PRESENTATIO

N
GROUP NO.7

1) MUHAMMAD
YOUNUS
2) MUHAMMAD
RIZWAN
3) MUHAMMAD AHSAN
ULLAH
4) ALI SHEHZAD
5) MUHAMMAD WAQAS
 TOPICS

 PCV  ESR
 (Packed  (Erythrocyte
Cell Volume) Sedimentation
Rate)
 Packed Cell Volume (PCV)

• DEFINATION:
 Packed cell volume is defined as
ratio of volume of packed RBCs
to that of whole blood .
 It is the volume occupied by red
blood cells when anticoagulated
blood is centrifuged.
 Expressed in percentage.
 USES OF PCV

 Detection of presence or absence

of anemia or polycythemia
 Estimation of red cell indices
(mean cell volume and mean
corpuscular hemoglobin
concentration)
 Checking accuracy of hemoglobin
value (Hemoglobin in grams/dl × 3
= PCV).
 METHODS OF PCV

 Macro method  Micro method

( Wintrobe’s tube
( capillary tube
method ) method)
Automated Method
 1.Wintrobe’s Method

Equipment:
1) Wintrobe’s
tube
2) Pasteur
pipette
3) Centrifuge
Machine
  Wintrobe’s Tube
 Special thick walled glass tube
 Length – 110 mm
 Internal diameter – 3 mm
 Flat inner base
 It is graduated from 0 ( bottom ) to 10 (top ) for PCV and 0
( top ) to 10 ( bottom ) for ESR.
 The markings are at an interval of 1mm each and holds 1 ml
of blood.
 Uses Of Wintrobe’s Tube

Determination of Packed cell

volume (PCV).
 Determination of Erythrocyte
sedimentation rate (ESR)
 Preparation of Buffy coat smear.
This smear is used to determine LE
cell phenomenon and to study the
abnormal cells in cases of
aleukemic leukemia.
 1.Wintrobe’s Method

Specimen
Venous blood collected in
EDTA (1.5 mg EDTA for 1 ml
of blood) or in double
oxalate. Test should be
performed within 6 hours of
collection.
 Procedure

1) Mix the anticoagulated blood sample thoroughly.

2) Draw the blood sample in a Pasteur pipette and introduce the pipette up
to the bottom of the Wintrobe tube. Fill the tube from the bottom
exactly up to the 100 mark. During filling, tip of the pipette is raised, but
should remain under the rising meniscus to avoid foaming.
3) Centrifuge the sample at 3000 rpm for 30 min
4) Note the lower most height of coloumn of packed RBC layer and express
in percentage.
 Procedure

 Upper most layer of PLASMA

(yellow)
 Middle narrow layer of
BUFFYCOAT comprised of
WBCs and platelets
 Lower most layer of PACKED
RBCs(red)
 AUTOMATIC ELECTONIC ANALYSER

 In multi channel NORMAL VALUE:

coulter counter , PCV  Adult male – 40 – 50%
can be estimated with
other hematologic  Adult female – 38 –
indices in 40 – 50 45%
seconds.  New born - 44 – 60%
 Causes Of Increased/Decreased PCV

CAUSES OF INCREASED • CAUSE OF DECREASED

PCV : PCV:
 Polycythaemia  Anaemia
 Dehydration due to severe  Pregnancy
vomiting , diarrhoea
 Burns
 Shock
Erythrocyte
Sedimentation Rate
(ESR)
 HISTORY
 The test was invented in 1897 by the Polish pathologist Edmund
Biernacki. In some parts of the world the test continues to be
referred to as Biernacki’s reaction.

 In 1918, Dr Robert Fahraeus noted that ESR differed only during

pregnancy. Therefore, he suggested that ESR could be used as an
indicator of pregnancy.

 In 1921, Dr Alf Vilhelm Albertsson Westergren used ESR to

measure the disease outcome of tuberculosis. He defined the
measurement standards of ESR which is still being used today
 DEFINATION

The erythrocyte
sedimentation rate (ESR or
sed rate) is the rate at which
red blood cells in
anticoagulated whole blood
descend in a standardized
tube over a period of one
hour. It is a common
hematology test, and is a non-
specific measure of
inflammation.
 ESR is the measurement of the rate of sedimentation of red cells
in anti-coagulated blood.
 Blood is allowed to stand for 1 hour in an open-ended glass tube
mounted vertically on a stand
 Length of column of plasma above the red cells is measured in
mm.
 Anticoagulated blood is drawn up into a tube of standardized
dimensions and left in a vertical position for exactly one hour
 By that time, the red cells would have separated and settled
from the plasma.
 Upper plasma column is recorded by reading from the scale
on the side of the tube.
 Measures the distance that RBCs will fall in a vertical tube
over a given time period
 Three definite phases:

• First or Lag Phase (10mins) – red cells form a characteristic

rouleaux pattern (aggregation) and sedimentation is generally slow.
(Pack of coins)
• Decantation Phase (40mins) – The rate accelerates in this phase;
fast settling or sinking of RBCs •
• Final Packing Phase (last 10mins) – slows again as red cell
aggregates pile up at the base of the tube. There is slow
sedimentation.
 FACTORS AFFECTING ESR

 Plasma factor

 RBC factor

 Technical factor
 PLASMA FACTORS

 Increased fibrinogen increases rouleaux formation thereby

increasing ESR
 Alpha globulin , C - reactive protein & cholesterol also increases
ESR
 Albumin and lecithin decreases sedimentation i.e. decreasing
ESR
 RBC FACTORS

 Primarily through changes in number and/or shape

 Anemia responsible for increased ESR
◦Microcytes – sediment more slowly
◦Macrocytes – sediment faster
 ESR is also higher in women during menstruation and
pregnancy.
 raised ESR include , kidney failure, obesity, ageing
 TECHNICAL FACTORS

 Poor temperature control

 Length and bore of the tube
 Vibration
 Verticality
 Time
 METHODS

1) Westergren’s
method

2) Wintrobe’s
method
 WESTERGREN METHOD

 The recommended tube is a straight glass or rigid transparent plastic

tube 30 cm in length
 2.55 mm in diameter.
 Bore must be uniform
 A scale graduated in mm extends over the lower 20 cm.
 Dilution – 1:4
 0.25ml trisodium citrate : 1ml blood
 Mix the blood sample thoroughly and then draw it up into the
Westergren tube to the 200 mm mark by means of a rubber teat or a
mechanical device
 WESTERGREN METHOD

 Place the tube exactly vertical

and leave undisturbed for
exactly 60 min, free from
vibrations and draughts and not
exposed to direct sunlight. Then
read to the nearest 1 mm the
height of the clear plasma above
the upper limit of the column of
sedimenting cells.
 WINTROBE METHOD

 Add well mixed double oxalate /

EDTA blood to the zero mark of
the Wintrobe tube, using a pipette
Avoid air bubbles
 Place in vertical position in a rack
and let sit for 60 minutes
 Read and record results in
millimeter (distance which the cells
have settled)
 Normal ESR test results
 ESR test results are measured in millimeters per hour
(mm/hr).

 The following are considered normal ESR test results:

 Women under age 50 should have an ESR between 0 and

20 mm/hr.
 Men under age 50 should have an ESR between 0 and 15
mm/hr.
 Women over age 50 should have an ESR between 0 and 30
mm/hr.
 Men over age 50 should have an ESR between 0 and 20
mm/hr.
 Children should have an ESR between 0 and 10 mm/hr.
 Increased ESR
 Chronic infections e.g. Tuberculosis
 Extensive/ Chronic inflammation
 Collagen vascular disorders
o Systemic Lupus Erythromatosus
o Rheumatoid asthritis
o Systemic Sclerosis
 Shock
 Active syphilis
 Active infectious infections
 Decreased ESR

 Newborns
 Congestive heart failure
 Polycythemia
 Marked leukocytosis
 Allergic states
 Sickle cell anemia
 Reference/Source

• www.bioscience.pk.com
• www.Wikipedia.com
• www.shutterstock.com
• Dacie and Lewis Practical Haematology,10th ed.
• Essential Haematology A. V. Hoffbrand,6th ed.
• Abc of clinical haematology: Second Edition