HEMA ESR

Question 1

Refers to the speed of the settling of RBC in ___.
Measures the ___ and ____ of RBCs in plasma in a tube of a standard bore and length after standing ___

Answer 1

ERYTHROCYTE SEDIMENTATION
RATE
- anticoagulated blood
-distance and speed of fall
-perpendicularly

Question 2

____ are the most important factor
influencing ESR

Answer 2

Plasma proteins

Question 3

STAGES OF ESR

Answer 3

1. Initial period of aggregation or rouleaux formation - 10 mins
   2.Period of fast settling - 40 mins
   3.Final period of packing - 10 mins

Question 4

IMPORTANCE OF ESR

Answer 4

1. Indirectly measures inflammation in the body
2. Used as an index of the presence of active infection
3. Measures the suspension stability of RBCs
4. Indicates abnormal concentration of fibrinogen,
   globulin, and other plasma proteins

Question 5

METHODS OF ESR
DETERMINATION

Answer 5

1.Wintrobe-Landsberg Method
2.Westergren Method

Question 6

ESR MATERIALS

Answer 6

EDTA anticoagulated blood
Wintrobe tube
Pasteur pipette
Timer
Westergren tube
Westergren rack
Test tube rack

Question 7

Quite accurate
Utilizes Wintrobe tube which contains ____

Answer 7

WINTROBE-LANDSBERG
METHOD
-two calibrations

Question 8

WINTROBE-LANDSBERG
METHOD (procedure)

Answer 8

1. Fill the Wintrobe tube with blood using the Pasteur
   pipette.
   2.Place the tube in a vertical position on a rack.
2. After letting the tube stand for one hour, record the ESR in millimeters.

Question 9

WINTROBE-LANDSBERG
METHOD (Normal Values)

Answer 9

Male: 0-10 mm/hr
Female: 0-20 mm/hr

Question 10

WINTROBE-LANDSBERG
METHOD
Has 2 calibrations
⚬0-10 (Red) is used for ________
⚬10-0 (White) is used for ________

Answer 10

ESR
HEMATOCRIT

Question 11

The most sensitive for ESR determination
Can be used for the serial study of ____ like _____ and _____

Answer 11

WESTERGREN METHOD
chronic diseases like tuberculosis, carcinoma and others

Question 12

WESTERGREN METHOD procedure

Answer 12

1.Fill the Westergren tube with blood
2.Let the tube stand vertically on a Westergren rack.
3.Record the ESR in millimeters after an hour.

Question 13

WESTERGREN METHOD Normal values

Answer 13

Male: 0-15 mm/hr
Female: 0-17 mm/hr

Question 14

COMPARISON BET. WINTROBE AND WESTERGREN METHODS
LENGTH
DIAMETER OF BORE
BOTTOM OF TUBE
CALIBRATION
ANTICOAG OF CHOICE
ADV
DISADV

Answer 14

WESTERGREN
30CM
2.5MM
OPEN
0-200 mm
3.8% trisodium citrate
most sensitive method for serial study of chronic dses.
Large amnt of blood is necessary
WINTROBE
11.5 cm
3mm
Flat and closed
0-100mm
Hellen and Paul’s double oxalate
Smaller amnt of blood is needed, other test can be performed after ESR determination (hematocrit and LE cell prep)
Less senstive due to a shorter column

Question 15

CLINICAL SIGNIFICANCE
Increased ESR

Answer 15

Chronic inflammatory conditions including rheumatoid arthritis
Pregnancy (increased fibrinogen)
Bacterial infection
Malignancy
Tissue damage
Multiple myeloma
Waldenstrom macroglobulinemia
Severe anemia

Question 16

CLINICAL SIGNIFICANCE
Normal to Decreased ESR

Answer 16

Polycythemia
Sickle cell anemia
Spherocytosis and other conditions with poikilocytosis (prevents rouleaux formation)
Viscosity of plasma lessens ESR (More viscous = Decreased ESR)

Question 17

SOURCES OF ERROR
Falsely increased results

Answer 17

Tilted column
Hemolysis
Increased room temperature

Question 18

SOURCES OF ERROR
Falsely decreased results

Answer 18

Clotted sample
Excess anticoagulant
Old blood (spherocytes form)

Question 19

FACTORS AFFECTONG ESR

Answer 19

1. Blood proteins and lipids
2. Red blood cells
3. WBC
4. Drugs
5. Clinical conditions
6. Specimen handling
7. Technique

Question 20

Blood protein and Lipids Increased ESR

Answer 20

Hypercholesterolemia
Hyperfibrinogenemia
Hypergammaglobulinemia
Hypoalbuminemia

Question 21

Blood protein and Lipids decreased ESR

Answer 21

Hyperalbuminemia
Hyperglycemia
Hypofibrinogenemia
Hypogammaglobulinemia
Increased bile salts
Increased phospholipids

Question 22

RBC Increased ESR

Answer 22

Anemia macrocytosis

Question 23

RBC Decreased ESR

Answer 23

Acanthocytosis
Anisocytosis(marked)
Hemoglobin C
Microcytosis
Polycythemia
Sickle cells
Spherocytosis
Thalassemia

Question 24

WBC Increased ESR

Answer 24

Leukemia

Question 25

WBC decreased ESR

Answer 25

Leukocytosis (marked)

Question 26

DRUGS Increased ESR

Answer 26

Dextran heparin Penicillamine Procainamide Theophylline Vitamin A

Question 27

Drug decreased ESR

Answer 27

Adrenocorticotropic hormone (corticotropin) Cortisone Ethambutol Quinine Salicylates

Question 28

Clinical conditions Increased ESR

Answer 28

Acute heavy metal poisoning Acute bacterial infections Collagen vascular dses Diabete mellitus End-stage renal failure Gout Malignancy Menstruation Multiple myeloma Myocardial infarction Pregnancy Rheumatic fever Rheumatoid Arthritis Syphilis Temporal arteritis

Question 29

Clinical conditions Decreased ESR

Answer 29

Cachexia Congestive heart failure Newborn status

Question 30

Specimen handling Increased ESR

Answer 30

Refrigerated specimen not returned to room temp

Question 31

Specimen handling Decreased ESR

Answer 31

Clotted blood specimen Delay in testing

Question 32

Technique Increased ESR

Answer 32

High room temp Tilted ESR tube Vibration

Question 33

Technique decreased ESR

Answer 33

Bubbles in ESR column Low room temperaure Narrow ESR Column diameter