Hematocrit Value & ESR (Practical Section) PDF

Hematocrit value & (ESR ) Dr. Haidy Khatab Pr Dr Abeer Abed (Practical Section)  Objectives Hematocrit value (H.V) - (Definition , principle, Method , Normal value, Factors affecting, disadvantage). The erythrocyte sedimentation rate (ESR ) - (Definition , pr...

Hematocrit value & (ESR ) Dr. Haidy Khatab Pr Dr Abeer Abed (Practical Section)  Objectives Hematocrit value (H.V) - (Definition , principle, Method , Normal value, Factors affecting, disadvantage). The erythrocyte sedimentation rate (ESR ) - (Definition , principle , Normal value , Mechanism , method, Factors affecting, clinical significant )  Hematocrit value (H.V ) Packed cell volume (P.C.V )  Hematocrit value (H.V ) Packed cell volume (P.C.V ) Definition: It is the percentage ratio of R.B.Cs volume to Total blood volume. P.C.V. = (R.B.Cs. volume ÷ total blood volume) ×100.  2-Principle: Centrifugation leads to separation of blood cells from plasma. ✓ (R.B.Cs S.G. 1090 ) sink into the bottom ✓ (Plasma S.G.1030 ) on top ✓ (WBCs, Platelets S.G.1060 ) a thin puffy layer. 3-Methods: Capillary tube method Wintrobe. tube method Materials: 70% alcohol, lancet, syringe Centrifuge apparatus. Capillary tube or Wintrobe tube containing anticoagulant  1. (Wintrobe tube method) (macro method) 1-A blood sample from the subject is placed in a special tube called Wintrobe containing anti- coagulant to prevent blood coagulation. 2- The blood is then centrifuged (at 3000 revolutions/min) for 10-15 minutes 3-From the graduation of the tube, the H.V. can be calculated by measuring: RBCs colum H.V. = x100 Total blood column 2.Capillary tube (micro method) Procedure: 1-Disinfect your finger with 70% alcohol. 2- Taking Blood Sample from the thumb :- 3- Putting of Wax at end of Capillary Tube:- 4- Site the Capillary tube in the Centrifuge :- 5- After Centrifugation :- Hematocrite scale 4-Normal value: Varies according to age and sex Adults (45%) Cause Testosterone hormone stimulates Adult male 45% erythropoiesis through erythropoietin release Adult 42% female Intrauterine hypoxia stimulates erythropoiesis through erythropoietin Newborn 60% release (physiological polycythemia) Iron depletion in tissue child 40% building  5-Factors affecting H.V : H.V is affected by changes in the red cell volume relative to the plasma volume. P.C.V. = (R.B.Cs. volume ÷total blood volume) ×100 Increased H.V Decreased H.V a) Decrease number of RBCs a) Increase number of RBCs (anemia). (polycythemia). b) Increase plasma volume b) Decrease plasma volume as due e.g. overhydration as to: due to excessive i. Dehydratione.g. diarrhea, intravenous fluid intake. vomiting& excessive sweating. ii. Severe burns due to plasma loss from the surface of the burn. Disadvantages: 1- Not diagnostic alone. 2- Not constant in all blood vessels. a. It is small in smaller blood vessels and large in larger blood vessels due to Plasma skimming. b. H.V is higher in venous blood than arterial blood due to Chloride shift phenomenon.  Plasma Skimming Def: it means that red cells tend to accumulate in the center of the flowing blood stream , so the blood along the sides of the vessels has a low H.V. The branches leaving a large vessel at right angels receives red cell poor blood. Chloride shift phenomenon: - CO2 from tissues enters inside RBCs - CO2 + H2O H2CO3 HCO3- H+ Hco3 Passes outside RBCs in Exchange with Cl- ion increased osmotic P inside RBCs Shift water inside RBCs incresed RBCS volume and increased H.V. Questions Q1) If tube A refers to a normal blood sample after centrifugation, tube B refers to what physiological condition? a. Anemia. b. Diarrhea. c. Newborn babies. d. Vomiting. Q2) This method is used for determination of ………… a. Hb content. b. E.S.R. c. Hematocrit value. d. Blood groups. Q3) What is the effect of this phenomenon on H.V? a. H.V is higher in large blood vessel than Small blood vessel b. H.V is lower in large blood than Small blood vessel. c. H.V in large blood vessel is equal to Small blood vessel. d. Has no effect on H.V.  The erythrocyte sedimentation rate (ESR )  The erythrocyte sedimentation rate (ESR ) Definition: is the height of the plasma column on top of the sedimented RBCS when non-coagulated blood sample is suspended vertically after the 1st hr and 2nd hr - In males: - 6 mm/ 1st hr - ( 12 mm/ 2nd hr). In females: 8 mm/ 1st hr 16 mm/ 2nd hr. 2-Principle: 1- Specific gravity RBC’s : 1090 Plasma :1030 2- Rouleaux Shape Formation  Mechanism With any tissue damage there will be excess production of the gamma globulins and fibrinogen. RBCs contain negative charges on its surface caused by (antigens) which repelled each other. When tissue damage occurs or infection, excess fibrinogen and gamma globulin are produced which decrease these negative charges and allow attraction force of RBCs lead to rouleaux formation. Materials : 1 Westergren Tube. 2 Modified Westergren Tube. 3 Sedimentation Stand. 4 Venous Blood Sample. 5 Anti-Coagulant Method: (Westergren Tube method) 1- Taking Venous blood sample 2- mix the blood in the test tube with anti-coagulant (The ratio between blood & Na citrate must be (4:1) 2 ml blood and 0.5ml Na citrate ) 3-Fill the sediment tube by suction so upper level at zero level 4- Fix the tube vertically in the sedimentation stand. 5- Leave for I hour and record the reading and leave for a second hour and record the reading. the reading is at the upper border of blood Modified Westergren tube is typically shorter and has a narrower bore compared to the original. Calibration: It may have different calibration marks, Blood Sample: Requires a smaller volume of blood (usually around 1 mL). Sedimentation Principle: The measurement time may vary, and it may use different anticoagulants(EDTA). Standardization: It is designed to provide consistent results with a reduced volume of blood, making it more convenient for clinical use. Normal Values : ❖ESR affects according to sex as following :- 1 Adult Male At the end of the first hour :- 6 mm. At the end of the second hour :- 12 mm. 2 Adult Female ( non pregnant , non menstruating ) : At the end of the first hour :- 8 mm. At the end of the second hour :- 16 mm. 3 Menstruating Female :- At the end of the first hour :- 15 mm. At the end of the second hour :- 30 mm. 4- Pregnant Female At the end of the first hour :- 30 mm. At the end of the second hour :- 60 mm. Factors causing increase ESR : 1. Physiological Factors: a) Pregnancy due to salt and water retention due to hormonal cause. b) Menstruation due to tissue break down. c) After Vaccination due to increase gamma globulin. 2. Pathological Factors: Any Disease Produce Tissue Breakdown (Trauma , infection, Tumors, Autoimmune diseases ) Clinical significance of ESR : a) Prognostic not diagnostic ( alone can’t diagnose diseases as it is increased in many diseases). b) Help in follow-up of diseases. c) Determine activity and relapse of diseases. Questions Q1) These tubes are used for measurment of ………….. a. Packed cell volume. b.Erythrocyte sedimentation rate. c.Coagulation time. d.Hemoglobin content. Q3) What is the cause of this shape? a. Increased Globulins and prothrombin. b. Increased Albumin and prothrombin. c. Increased Globulins and fibrinogen. d. Increased Globulins and albumin Q3) Increased level of this test in inflammation may be explained by increased level of ……………. a. Albumin. b. Globulins. c. Fibrinogen. d. Prothrombin. Thank You