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Part- 01

Introduction and Theory for Determination of

Erythrocyte Sedimentation Rate (ESR)

Erythrocyte Sedimentation Rate (ESR)

Erythrocyte means- Red Blood Cells (RBC) and sedimentation means- settling down of something at the bottom and
Rate means- Any process in per unit time. So the term “Erythrocyte sedimentation rate” means the amount (Volume) of
RBC or Erythrocyte which get settle down at the bottom of experimental tube in a any specific time duration (60
The ESR is a simple non-specific screening test that indirectly measures the presence of inflammation in the body. It
reflects the tendency of red blood cells to settle more rapidly in the face of some disease states, usually because of
increases in plasma fibrinogen, immunoglobulin's, and other acute-phase reaction proteins. Changes in red cell shape
or numbers may also affect the ESR.
The RBCs sediment because their density is greater than that of plasma; This is because of there is an alteration in the
distribution of charges on the surface of the RBC (which normally keeps them separate form each other) resulting in
their coming together to form large aggregates known as rouleaux. Rouleaux formation is determined largely by
increased levels of plasma fibrinogen and globulins, and so the ESR reflects mainly changes in the plasma proteins that
accompany acute and chronic infections, some tumors and degenerative diseases. In such situations, the ESR values
are much greater than 20mm/hr. Note that the ESR denotes merely the presence of tissue damage or disease, but not its
severity; it may be used to follow the progress of the diseased state, or monitor the effectiveness of treatment.
Methods of ESR Determination
When anticoagulated whole blood is allowed to stand in a narrow vertical tube for a period of time, the RBCs – under the influence of gravity - settle out from the plasma. The
rate at which they settle is measured as the number of millimeters of clear plasma present at the top of the column after one hour (mm/hour)

Westergren Method Wintrobe Method

The Westergren method requires collecting 2 ml of venous The Wintrobe method is performed similarly except
blood into a tube containing 0 .5 ml of sodium citrate. It that the Wintrobe tube is smaller in diameter than the
should be stored no longer than 2 hours at room Westergren tube and only 100 mm long. EDTA
temperature or 6 hours at 4 °C. The blood is drawn into a anticoagulated blood without extra diluent is drawn
Westergren-Katz tube to the 200 mm mark. The tube is into the tube, and the rate of fall of red blood cells is
placed in a rack in a strictly vertical position for 1 hour at measured in millimeters after 1 hour. The shorter
room temperature, at which time the distance from the column makes this method less sensitive than the
lowest point of the surface meniscus to the upper limit of Westergren method because the maximal possible
the red cell sediment is measured. The distance of fall of abnormal value is lower. However, this method is more
erythrocytes, expressed as millimeters in 1 hour, is the ESR. practical for demonstration purposes.
For males : 0-10 mm/hour * For males : 0-9 mm/hour *
For females : 0-15 mm/hour * For females 0-20 mm/hour *
* Value Reference- https://laboratoryinfo.com/esr/ Method References- https://www.medicine.mcgill.ca/physio/vlab/bloodlab/ESR.htm
Starting Time After 60 Minutes
00 00 00

20 20 20

Blood Plasma
40 40 40
60 60 60

0-200 units in mm
2 ml of venous blood 80

Westergren-Katz tube
80 80


Distance Erythrocytes has fallen

100 100 100

Westergren Method 120

120 120

140 140 140

160 160 160
Tube Containing
0 .5 ml of sodium citrate
180 180 180

200 200 200

Starting Time After 60 Minutes

01 10 01 10

02 09 02 09

08 03 08

0-100 units in mm
04 07 04 07

EDTA anticoagulated blood

Distance Erythrocytes has fallen

05 06 05 06

06 05 06 05
Wintrobe Method
04 07 04

08 08 03

09 02 09 02
Wintrobe Tube 10 01
RBC/Erythrocytes 10 01
Clinical Interpretation
The erythrocyte sedimentation rate (ESR) is a non-specific test. It is raised in a wide range of infectious, inflammatory,
degenerative, and malignant conditions associated with changes in plasma proteins, particularly increases in fibrinogen,
immunoglobulin's, and C-reactive protein The ESR is also affected by many other factors including anemia, pregnancy,
haemoglobinopathies, haemo concentration and treatment with anti-inflammatory drugs.

Cause which Raise ESR Cause which Decrease ESR

1. All types of anemia except sickle cell anemia
2. Acute and chronic inflammatory conditions and 1. Polycythaemia
infections including:- HIV disease, Tuberculosis, Acute 2. Poikilocytosis
viral hepatitis, Arthritis, Bacterial endocarditis, African 3. New-born infants
trypanosomiasis (rises rapidly) 4. Dehydration
3. Visceral leishmaniasis 5. Dengue haemorrhagic fever
4. Myelomatosis, lymphoma, Hodgkin's disease, some 6. and other conditions associated with
tumours haemoconcentration
5. Drugs, including oral contraceptives