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Erythrocyte sedimentation rate (ESR)
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The ESR is a simple non-specific screening test that indirectly measures the presence of inflammation in the body. It reflects the tendency of red blood cells to settle more rapidly in the face of some disease states, usually because of increases in plasma fibrinogen, immunoglobulins, and other acute-phase reaction proteins. Changes in red cell shape or numbers may also affect the ESR.

Method

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Wx711v2 Balance Balance Women Wx711v2 Balance New New Wx711v2 Balance Wx711v2 Women New New Women When anticoagulated whole blood is allowed to stand in a narrow vertical tube for a period of time, the RBCs – under the influence of gravity - settle out from the plasma. The rate at which they settle is measured as the number of millimeters of clear plasma present at the top of the column after one hour (mm/hr).


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The Wintrobe sedimentation rack

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There are two main methods used to measure the ESR: the Westergren method and the Wintrobe Method. Each method produces slightly different results. Most laboratories use the Westergren method.

Westergren method:
The Westergren method requires collecting 2 ml of venous blood into a tube containing 0 .5 ml of sodium citrate. It should be stored no longer than 2 hours at room temperature or 6 hours at 4 °C. The blood is drawn into a Westergren-Katz tube to the 200 mm mark. The tube is placed in a rack in a strictly vertical position for 1 hour at room temperature, at which time the distance from the lowest point of the surface meniscus to the upper limit of the red cell sediment is measured. The distance of fall of erythrocytes, expressed as millimeters in 1 hour, is the ESR.
Wintrobe method:
The Wintrobe method is performed similarly except that the Wintrobe tube is smaller in diameter than the Westergren tube and only 100 mm long. EDTA anticoagulated blood without extra diluent is drawn into the tube, and the rate of fall of red blood cells is measured in millimeters after 1 hour.  The shorter column makes this method less sensitive than the Westergren method because the maximal possible abnormal value is lower. However, this method is more practical for demonstration purposes.

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This picture shows a rack holding Wintrobe tubes, in which anticoagulated whole blood has just been added.
(Time: 0)

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Red blood cells have settled, leaving plasma at the top of the tube. Reading: 18 mm/hour
(Time: one hour)
Wx711v2 Balance Balance Women Wx711v2 Women Women New Wx711v2 Balance New New Wx711v2 Balance New Average values in healthy men are: <15mm/hr; in healthy females, they are somewhat higher: <20mm. The values are slightly higher in old age, in both genders.
Theoretical considerations

New New Balance Wx711v2 New Balance New Balance Women Wx711v2 Women Wx711v2 Women Wx711v2 Balance New Women Women Wx711v2 Wx711v2 New New Balance Balance Wx711v2 New Wx711v2 Balance Balance Women The RBCs sediment because their density is greater than that of plasma; this is particularly so, when there is an alteration in the distribution of charges on the surface of the RBC (which normally keeps them separate form each other) resulting in their coming together to form large aggregates known as rouleaux.

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Some interferences which increase ESR:

  • increased level of fibrinogen, gamma globulins.

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Some interferences which decrease ESR:

  • abnormally shaped RBC (sickle cells, spherocytosis).
  • technical factors: short ESR tubes, low room temperature, delay in test performance (>2 hours), clotted blood sample, excess anticoagulant, bubbles in tube.
Chronic inflammatory disease (collagen and vascular diseases) increases ESR.
Polycythemia decreases ESR.
 

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Home
Introduction
Red cell fragility
ESR
Hemostasis
Blood cell indices
Blood typing
Osmotic hemolysis
Procedure
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Procedure continued
Clotting & bleeding
PT and PTT tests
Red cell count
Hematocrit
Hemoglobin
MCV & MCHC
White cell count
Differential cell count
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