What is ESR ( Erythrocyte sedimentation rate )?
ESR is the rate at which the cells settle. If the blood to which an anticoagulant has been added is allowed to stand vertically in a tube for 1 hour, the cells will settle to the bottom, leaving the plasma as a clear supernatant fluid.
Procedures:
- Fill the blood in the tube until it reach the line, then fully mix the blood with the anticoagulant by inversion.
- Insert the capillary tube and allow it to stand vertically for 1 hour. ( write down the time and start the timer)
- Compare with the HGB ( Hemoglobin ) result. Normally if the HGB result is normal,the blood cells will sediment very slow.
Factors that affect the sedimentation:
- Rouleaux formation
( RBC may form aggregates in the presence of plasma protein or other macromolecules ) - Plasma content of blood
- Fibrinogen ↑ ESR ↑ , (Fibrin will control the rouleaux formation)
- Globulin ( Reduction of globulin will indicate the red cell's sedimentation rate )
- Albumin↑ ESR↓
- Ratio of cells to plasma ( ↓no. of blood cells favor the formation of rouleaux,↑ ESR )
- Deviation of the tube from the vertical position,↑ ESR
- Temperature
Precautions:
- Slanting of tube
- Inclusion of air bubbles in the blood column
- Leakage from the bottom of tube
Reason of rapid sedimentation rate:
- Extensive inflammation, cell destruction, toxemia.
- Pregnancy ( after second month )
- Menstruation
- Acute myocardial infarction
- Infected, necrotic/maglinant tumor
- Liver disease
- Tuberculosis ( esp. Miliary tuberculosis)
- Rheumatic fever
- Active rheumatoid arthritis
- Nephrosis ( low blood albumin, anaemia )
- Shock
- Active syphilis ( moderate acceleration )
- Postoperative states
- Active infectious disease
- Salpingitis, appendicitis
- Puerperium (the time from the delivery of the placenta through the first few weeks after the delivery.)
Reason of Slow sedimentation rate:
- Newborn infant
- Polycythemia
- Congestive heart failure
- Allergic condition
- Sickle cell anemia
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