Erythrocyte Sedimentation Rate (ESR)

 Is the distance (in millimeter) that erythrocytes fall per unit of

time (usually 1 hour).

 If anticoagulant blood is allowed to stand vertically in a tube

undisturbed, the R.B.C.s will gradually fall down.

 The distance that the cells fall in 1 hour can be measured and is
called the Sedimentation rate.
 Erythrocyte Sedimentation Rate (ESR)

The Sedimentation occurs in three phases:

1. In the first phase the red cells aggregates together and
from roleamx and fall slight.

2. In the second phase the speed of the fall is increased.

3. In the third phase as the cells pack the speed of the fall is
decreased.
The R.B.C.s settle because their density is greater
than that of the plasma
 Erythrocyte Sedimentation Rate (ESR)
 Factors affecting ESR
1. Specific gravity of blood. 2. Hb content 3. Blood viscosity.
4. Rouleaux formation , 5. Red cell volume :
a. Size of R.B.C.s: in vitamin B12 deficiency R.B.C.s are large in
size "macrocytes" and the sedimentation rate is increased,
while in iron deficiency the R.B.C.s are small in size
"microcytes" and the sedimentation rate decreased .
b. Number of R.B.C.s: in anemia, E.S.R. increased while in
polycythemia, E.S.R. decreased.
Clinical applications:
 The E.S.R. is of great value to the clinician and is commonly used
as a screening test at the initial examination of the patients.

 ESR increased in:

1. Chronic condition such as Rheumatoid Arthritis and tuberculosis
acute and chronic infections.
2. Malignant diseases such as myeloma where the plasma proteins are
abnormal.

ESR decrease in :
1.Polycythemia. 2. Congestive heart failure.
 Erythrocyte Sedimentation Rate (ESR)
 There are two main methods of performing the E.S.R.

A. Wintrob's method. B. Westergren's method

 Westergren's method:
Apparatus and Reagents:

1. Westergren’s E.S.R. tube:

This tube looks rather a 1 ml pipette is 300mm long with an
internal diameter of 2.5mm. It is graduated from the bottom over
a 200mm scale in millimeter divisions.
2. Westergren E.S.R. rack :
3. Material for vein puncture (Sterile 20g, needle disposable syring,
tourniquet, 70% alcohol, Cotton).
Figure explain Erythrocyte sedimentation Rate