Erythrocyte Chapter

Sedimentation Rate 12
„ DEFINITION
„ DETERMINATION
„ WESTERGREN’S METHOD
„ WINTROBE’S METHOD
„ NORMAL VALUES
„ SIGNIFICANCE OF DETERMINING ESR
„ VARIATIONS OF ESR
„ PHYSIOLOGICAL VARIATION
„ PATHOLOGICAL VARIATION
„ FACTORS AFFECTING ESR
„ FACTORS INCREASEING ESR
„ FACTORS DECREASEING ESR

„ DEFINITION Westergren Tube

Erythrocyte sedimentation rate (ESR) is the rate at which
the erythrocytes settle down. Normally, the red blood
cells (RBCs) remain suspended uniformly in circulation.
This is called suspension stability of RBCs. If blood is
mixed with an anticoagulant and allowed to stand on a
vertical tube, the red cells settle down due to gravity with
a supernatant layer of clear plasma.
ESR is also called sedimentation rate, sed rate or
Biernacki reaction. It was first demonstrated by Edmund
Biernacki in 1897.
„ DETERMINATION OF ESR
There are two methods to determine ESR.
1. Westergren method
2. Wintrobe method
„ WESTERGREN METHOD
In this method, Westergren tube is used to determine
ESR.
The tube is 300 mm long and opened on both ends (Fig.
12.1A). It is marked 0 to 200 mm from above down­
wards. Westergren tube is used only for determining
ESR.
1.6 mL of blood is mixed with 0.4 mL of 3.8% sodium
citrate (anticoagulant) and loaded in the Westergren
tube. The ratio of blood and anticoagulant is 4:1. The
tube is fitted to the stand vertically and left undisturbed.
The reading is taken at the end of 1 hour.
„ WINTROBE METHOD
In this method, Wintrobe tube is used to determine
ESR.
Wintrobe Tube
Wintrobe tube is a short tube opened on only one end
(Fig. 12.1B). It is 110 mm long with 3 mm bore. Wintrobe
tube is used for determining ESR and PCV. It is marked
 84 Section 2 t Blood and Body Fluids

on both sides. On one side the marking is from 0 to 100

(for ESR) and on other side from 100 to 0 (for PCV).
About 1 mL of blood is mixed with anticoagulant,
ethylenediaminetetraacetic acid (EDTA). The blood is
loaded in the tube up to ‘0’ mark and the tube is placed
on the Wintrobe stand. And, the reading is taken after 1
hour.

„ NORMAL VALUES OF ESR

By Westergren Method
In males : 3 to 7 mm in 1 hour
In females : 5 to 9 mm in 1 hour
Infants : 0 to 2 mm in 1 hour
By Wintrobe Method
In males : 0 to 9 mm in 1 hour
In females : 0 to 15 mm in 1 hour
Infants : 0 to 5 mm in 1 hour

„ SIGNIFICANCE OF DETERMINING ESR

Erythrocyte sedimentation rate (ESR) is an easy,
inexpensive and non-specific test, which helps in diagno-
sis as well as prognosis. It is non-specific because it
cannot indicate the exact location or cause of disease.
But, it helps to confirm the diagnosis. Prognosis means
monitoring the course of disease and response of the
patient to therapy. Determination of ESR is especially
helpful in assessing the progress of patients treated for
certain chronic inflammatory disorders such as:
1. Pulmonary tuberculosis (Chapter 14)
2. Rheumatoid arthritis (Chapter 14)
FIGURE 12.1: A. Westergren tube: This is used for determining
3. Polymyalgia rheumatica (inflammatory disease ESR; B. Wintrobe tube: This is used to determine ESR and PCV.
characterized by pain in shoulder and hip)
4. Temporal arteritis (inflammation of arteries of head).
„ PATHOLOGICAL VARIATION
„ VARIATIONS OF ESR
ESR increases in diseases such as the following
„ PHYSIOLOGICAL VARIATION conditions:
1. Tuberculosis
1. Age: ESR is less in children and infants because of 2. All types of anemia except sickle cell anemia
more number of RBCs. 3. Malignant tumors
2. Sex: It is more in females than in males because of 4. Rheumatoid arthritis
less number of RBCs. 5. Rheumatic fever
3. Menstruation: The ESR increases during menstrua­ 6. Liver diseases.
tion because of loss of blood and RBCs
4. Pregnancy: From 3rd month to parturition, ESR ESR decreases in the following conditions:
increases up to 35 mm in 1 hour because of 1. Allergic conditions
hemodilution. 2. Sickle cell anemia
 Chapter 12 t Erythrocyte Sedimentation Rate 85

3. Peptone shock 3. Increase in Size of RBC

4. Polycythemia
When the size of RBC increases (macrocyte), ESR also
5. Severe leukocytosis.
increases.
„ FACTORS AFFECTING ESR
„ FACTORS DECREASING ESR
„ FACTORS INCREASEING ESR
1. Viscosity of Blood
1. Specific Gravity of RBC Viscosity offers more resistance for settling of RBCs.
When the specific gravity of the RBC increases, the So when the viscosity of blood increases, the ESR
cells become heavier and sedimentation is fast. So ESR decreases.
increases.
2. RBC count
2. Rouleaux Formation
When RBC count increases, the viscosity of blood is
Rouleaux formation increases the ESR. Globulin and increased and ESR decreases. And when the RBC
fibrinogen accelerate the rouleaux formation. count decreases, ESR increases.