Q1: What are the sedimentation factor and anti-sedimentation factor that determine the ESR?

The ESR is determined by the balance between two opposing forces:

Sedimentation factor: This is the force that causes the red blood cells (RBCs) to settle to the bottom of
the tube. It is influenced by the size and shape of the RBCs, the plasma protein concentration, and the
fibrinogen concentration.
Anti-sedimentation factor: This is the force that keeps the RBCs suspended in the plasma. It is
influenced by the negative charge on the RBCs and the presence of albumin in the plasma.
Q2: Name the type of the tube used to perform ESR test, and how do you report the result of ESR?
The type of tube used to perform an ESR test is called a Wintrobe tube. It is a tall, thin tube with a
graduated scale on the side.
To report the result of an ESR test, the distance that the red blood cells have sedimented in one hour
is measured in millimeters (mm). The normal ESR range for adults is 0-20 mm/hr for men and 0-28
mm/hr for women.
Q3: Why the ESR test has been standardized for only one hour in clinical practice?
The ESR test has been standardized for only one hour in clinical practice because this is the amount of
time that it takes for the red blood cells to sediment to a relatively constant level. After one hour, the
sedimentation rate begins to slow down due to the formation of rouleaux (stacks of red blood cells).
Q4: Why ESR increases in inflammation?
In inflammation, there is an increase in the production of plasma proteins, such as fibrinogen.
Fibrinogen can form a mesh that traps red blood cells and increases the sedimentation rate.
Additionally, inflammation can cause the red blood cells to become larger and more spherical, which
also increases the sedimentation rate.
ESR is a nonspecific test, meaning that it can be elevated in a variety of conditions, including
inflammation, infection, autoimmune diseases, and cancer. Therefore, it is important to interpret the
results of an ESR test in the context of the patient's clinical presentation and other laboratory findings.