Erythrocyte

Sedimentation Rate
SANDHYA NANU REGMI
8TH BATCH MBBS
BIRAT MEDICAL COLLEGE
Objectives :-

 Definition
 History
 Measurement Technique
 Principle
 Mechanism
 Factors affecting ESR
 Application of ESR
Definition
Height of plasma separated in mm per hour when blood is allowed to stand in narrow
verticle tube.

Normal Value
Male: 4 mm/hr
Female: 8 mm/hr
- It occurs due to Rouleaux formation.
History

 Itsscientific basis was disclosed in the 18th century,

subsequently forgotten and rediscovered in the 19th
century. Fahraeus and his scholar Westergren finally
popularized the method. The ESR is a simple test
which is determined by a complex interaction of
various factors
ESR Tube

 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.
Principle

When the anti coagulated blood is allowed to stand

vertically, the red cells will settle towards the bottom
of the tube till they form a packed column in a given
interval of time. The process of sedimentation is
called ESR.
Mechanism

 ESR is determined by the interaction between factors that

promote ( fibrinogen ) and resist ( negative charge of RBCs –
that repel each other ) sedimentation.
 Normal RBCs settle slowly as they do not form rouleaux.
Instead they gently repel each other due to the negative charge
on their surfaces.
 Rouleaux are stacks of many RBCs that become heavier and
sediment faster.
Factors affecting ESR
Physiological Factors :- Laboratory Factors :-
 Plasma factors  Temperature
 Red cell factors  Time
 Rouleaux formation  Anticoagulants
 Age  Tube factor
 Sex  Tilting of tube
 Pregnancy  Vibration
 Sunlight
Application of ESR

 To follow the course of the disease.

 To establish the prognosis in certain chronic diseases.
 Increase in two or more consecutive tests indicates continuation
of the increased activity.
 To distinguish between organic and non organic disorders.
 To support the diagnosis.