In a tabulated form, make a comparison between the Wintrobe method and Westergren method (ESR).

Wintrobe Method Westergren Method

Description • When the Wintrobe method was first • The most used method today is the
introduced, the specimen used was oxalate- modified Westergren method. One
anticoagulated whole blood. This was advantage of this method is that the taller
placed in a 100-mm column. Today, EDTA- column height allows the detection of
treated or citrated whole blood is used with highly elevated ESRs.
the shorter column.
Principle • When anticoagulated blood is allowed to stand at room temperature undisturbed for a
period of time, the red blood cells settle toward the bottom of the tube. The ESR is the
distance in millimeters that the RBCs fall in 1 hour. The ESR is affected by RBCs, plasma, and
mechanical and technical factors. RBCs have a net negative surface charge and tend to repel
one another.
Specimen Whole blood anticoagulated with EDTA or Fresh anticoagulated blood collected in
ammonium-potassium oxalate is used. either sodium citrate or EDTA may be used.
Blood should be at room temperature for
testing and should be no more than 2 hours
old.
Reagent, • The wintrobe tube is 115 mm long with an • Westergren pipettes must be made of
Supplies, internal bore of 3mm. thick- walled glass with an overlength of
Equipment • The rack that holds the Wintrobe tubes 300 mm + 0.5mm, and a tube bore of 2.65
must be level and in area free from + 0.15 mm.
vibration, direct sunlight, or drafts. • Vertical rack: This special rack is equipped
with a leveling bubble device to ensure
that the tubes are held in a vertical
position within 1°. The fittings on the rack
should be clean and uncracked to prevent
leakage of the diluted blood.
Procedure 1. Fill a tube to 0 mark using a Pasteur pipet 1. Mix the blood citrate or blood-EDTA-
with a 15-cm stem. The column of blood saline mixture thoroughly.
must be bubble free. 2. Aspirate a bubble-free specimen into a
2. Place tube in the rack and set timer for 60 clean and dry Westergren pipette. Fill to
minutes. the zero mark. Do not pipette by mouth.
3. After 60 minutes read the level of 3. Place the pipette into the vertical rack at
sedimented erythrocytes form the scale on 20°C to 25°C in an area free from
the left side of the tube and record ESR as vibrations, drafts, and direct sunlight.
millimeters in 1 hour. 4. After 60 minutes, read the distance in
millimeters from the bottom of the
plasma meniscus to the top of the
sedimented erythrocytes.
5. Record the value as millimeters in 1 hour.
Reporting Males → 0 to 9mm/hour Males → 0 to 15mm/hour
of Results Females → 0 to 20mm/hour Females → 0 to 20mm/hour
 Wintrobe Method Westergren Method
Sources of • Falsely increased results can be produced • The age of the specimen is important, the
Error by test should be performed at 20°C to 25°C,
➔ Positioning the tube at an incline rather and the blood should be at room
than in a vertical position temperature.
➔ Allowing the tube to stand for longer • Other sources of error include incorrect
than 1 hour ratios of blood and anticoagulant,
➔ A room temperature above normal bubbles in the Westergren tube, and
• Falsely decreased results can be produced tilting of the ESR tube. Tilting of the tube
by accelerates the fall of erythrocytes, and
➔ An improper concentration of an angle of even 3° from the vertical can
anticoagulant–whole blood ratio accelerate sedimentation by as much as
➔ Anticoagulated blood that is more than 30%.
2 hours old
➔ Allowing the tube to stand for less than
1 hour
➔ Refrigerated blood or a decreased room
temperature
Clinical • The ESR is directly proportional to the weight of the cell aggregate and inversely
Applications proportional to the surface area. Microcytes sediment more slowly than macrocytes.
Erythrocytes with abnormal or irregular shapes, such as sickle cells or spherocytes, hinder
rouleaux formation and lower the ESR. The removal of fibrinogen by defibrination also
produces a decreased ESR.
• An increased ESR value can be seen owing to various abnormal blood conditions: rouleaux,
increased fibrinogen levels, a relative increase of plasma globulins caused by the loss of
plasma albumin, and an absolute increase of plasma globulins. Clinical conditions
associated with increased ESR values include anemia, infections, inflammation, tissue
necrosis (such as myocardial infarction), pregnancy, and some types of hemolytic anemia.

References:

Keohane, E. M., and Smith, L. J., Walenga, J. M. (2016). RODAK’S Hematology Clinical Principles
and Applications (5th Edition). Elsevier Saunders. Pages 199 – 200.

Lotspeich-Steininger, C. A., Stiene-Martin, E.A., Keopke, J.A. (1992). Clinical Hematology

Principles, Procedures, Correlations. J.B. Lippincott Company. Pages 117 – 199.

Turgeon, M.L. (2012). Clinical Hematology Theory and Procedures (5th Edition). Lippincott
Williams and Wilkins. Pages 504 – 505.