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Erythrocyte Sedimentation Rate

Erythrocyte Sedimentation Rate. (ESR). Erythrocyte Sedimentation Rate. It is the rate of downward descent of RBCs in a vertical column of blood. Principle :

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Erythrocyte Sedimentation Rate

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  1. Erythrocyte Sedimentation Rate (ESR)

  2. Erythrocyte Sedimentation Rate It is the rate of downward descent of RBCs in a vertical column of blood. Principle: If anti-coagulated blood is allowed to stand vertically in a narrow tube , the red cells will settle progressively to the bottom leaving clear plasma above.

  3. -The cells settle due to : 1-Density of RBCs is greater than that of plasma. 2-RBCs tend to aggregate to form Rouleaux. (Rouleaux differs from agglutinatin that agglutinated cells are irreversibly bound together and can not be separated )

  4. Rouleaux formation.

  5. Westergren method for estimation of ESR : Equipments: -Westergren tube ( straight glass tube 30 cm in length , 2.5 mm in dimeter and graduated from 0 – 200 mm ) -Special stand. -3.8% Sodium Citrate. -5 ml disposable syringe.

  6. Procedure : 1-Withdraw blood sample in a syringe and mix it with 3.8% Na Citrate at a ratio 4 : 1 (e.g. 2ml blood + 0.5 ml Na Citrate) 2-suck the citrated blood to Westergren tube up to zero mark exactly and place your finger over its openning. 3-Place the tube in a special stand that fix the upper lip with a clip. 4-The height of clear plasma on the top of the tube is measured after one and two hours.

  7. Westergren tube for ESR.

  8. Normal values : -In males : 1st hr : 3-5 mm 2nd hr : 6-10 mm -In females : 1st hr : 8 -10 mm 2nd hr : 16 -20 mm

  9. Clinical significance of ESR : -Because the ESR is changed in a great variety of conditions , Its alteration is not specific and not diagnostic. -It is a prognostic test : 1-It detects the presence and severity of disease. 2-It gives an idea about the activity of disease 3-Repeated ESR estimation helps in prognosis and follow up of disease

  10. Factors determining the rate of sedimentation of RBCs : 1- plasma proteins : a- Albumin : If plasma albumin level is increased the ESR decreases. b- Fibrinogen and globulins : If plasma fibrinogen or globulins level is increased the ESR increases. 2- Red cell count : - If RBCs count is increased the ESR decreases.

  11. Factors affecting ESR : A- Physiological factors : a- ESR is increased in : 1-Old age. 2-Females. 3- Prgnancy. 4-Menestruation. b- ESR is decreased in : 1- Newborn. 2- Males. 3- High altitude.

  12. B- Pathological factors : a- ESR is increased in : 1-Acute inflammation as tonsillitis. 2- Malignancy. 3-Chronic inflammation as T.B. 4- Fevers. 5-Rheumatic fever . 6-Tissue trauma. b- ESR is decreased in : 1-polycythemia. 2-Hyperviscosity of plasma.

  13. Thank YOU With my best wishes Prepared by : Dr. Khaled Saleh.

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