‫‪:‬‬

‫ﻣﻌﺪﱠل ﺗﺮﺳﯿﺐ ﻛﺮﯾﺎت اﻟﺪم اﻟﺤﻤﺮاء )‪(ESR‬‬

‫ﻣﻌﺪﱠل ﺗﺮﺳﯿﺐ ﻛﺮﯾﺎت اﻟﺪم اﻟﺤﻤﺮاء )‪ (ESR‬ھﻮ أﺣﺪ اﺧﺘﺒﺎرات اﻟﻤﺨﺘﺒﺮ اﻷﻛﺜﺮ طﻠﺒﺎ ً ﻣﻦ ﻗﺒﻞ اﻷطﺒﺎء‪ .‬ﯾﻌﺘﻤﺪ ﻣﻌﺪﱠﻟﮫ ﻋﻠﻰ‬
‫ﻋﻮاﻣﻞ ﻓﯿﺰﯾﻮﻟﻮﺟﯿﺔ وﻣﺮﺿﯿﺔ ﻣﺨﺘﻠﻔﺔ ﺑﻤﺎ ﻓﻲ ذﻟﻚ ﺗﺮﻛﯿﺰ اﻟﮭﯿﻤﻮﻏﻠﻮﺑﯿﻦ‪ ،‬ﻧﺴﺒﺔ اﻟﺒﺮوﺗﯿﻨﺎت ﻓﻲ اﻟﺒﻼزﻣﺎ‪ ،‬ﺗﺮﻛﯿﺰ اﻟﺪھﻮن ﻓﻲ‬
‫اﻟﻤﺼﻞ‪ ،‬وﻗﯿﻤﺔ اﻟﺮﻗﻢ اﻟﮭﯿﺪروﺟﯿﻨﻲ ﻟﻠﺒﻼزﻣﺎ‪ .‬ﻟﻢ ﯾﻘﻠﻞ ھﺬا اﻟﻘﯿﺪ ﺑﻌﺪ ﻣﻦ اﺳﺘﺨﺪام ھﺬا اﻻﺧﺘﺒﺎر ﻓﻲ ﺑﯿﺌﺎت ﺳﺮﯾﺮﯾﺔ ﻣﺨﺘﻠﻔﺔ‪ .‬ﻻ‬
‫ﯾﺰال ﻏﺎﻟﺒﺎ ً ﻣﺎ ﯾُﺴﺘﺨﺪم ﻟﻺﺷﺎرة إﻟﻰ ﺷﺪة اﻟﻤﺮض ودﯾﻨﺎﻣﯿﻜﯿﺘﮫ‪ .‬ﻓﻲ ﻗﺴﻢ اﻟﻄﻮارئ‪ ،‬ﻓﺤﺺ ‪ ESR‬ﺟﺰء ﻣﮭﻢ ﻣﻦ اﻟﺘﺸﺨﯿﺼﺎت‬
‫اﻟﺤﺮﺟﺔ واﻟﻄﺎرﺋﺔ ﻣﺜﻞ اﻟﺘﮭﺎب اﻟﺸﺮﯾﺎن اﻟﻌﻤﻼق )‪ (GCA‬وﯾُﻌﺘﺒﺮ أﺳﺎﺳﺎ ً أﺳﺎﺳﯿﺎ ً ﻟﺘﻮﺟﯿﮫ اﻟﻤﺮﺿﻰ اﻟﺬﯾﻦ ﯾﻌﺎﻧﻮن ﻣﻦ ﺣﺎﻻت‬
‫رﺛﻤﺎﺗﯿﺰﻣﯿﺔ‪ .‬ﻋﻼوة ﻋﻠﻰ ذﻟﻚ‪ ،‬ﺗﻤﺖ إﻋﺎدة ﺗﺄﻛﯿﺪ دور ‪ ESR‬ﻓﻲ اﺗﺨﺎذ اﻟﻘﺮارات اﻟﺴﺮﯾﺮﯾﺔ ﺑﺸﺄن اﻟﺤﺎﻻت ﻏﯿﺮ اﻟﻄﺎرﺋﺔ ﻓﻲ‬
‫ﺑﯿﺌﺎت ﻣﺨﺘﻠﻔﺔ ﺑﻤﺎ ﻓﻲ ذﻟﻚ اﻟﺮوﻣﺎﺗﻮﻟﻮﺟﯿﺎ واﻟﮭﯿﻤﺎﺗﻮﻟﻮﺟﯿﺎ وﺣﺘﻰ طﺐ اﻟﻌﻈﺎم‪.‬‬

‫‪Although Fahraeus and Westergren are often credited for the introduction‬‬
‫‪of ESR and its clinical implications, the test was originally described by Biernacki in Poland‬‬
‫‪about a couple of decades before. It calculates the rate of sedimentation for red blood cells‬‬
‫‪(RBC) within a 200 mm vertical tube of anticoagulated blood. Blood containing an‬‬
‫‪anticoagulant remains as suspension for a relatively long time due to negative electrical‬‬
‫‪charges on RBC surfaces. the test requires at least 60 minutes, before it can be reported.‬‬

‫ﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ أن ﻓﺎرھﺎوس ووﯾﺴﺘﯿﺮﺟﺮﯾﻦ ﻏﺎﻟﺒًﺎ ﻣﺎ ﯾُﻨﺴﺒﺎن إﻟﻰ إدﺧﺎل ﻣﻌﺪل ﺗﺮﺳﯿﺐ ﻛﺮﯾﺎت اﻟﺪم اﻟﺤﻤﺮاء )‪(ESR‬‬
‫وﺗﺄﺛﯿﺮاﺗﮫ اﻟﺴﺮﯾﺮﯾﺔ‪ ،‬إﻻ أن اﻻﺧﺘﺒﺎر ُوﺻﻒ أﺻﻼً ﻣﻦ ﻗﺒﻞ ﺑﯿﺮﻧﺎﺗﺴﻜﻲ ﻓﻲ ﺑﻮﻟﻨﺪا ﻗﺒﻞ ﺣﻮاﻟﻲ ﻋﻘﺪﯾﻦ ﻣﻦ اﻟﺰﻣﻦ‪ .‬ﯾﺤﺴﺐ ﻣﻌﺪل‬
‫اﻟﺘﺮﺳﯿﺐ ﻟﻜﺮﯾﺎت اﻟﺪم اﻟﺤﻤﺮاء )‪ (RBC‬داﺧﻞ أﻧﺒﻮب رأﺳﻲ ﺑﻄﻮل ‪ 200‬ﻣﻠﻢ ﻣﻦ اﻟﺪم اﻟﻤﻀﺎد ﻟﻠﺘﺠﻠﻂ‪ .‬ﯾﻈﻞ اﻟﺪم اﻟﺬي‬
‫ﯾﺤﺘﻮي ﻋﻠﻰ ﻣﻀﺎد ﻟﻠﺘﺠﻠﻂ ﻋﻠﻰ ﺷﻜﻞ ﺗﻌﻠﯿﻖ ﻟﻔﺘﺮة زﻣﻨﯿﺔ طﻮﯾﻠﺔ ﻧﺴﺒﯿًﺎ ﺑﺴﺒﺐ اﻟﺸﺤﻨﺎت اﻟﻜﮭﺮﺑﺎﺋﯿﺔ اﻟﺴﻠﺒﯿﺔ ﻋﻠﻰ ﺳﻄﻮح ﻛﺮﯾﺎت‬
‫اﻟﺪم اﻟﺤﻤﺮاء‪ .‬ﯾﺘﻄﻠﺐ اﻻﺧﺘﺒﺎر ﻣﺎ ﻻ ﯾﻘﻞ ﻋﻦ ‪ 60‬دﻗﯿﻘﺔ ﻗﺒﻞ أن ﯾﻤﻜﻦ اﻹﺑﻼغ ﻋﻦ ﻧﺘﺎﺋﺠﮫ‪.‬‬
‫𝑻‬
‫𝑹‬
‫𝑨‬
‫𝑵‬
‫𝑺‬
‫𝑳‬
‫𝑨‬
‫𝑻‬
‫𝑬‬
‫𝑫‬
‫𝑩‬
‫𝒀‬
‫𝑨‬
‫𝑳‬
‫𝑾‬
‫𝑰‬
‫𝑵‬
‫𝑫‬
‫𝑨‬
‫𝑾‬
‫𝑰‬
The process of erythrocyte sedimentation is described in three phases:
aggregation, precipitation, and packing; aggregation is the most in uential phase in
determining the outcome of the test. There are two main factors, which may in uence
the aggregation process: high molecular weight components of the plasma and RBC
structure. Normally, RBCs have negative charges and repel each other; while, many
plasma proteins have positive charges and neutralize the surface charges of
erythrocytes, which promote the aggregation. Therefore, an in-crease in plasma
proteins wil be associated with higher ESR.

‫ واﻟﺘﺮاص؛ اﻟﺘﺠﻤﻊ ھﻮ‬،‫ اﻟﺮواﺳﺐ‬،‫ اﻟﺘﺠﻤﻊ‬:‫ﯾﺘﻢ وﺻﻒ ﻋﻤﻠﯿﺔ ﺗﺮﺳﯿﺐ ﻛﺮﯾﺎت اﻟﺪم اﻟﺤﻤﺮاء ﻓﻲ ﺛﻼث ﻣﺮاﺣﻞ‬
:‫ ھﻨﺎك ﻋﺎﻣﻼن رﺋﯿﺴﯿﺎن ﻗﺪ ﯾﺆﺛﺮان ﻋﻠﻰ ﻋﻤﻠﯿﺔ اﻟﺘﺠﻤﻊ‬.‫اﻟﻤﺮﺣﻠﺔ اﻷﻛﺜﺮ ﺗﺄﺛﯿ ًﺮا ﻓﻲ ﺗﺤﺪﯾﺪ ﻧﺘﯿﺠﺔ اﻻﺧﺘﺒﺎر‬
‫ ﺗﺤﻤﻞ ﻛﺮﯾﺎت اﻟﺪم اﻟﺤﻤﺮاء‬،ً‫ ﻋﺎدة‬.‫ﻣﻜﻮﻧﺎت اﻟﻮزن اﻟﺠﺰﯾﺌﻲ اﻟﻌﺎﻟﻲ ﻓﻲ اﻟﺒﻼزﻣﺎ وھﯿﻜﻞ ﻛﺮﯾﺎت اﻟﺪم اﻟﺤﻤﺮاء‬
‫ﺷﺤﻨﺎت ﺳﺎﻟﺒﺔ وﺗﺘﻨﺎﻓﺮ ﻣﻊ ﺑﻌﻀﮭﺎ اﻟﺒﻌﺾ؛ ﺑﯿﻨﻤﺎ ﺗﺤﻤﻞ اﻟﻌﺪﯾﺪ ﻣﻦ ﺑﺮوﺗﯿﻨﺎت اﻟﺒﻼزﻣﺎ ﺷﺤﻨﺎت إﯾﺠﺎﺑﯿﺔ وﺗﺤﯿﺪ‬
‫ ﻓﺈن زﯾﺎدة ﻓﻲ ﺑﺮوﺗﯿﻨﺎت اﻟﺒﻼزﻣﺎ‬،‫ ﻟﺬﻟﻚ‬.‫ ﻣﻤﺎ ﯾﻌﺰز ﻋﻤﻠﯿﺔ اﻟﺘﺠﻤﻊ‬،‫اﻟﺸﺤﻨﺎت اﻟﺴﻄﺤﯿﺔ ﻟﻜﺮﯾﺎت اﻟﺪم اﻟﺤﻤﺮاء‬
.‫ﺳﺘﺮﺗﺒﻂ ﺑﻤﻌﺪل ﺗﺮﺳﯿﺐ أﺳﺮع‬
fl
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 ‫ھﻨﺎك ﻋﺪة طﺮق ﻟﺘﺤﺪﯾﺪ ﻣﻌﺪل اﻟﺘﺮﺳﯿﺐ اﻟﻜﺮﯾﺎﺗﻲ )‪(ESR‬؛ اﻷﻛﺜﺮ ﺷﯿﻮﻋًﺎ ھﻤﺎ طﺮﯾﻘﺘﺎ وﯾﻨﺘﺮوب‬
‫ﻀﺎ طﺮﯾﻘﺔ آﻟﯿﺔ ﻟﺘﺤﺪﯾﺪ ﻣﻌﺪل اﻟﺘﺮﺳﯿﺐ‪.‬‬
‫ووﯾﺴﺘﺮﺟﺮﯾﻦ‪ ،‬اﻟﺘﻲ أطﻠﻘﺖ ﺑﺎﺳﻢ ﻣﻄﻮري اﻹﺟﺮاء‪ .‬ھﻨﺎك أﯾ ً‬

‫ﯾﺘﺤﻜﻢ ﻣﻌﺪﱠل اﻟﺘﺮﺳﯿﺐ اﻟﺴﺮﯾﻊ ﺑﺎﻟﺘﻮازن ﺑﯿﻦ ﻋﻮاﻣﻞ اﻟﺮﻛﻮد اﻟﻤﻮﺟﺒﺔ‪ ،‬واﻟﺘﻲ ﺗﺸﻤﻞ ﺑﺸﻜﻞ أﺳﺎﺳﻲ اﻟﻔﯿﺒﺮﯾﻨﻮﺟﯿﻦ‪ ،‬وﺑﯿﻦ ﺗﻠﻚ اﻟﻌﻮاﻣﻞ اﻟﺘﻲ ﺗﻘﺎوم ﻋﻤﻠﯿﺔ اﻟﺮﻛﻮد‪ ،‬وھﻲ ﺗﮭﺎﺟﻢ‬
‫اﻟﺸﺤﻨﺔ اﻟﺴﺎﻟﺒﺔ ﻟﻠﻜﺮﯾﺎت اﻟﺤﻤﺮ )اﻟﺠﮭﺪ اﻟﺰﯾﺘﺎ(‪ .‬ﻋﻨﺪﻣﺎ ﯾﻜﻮن اﻟﻌﻤﻞ اﻻﻟﺘﮭﺎﺑﻲ ﻣﻮﺟﻮدًا‪ ،‬ﺗﺆدي اﻟﻨﺴﺒﺔ اﻟﻌﺎﻟﯿﺔ ﻣﻦ اﻟﺒﺮوﺗﯿﻨﺎت اﻟﺒﻼزﻣﯿﺔ ﻣﺜﻞ اﻟﻔﯿﺒﺮﯾﻨﻮﺟﯿﻦ‪ ،‬وﺑﺮوﺗﯿﻦ ‪ C‬اﻟﻨﺸﻂ‬
‫ﺑﺎﻟﺘﻔﺎﻋﻞ اﻻﻟﺘﮭﺎﺑﻲ‪ ،‬واﻷﺟﺴﺎم اﻟﻤﻀﺎدة إﻟﻰ ﺗﻤﺎس اﻟﻜﺮﯾﺎت اﻟﺤﻤﺮاء ﺑﺒﻌﻀﮭﺎ اﻟﺒﻌﺾ‪ .‬ﺗﺘﺸﻜﻞ اﻟﺨﻼﯾﺎ اﻟﺤﻤﺮاء ﻓﻲ ﺗﻜﺪﺳﺎت ﺗﺴﻤﻰ "رووﻟﻮ" اﻟﺘﻲ ﺗﺘﺮﺳﺐ ﺑﺸﻜﻞ أﺳﺮع‪.‬‬

‫ﺗﺰداد ﺳﺮﻋﺔ ﺗﺮﺳﯿﺐ ﻛﺮﯾﺎت اﻟﺪم اﻟﺤﻤﺮاء ﺑﻮاﺳﻄﺔ أي ﺳﺒﺐ أو ﺗﺮﻛﯿﺰ ﻟﻼﻟﺘﮭﺎب‪ .‬ﺗﺰداد ﺳﺮﻋﺔ ﺗﺮﺳﯿﺐ ﻛﺮﯾﺎت اﻟﺪم اﻟﺤﻤﺮاء‬
‫ﻓﻲ ﻓﻘﺮ اﻟﺪم اﻟﻤﻨﺠﻠﻲ‪ ،‬واﻟﺘﮭﺎب اﻟﻤﻔﺎﺻﻞ‪ ،‬وﺣﻤﻰ اﻟﺮوﻣﺎﺗﯿﺰﻣﯿﺔ‪ ،‬واﻹﺻﺎﺑﺔ اﻟﻘﻠﺒﯿﺔ اﻟﻌﻀﻠﯿﺔ‪ ،‬واﻟﻌﺪوى‪ ،‬وﺑﻌﺾ أﻧﻮاع اﻷورام‬
‫اﻟﺨﺒﯿﺜﺔ‪ ،‬وﻓﺘﺮة اﻟﻄﻤﺚ‪ ،‬وأﻣﺮاض اﻟﻜﻠﻰ‪ ،‬واﻟﻠﻮﻛﯿﻤﯿﺎ‪ ،‬واﻟﻠﻤﻔﻮﻣﺎ‪ ،‬واﻟﺴﻞ‪ ،‬وﻛﺬﻟﻚ ﻣﻊ ﺗﻘﺪم اﻟﻌﻤﺮ وﻓﻲ ﻓﺘﺮة اﻟﺤﻤﻞ اﻟﻄﺒﯿﻌﻲ‪.‬‬

‫‪The ESR decreased in polycythemia, and congestive heart failure, spherocytosis.‬‬

‫اﻧﺨﻔﺾ ﻣﻌﺪل ﺗﺮﺳﯿﺐ ﻛﺮﯾﺎت اﻟﺪم اﻟﺤﻤﺮاء ﻓﻲ ﺣﺎﻻت زﯾﺎدة ﺗﺮﻛﯿﺰ ﻛﺮﯾﺎت اﻟﺪم اﻟﺤﻤﺮاء‪ ،‬وﻓﺸﻞ اﻟﻘﻠﺐ اﻻﺣﺘﻘﺎﻧﻲ‪ ،‬وﻛﺮوﯾﺎت اﻟﺪم‪.‬‬
‫‪Material & instruments:‬‬
‫‪* Westergen pipette (glass pipette: 30cm length &2.55 cm width), it is graduated (0-200mm) and open at‬‬
‫‪both ends.‬‬
‫‪* Westergren pipette rack.‬‬
‫‪* 3.8% sodium citrate as anticoagulant in a ratio of 1:4 with‬‬
‫‪blood (0.4 ml sodium citrate + 1.6ml blood) or EDTA.‬‬
‫‪* Syringe, coton, alcohol, for blood draw yb vein puncture.‬‬

‫اﻟﻤﻮاد واﻷدوات‪:‬‬
‫* ﻣﺴﺤﺔ وﯾﺴﺘﺮﻏﯿﻦ )ﻣﺴﺤﺔ زﺟﺎﺟﯿﺔ‪ :‬طﻮل ‪ 30‬ﺳﻢ وﻋﺮض ‪ 2.55‬ﺳﻢ(‪ ،‬ﻣﺪرﺟﺔ )‪ 200-0‬ﻣﻢ( وﻣﻔﺘﻮﺣﺔ ﻣﻦ اﻟﻄﺮﻓﯿﻦ‪.‬‬
‫* ﺣﺎﻣﻞ ﻣﺴﺤﺔ وﯾﺴﺘﺮﻏﯿﻦ‪.‬‬
‫* ﺳﯿﺘﺮات اﻟﺼﻮدﯾﻮم ‪ ٪3.8‬ﻛﻤﻀﺎد ﺗﺠﻠﻂ ﺑﻨﺴﺒﺔ ‪ 1:4‬ﻣﻊ اﻟﺪم )‪ 0.4‬ﻣﻞ ﺳﯿﺘﺮات اﻟﺼﻮدﯾﻮم ‪ 1.6 +‬ﻣﻞ دم( أو إي دي ﺗﻲ إﯾﮫ‪.‬‬
‫* ﺣﻘﻨﺔ‪ ،‬ﻗﻄﻦ‪ ،‬ﻛﺤﻮل‪ ،‬ﻟﺴﺤﺐ اﻟﺪم ﻋﻦ طﺮﯾﻖ ﺛﻘﺐ اﻟﻮرﯾﺪ‪.‬‬
‫‪Or:‬‬
‫‪* Disposable ESR set: plastic graduated pipette +smal tube contains anticoagulant (sodium citrate).‬‬

‫ﻣﺠﻤﻮﻋﺔ ‪ ESR‬ﻗﺎﺑﻠﺔ ﻟﻠﺘﺼﺮف‪ :‬أﻧﺒﻮب ﺑﻼﺳﺘﯿﻜﻲ ﻣﺪرج ‪ +‬أﻧﺒﻮب ﺻﻐﯿﺮ ﯾﺤﺘﻮي ﻋﻠﻰ ﻣﻀﺎد ﺗﺠﻠﻂ )ﺳﺘﺮات اﻟﺼﻮدﯾﻮم(‪.‬‬
 ‫إﺟﺮاء‬
‫ﺳﺤﺐ ‪cc ٣-٢‬ﻣﻦ اﻟﺪم ﻣﻦ ورﯾﺪ اﻟﻤﺮﯾﺾ ﺑﺎﺳﺘﺨﺪام ﺣﻘﻨﺔ‪.‬‬

‫‪-2‬وﺿﻊ ‪ cc 0.4‬ﻣﻜﻌﺐ ﻣﻦ )ﺳﺘﺮات‬

‫اﻟﺼﻮدﯾﻮم ﺑﻨﺴﺒﺔ ‪ (٪3.8‬ﻓﻲ أﻧﺒﻮب ﻓﺎرغ‪.‬‬

‫‪ 3.‬أﺿﻒ ﻣﺒﺎﺷﺮة ‪ cc 1.6‬ﻣﻜﻌﺐ ﻣﻦ اﻟﺪم ﻣﻦ اﻟﻤﺤﻘﻨﺔ إﻟﻰ أﻧﺒﻮب ﻓﺎرغ واﻣﺰج ﺟﯿﺪًا‪.‬‬

‫‪-4‬اﻣﻸ أﻧﺒﻮب وﯾﺴﺘﯿﺮﻏﺮﯾﻦ ﺣﺘﻰ اﻟﻌﻼﻣﺔ ‪ ،٠‬ﺗﺄﻛﺪ ﻣﻦ ﻋﺪم وﺟﻮد أي ﻓﻘﺎﻋﺎت ھﻮاﺋﯿﺔ ﻓﻲ اﻟﺪم‪.‬‬

‫‪ .5‬ﺿﻊ اﻟﻤﺎﺻﺔ ﻋﻤﻮدﯾًﺎ ﻋﻠﻰ اﻟﺮف ﻟﻤﺪة ﺳﺎﻋﺔ واﺣﺪة‪.6.‬ﻓﻲ‬

‫ﻧﮭﺎﯾﺔ ‪ 60‬دﻗﯿﻘﺔ‪) .‬ﺳﺎﻋﺔ واﺣﺪة( اﻗﺮأ اﻟﻨﺘﯿﺠﺔ‪.‬‬

‫أو‪ :‬ﻓﻲ ﺣﺎل اﺳﺘﺨﺪاﻣﻨﺎ ﻣﺠﻤﻮﻋﺔ ﻗﯿﺎس ﺳﺮﻋﺔ ﺗﺮﺳﯿﺐ ﻛﺮﯾﺎت اﻟﺪم اﻟﻘﺎﺑﻠﺔ ﻟﻠﺘﺨﻠﺺ‪ :‬أﻧﺒﻮب ﺑﻼﺳﺘﯿﻜﻲ ﻣﺪرج ‪ +‬أﻧﺒﻮب ﺻﻐﯿﺮ ﯾﺤﺘﻮي ﻋﻠﻰ ﻣﻀﺎد ﻟﻠﺘﺠﻠﻂ )ﺳﺘﺮات اﻟﺼﻮدﯾﻮم(‪.‬‬

‫‪ .1‬اﺳﺤﺐ ‪ cc ٣-٢‬ﻣﻦ اﻟﺪم ﻣﻦ ورﯾﺪ اﻟﻤﺮﯾﺾ ﺑﺎﺳﺘﺨﺪام ﺣﻘﻨﺔ‪.‬‬

‫‪ .2‬أﺿﻒ اﻟﺪم ﻣﻦ اﻟﺤﻘﻨﺔ ﻋﻠﻰ اﻟﻔﻮر إﻟﻰ رﻗﺒﺔ اﻷﻧﺒﻮﺑﺔ اﻟﺼﻐﯿﺮة اﻟﺘﻲ ﺗﺤﺘﻮي ﻋﻠﻰ ﻣﻀﺎد ﻟﻠﺘﺠﻠﻂ واﻣﺰج ﺟﯿﺪًا‪.‬‬
‫‪ .3‬أدﺧﻞ اﻟﺤﻘﻨﺔ اﻟﺒﻼﺳﺘﯿﻜﯿﺔ ﻣﻦ ﺧﻼل اﻟﻐﻄﺎء اﻟﺨﺎص ﺑﺎﻷﻧﺒﻮﺑﺔ اﻟﺼﻐﯿﺮة وﻗﻢ ﺑﺪﻓﻊ اﻟﺪم ﻟﻸﻋﻠﻰ ﻋﻦ طﺮﯾﻖ ﻣﻤﺎرﺳﺔ‬
‫اﻟﻀﻐﻂ ﻋﻠﻰ اﻟﺤﻘﻨﺔ ﻣﻊ ﻟﻮﻟﺐ اﻟﺤﻘﻨﺔ أو اﻷﻧﺒﻮﺑﺔ اﻟﺼﻐﯿﺮة ﻓﻲ ﻧﻔﺲ اﻟﻮﻗﺖ‪.‬‬
‫‪ .4‬ﺿﻊ اﻟﺤﻘﻨﺔ ﻋﻤﻮدﯾًﺎ ﻋﻠﻰ اﻟﺮف ﻟﻤﺪة ﺳﺎﻋﺔ واﺣﺪة‪.‬‬
‫‪ .5‬ﻓﻲ ﻧﮭﺎﯾﺔ ‪ ٦٠‬دﻗﯿﻘﺔ )ﺳﺎﻋﺔ واﺣﺪة(‪ ،‬ﻗﻢ ﺑﻘﺮاءة اﻟﻨﺘﯿﺠﺔ‪.‬‬
‫‪Normal ranges:‬‬
‫‪Adult men: 0-10 mm/hr. or 0-15 mm/hr.‬‬
‫‪Adult women: 0-15 mm/hr. or 0-20mm/hr.‬‬

‫اﻟﻨﻄﺎﻗﺎت اﻟﻄﺒﯿﻌﯿﺔ‪:‬‬
‫اﻟﺮﺟﺎل اﻟﺒﺎﻟﻐﯿﻦ‪ 10-0 :‬ﻣﻠﻢ‪/‬ﺳﺎﻋﺔ أو ‪ 15-0‬ﻣﻠﻢ‪/‬ﺳﺎﻋﺔ‪ .‬اﻟﻨﺴﺎء اﻟﺒﺎﻟﻐﺎت‪ 15-0 :‬ﻣﻠﻢ‪/‬ﺳﺎﻋﺔ أو ‪ 20-0‬ﻣﻠﻢ‪/‬ﺳﺎﻋﺔ‪.‬‬