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</p> Signup and view all the answers

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

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

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

    <p>Polycythemia</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</p> Signup and view all the answers

    Which factor does NOT influence the erythrocyte sedimentation rate?

    <p>Temperature of the sample</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.</p> Signup and view all the answers

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

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

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

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

    Which anticoagulant is used in the Original Westergren method?

    <p>Sodium citrate</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.</p> Signup and view all the answers

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

    <p>0-9 mm/hr</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</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.</p> Signup and view all the answers

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

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

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

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

    Which of the following factors can falsely elevate the ESR?

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

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

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

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

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

    Which component can invalidate the results of an ESR test?

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

    What is the anticoagulant of choice for the Linzenmeier method?

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

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

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

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

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

    What feature distinguishes Bray’s tube from other methods?

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

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

    <p>Ves-matic</p> Signup and view all the answers

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

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

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

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

    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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    Description

    This quiz explores the concept of Erythrocyte Sedimentation Rate (ESR), a crucial laboratory test used to detect inflammation in the body. It covers the phases of ESR, the factors influencing sedimentation rate, and its significance in monitoring various medical conditions. Test your knowledge on the principles and applications of ESR in clinical practice.

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