To:

1. Describe the clinical importance of doing ESR.

2. Explain why red cells settle down when blood is kept in
a tube, and indicate the factors that affect their rate of
settling.
3. Name the various conditions in which ESR increases or
decreases and their physiological basis.
* The erythrocyte sedimentation rate (ESR), is
the rate at which red blood cells precipitate
(settle) in a period of 1 hour.
* It's a common haematological test which is a
non-specific measure of inflammation.

*
* In the circulating blood the red cells
remain uniformly suspended in the
plasma.
* However, when a sample of blood, to
which an anticoagulant has been added,
is allowed to stand in a narrow vertical
tube, the red cells settle or sediment
gradually towards the bottom of the
tube.
*

1. As an indicator of bodily reaction to tissue

injury and inflammation: Autoimmune
disease, cancers and infections.
2. As a prognostic tool: a valuable prognostic
test while a patient is on treatment for
tuberculosis, rheumatoid arthritis, etc.
 * Manual:
a. Westergren Method.
b. Wintrobe Method.

* Automatic.

* Methods of Performing
ESR….
WESTERGREN’S METHOD
* Draw 2.0 ml of venous blood and transfer it into a
vial containing 0.5 ml of 3.8% sodium citrate
solution.
* Fill the Westergren’s pipette with blood-citrate
mixture by sucking and Bring the blood column to
exact zero mark.
* Transfer it to the Westergren stand by firmly
pressing its lower end into the rubber cushion.
* Leave the pipette undisturbed for one hour at the
end of which read the mm of clear plasma above
the red cells.
1- Viscosity of plasma: protein constitution of the
plasma is the most important factor that affects ESR .
Increased levels of plasma fibrinogen and globulins that
accompany acute and chronic infections, some tumors and
degenerative diseases will increase ESR values.

2- Rouleaux formation of erythrocytes: the cells

aggregate (cells piled one on top of the other) to form
rouleaux, increasing the rate of sedimentation. Fibrinogen,
globulin and certain products of tissue destruction increase
rouleaux formation, while albumin decreases it.
* Males : 3–9 mm 1st hour
* Females : 5–12 mm 1st hour.

* ESR is increased in: malignancy, infection, and

rheumatoid arthritis. (Increased in conditions
associated with inflammation or tissue
destruction)
* ESR is reduced in: polycythemia.

*
* Note: that the ESR denotes merely the
presence of tissue damage or disease, but not
its severity; it may be used to follow the
progress of the diseased state, or monitor the
effectiveness of treatment.
 *
*Age : ESR is low in infants (0.5 mm 1st hour Westergren )
because of polycythemia. ESR starts to increase after the age of
50 years.
*Gender: The ESR is somewhat higher in females, probably due
to lower hematocrit (PCV).
*Pregnancy: The ESR begins to rise after about 3rd month of
pregnancy and returns to normal a few weeks after delivery.
Hemodilution during pregnancy and increased fibrinogen:
albumin ratio are probably the cause of increased rouleaux
formation.
*Body temperature: Within limits, ESR varies with body
temperature, which tends to affect viscosity.