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EXERCISE 1: Erythrocyte Sedimentation Rate

MLAB 1315 Hematology Page 1

ERYTHROCYTE SEDIMENTATION RATE
LAB OBJECTIVE The student will able to perform, within ∓ 2 mm/hr accuracy compared with the instructor’s value, three erythrocyte sedimentation rates using the Westergren method. PRINCIPLE The erythrocyte sedimentation rate (E !", also called the sed rate, measures the settling of erythrocytes in diluted human plasma over a specified time period. This numeric value is determined (in millimeters" by measuring the distance from the bottom of the surface meniscus to the top of erythrocyte sedimentation in a vertical column containing diluted whole blood that has remained perpendicular to its base for #$ minutes. %arious factors affect the E !, such as !&' si(e and shape, plasma fibrinogen, and globulin levels, as well as mechanical and technical factors. The E ! is directly proportional to the !&' mass and inversely proportional to plasma viscosity. )n normal whole blood, !&'s do not form rouleau*+ the !&' mass is small and therefore the E ! is decreased (cells settle out slowly". )n abnormal conditions when !&'s can form rouleau*, the !&' mass is greater, thus increasing the E ! (cells settle out faster". The Westergren method is preferred by ,''- standards because of its simplicity and greater distance of sedimentation measured in the longer Westergren tube. The straight tube is .$ cm long, 2./ mm in internal diameter, and calibrated in millimeters from $02$$. 1ppro*imately 2 m- of blood is re3uired. The method it replaces is called the Wintrobe method. SPECIMEN 4resh anticoagulated blood collected in E5T1. &lood should be at room temperature and should be no more than 2 hours old. )f anticoagulated blood is refrigerated, the test must be set up within # hours. 6emoly(ed specimens cannot be used. REAGENTS, SUPPLIES, AND EQUIPMENT

LAB EXERCISES

MLAB 1315

EXERCISE 1: Erythrocyte Sedimentation Rate Hematology 2. #. They will not be used for this e*ercise. PROCEDURE LAB EXERCISES MLAB 1315 . 2.. Westergren tubes Westergren rac7 5isposable pipets $. . 8. /./ ml sodium chloride in puncture ready vials -eveling plate for holding the Westergren rac7 Timer MLAB 1315 Page QUALITY CONTROL 'ommercial controls are available for this procedure.

. MLAB 1315 Page . 8. 2. et timer for 2 hour. 1fter 2 hour has passed. )t is usually negligible.EXERCISE 1: Erythrocyte Sedimentation Rate Hematology 2.. !eplace cap and invert 9 times ma7ing sure the blood and saline mi* well. . 9. /. 'arefully insert the Westergren tube into plungeable vial cap of blood/diluent mi*ture twisting as you push the tube down. . #. 'ollect whole blood anticoagulated with E5T1. !emove cap from the puncture ready vial and add well mi*ed blood up to the line (see illustration". (The buffy coat is the layer of white cells and platelets at the interface of red cells and plasma. -abel the puncture ready vial with the patient’s name. read the distance in millimeters from the bottom of the plasma meniscus to the top of the sedimented erythrocytes. but may be noticeable in cases of leu7ocytosis or thrombocytosis." REPORTING RESULTS . 5o not include the buffy coat in this measurement. :lace the tube in the Westergren rac7 to a vertical position and leave undisturbed for e*actly 2 hour.ormal values 1dult male $02/ mm/hr 1dult female $02$ mm/hr PROCEDURE NOTES ources of error LAB EXERCISES MLAB 1315 .

it is elevated. Temperature 0 must be between 2$02/ ' and blood must be at room temperature. &iological factors affecting the E ! LAB EXERCISES MLAB 1315 . and pyogenic arthritis. )ncorrect ratio of blood to diluent &ubbles in the Westergren tube Tilting of the Westergren tube (accelerates the fall of the erythrocytes+ an angle of even . degrees from vertical can accelerate sedimentation by as much as . 8. The E ! is elevated in established myocardial infarction but normal in angina pectoris. )t can be used to differentiate among diseases with similar symptoms or to monitor the course of an e*isting disease. 4or e*ample. MLAB 1315 ! 1ge of specimen 0 must be less than 2 hours at room temperature. The E ! can be an inde* to disease severity. less thanPage # hours refrigerated.EXERCISE 1: Erythrocyte Sedimentation Rate Hematology 2. but not in osteoarthritis. . early in the course of an uncomplicated viral infection. /. #.$<" %ibration such as from a nearby centrifuge will cause a false E !. )t is elevated in rheumatic fever. temperatuare will cause a false E !. but in the early stage of acute pelvic inflammatory disease or ruptured ectopic pregnancy. =sefulness of the E ! The E ! is not a specific test therefore it is used for screening for certain disease conditions.. the E ! is usually normal. . the E ! is not elevated.. rheumatoid arthritis. 2. but it may rise later with a superimposed bacterial infection. Within the first 28 hours of acute appendicitis.

0#$/. )t can therefore be e*pected that disease states that are characteri(ed by hyperfibrinogenemia or elevated immunoglobulin levels will result in an increased E !. This is observed with sic7le cells and spherocytes. . 4actors affecting the E ! )ncrease !ouleau* formation Elevated fibrinogen E*cess immunoglobulin 5ecrease >icrocytes ic7le cells pherocytes REFERENCES 6armening. . Turgeon.rd edition. 'linical 6ematology and 4undamentals of 6emostasis. LAB EXERCISES MLAB 1315 . The E ! is of little diagnostic value in severe anemia or in hematologic states evidenced by poi7ilocytosis. >ary -ouise.. #$. 5enise. along with immunoglobulin. a decreased or low E ! is e*pected. owing to the shape or si(e of the !&'.2#. 'linical 6ematology 0 Theories and :rocedures.rd edition. MLAB 1315 2. !&' factors When rouleau* formation cannot occur.EXERCISE 1: Erythrocyte Sedimentation Rate Hematology 2. Page 5 :lasma factors )ncreased plasma concentration of fibrinogen. pp . will result in rouleau* formation and an increased E !. pp.

LAB EXERCISES MLAB 1315 .EXERCISE 1: Erythrocyte Sedimentation Rate Hematology MLAB 1315 Page " Erythrocyte Se !"e#t$t!o# R$te Re%ort For" &or L$' E(erc!)e tudent’s name?@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@5ate?@@@@@@@@@@@@@@@@ Westergren 7it lot A?@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ 5ate?@@@@@@@@@@@@@@ E*piration :atient name )5 A E ! position on rac7 E ! result mm/hr )nstructor result Within normal rangeB C/.

ame@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ 5ate@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ LAB EXERCISES MLAB 1315 .EXERCISE 1: Erythrocyte Sedimentation Rate Hematology MLAB 1315 Page # STUDY QUESTIONS .

The E ! can be used to differentiate anginia pecoris from? (2 pt...EXERCISE 1: Erythrocyte Sedimentation Rate Hematology 2. What is the normal range for E ! in (state reporting units" (2 pts." @@@@@@@@@@@@@@@@@@@@@@@@@@. 4or how long do you time a sed rateB (2 pt. (8 pts." tate four (8" sources of error when performing an E !. . 'ircle or highlight the condition in which the LAB EXERCISES MLAB 1315 . (. The E ! can be used to differentiate appendicitis from? (8 pts. tate the principle of the E !." MLAB 1315 Page $ 2." >enB @@@@@@@@@ WomenB @@@@@@@@@@@@@@ . tate the specimen re3uirement for E ! and time limits for performing the test. /. (2 pt. pts." #." @@@@@@@@@@@@@@@@@@@@@@ and @@@@@@@@@@@@@@@@@@@@@@@@@ 'ircle or highlight the conditions(s" in which the E ! is elevated in the first 28 hours." 8.

ic7le cells present )ncreased room temperature =nlevel E ! rac7 . Which arthritis does not cause an elevated E !B (2 pt. &.earby centrifuge in use Elevated plasma immunoglobulin 2$. 5. What is the name of the E ! method that the Westergren method replacesB (2 pt. )s the E ! E or F in the following conditionsB (/ pts. '." MLAB 1315 Page % D." LAB EXERCISES MLAB 1315 . E." 1.EXERCISE 1: Erythrocyte Sedimentation Rate Hematology E ! is elevated. 9.

EXERCISE 1: Erythrocyte Sedimentation Rate Hematology MLAB 1315 Page 1& LAB EXERCISES MLAB 1315 .

EXERCISE 1: Erythrocyte Sedimentation Rate MLAB 1315 Hematology Page 22 LAB EXERCISES MLAB 1315 .