors Influencing ESR - Erythrocytes

  • Size/Mass of RBCs: Larger RBCs have a faster sedimentation rate (macrocytes = increased, microcytes = decreased, anisocytosis = decreased, poikilocytes = decreased).
  • Shape of RBCs: Changes in RBC shape reduce the ability to form large aggregates.
  • Anemia: Increased concentration of RBCs in the blood leads to a faster sedimentation rate.
  • Polycythemia: Viscous blood with many RBCs decreases rouleau network compactness and a reduced sedimentation rate.

Factors Influencing ESR - Plasma Composition

  • Plasma Viscosity: Increased protein concentration increases plasma viscosity, which inhibits RBC fall.
  • Acute Phase Proteins: Rouleaux and aggregation of RBCs are controlled by acute phase proteins; increased plasma proteins greatly affect ESR.

Factors Influencing ESR - Plasma Composition (Specific Proteins)

  • Fibrinogen: Increased
  • Alpha 1 globulin: Increased
  • Alpha 2 globulin: Increased
  • Albumin: Decreased

Factors Influencing ESR - Mechanical/Technical Factors

  • Tilting of Tube: Increases sedimentation rate.
  • Increased Temperature: Increases sedimentation rate.
  • Vibration: Increases sedimentation rate.
  • Length and Diameter of Tube: Increased length/diameter increases sedimentation rate.

Methods of ESR

  • Wintrobe and Landsberg: Tube length: 11cm, Bore: 3 mm, Anticoagulant: EDTA, Double oxalate, can be used for hematocrit determination.
  • Original Westergren: Tube length: 30 cm, Bore: 2.5 mm, Anticoagulant: Sodium citrate.
  • Modified Westergren: Anticoagulant: EDTA, Diluted blood. Undiluted blood leads to poor precision.

Westergren Tube vs. Wintrobe Tube

  • Westergren: 300 mm long pipette, calibrated from 0 to 200 from the top, bore diameter of 2.5 mm, known as the pipette because it’s both ends are open.
  • Wintrobe: 11 cm long, heavy, cylindrical, glass tube, bore diameter of 2.5 mm, lower end is closed and flat, calibrated from 0 to 10.

Wintrobe Method of ESR

  • Fill tube with oxalated or EDTA blood to 0 mark.
  • Avoid bubble formation, tilting, sunlight, and vibration.
  • Stand in vertical position for 1 hour.
  • Read and record result in mm/hr.

Westergren Method of ESR

  • Mix whole blood with 0.109M TSC (1 volume) and draw to 0 mark.
  • Avoid tube tilting, sunlight, and vibration.
  • Allow to stand in vertical position for 1 hour.
  • Read and record result in mm/hr.

Sources of Error

  • EDTA Concentration: High concentration leads to falsely low ESR.
  • Anticoagulants (Oxalate, Heparin): Can shrink red blood cells, leading to falsely elevated ESR.
  • Standing Time: ESR of more than 60 minutes will falsely elevate the result; less than 60 minutes will underestimate the result.
  • Temperature: Increased room temperature leads to increased ESR; vice versa.
  • Tilting/Bubbles: Increased sedimentation rate.
  • Fibrin Clots: Invalidate test.
  • Increased Reticulocytes: Poor separation of RBCs and Plasma = "Stratified sedimentation." Improper blood storage times will also affect the accuracy of result.

Increased and Decreased ESR

  • Increased:* Pregnancy, menstruation, acute/chronic infections, rheumatic fever, rheumatic arthritis, nephrosis, TB, macroglobulinemia, cryoglobulinemia.
  • Decreased:* Polycythemia, congestive heart failure, hypofibroginemia, presence of RBC abnormalities.

Other Methods of ESR Determination

  • Macromethods: Graphic (Cutler), Linzenmeier.
  • Micromethods: Micro Landau, Smith, Crister or Hillige-Vollmer.
  • Automated Methods: Vega Biomedical (Mini-VES, VES-MATIC, VES-MATIC 60) for rapid processing.

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