Males—0 to 9 mm at the end of 1st hour. Females—0 to
Microsedimentation (Landau) Method
1. 5.0 g/dL sodium citrate solution.
2. Landau pipette: This pipette resembles RBC pipette.
It is graduated from 0 to 50 mm.
FIG. 9.8: Westergren’s ESR pipette with stand
16 years 2800/µL or mm3 2800 × 106
18 years 2700/µL or mm3 2700 × 106
20 years 2500/µL or mm3 2500 × 106
Adults 150,000–400,000/ 150–400 × 109
Panic/Levels <30,000/µL or mm3 <30 × 109
>l,000,000/µL or mm3 >1000 × 109
3 months 260,000/µL or mm3 260 × 109
1–10 years 250,000/µL or mm3 250 × 109
Panic/Levels <20,000/µL or mm3 <20 × 109
> 1,000,000/µL or mm3 >1000 × 109
4. Suction device for drawing blood into the pipette.
5. Capillaries for blood collection.
1. Attach Landau pipette to the suction device.
2. Draw 5.0 g/dL citrate up to first line on the stem.
3. Now draw blood by suction device up to second mark
on the stem (avoid air bubbles).
4. Wipe excess blood on the external side of the pipette.
5. Draw citrate solution and blood into the bulb of the
pipette. Mix the contents thoroughly.
6. Force back the mixture into the stem of the pipette.
7. Set the upper level of the mixture of the zero mm mark
9. Place the pipette in vertical position on the stand, set
10. Note the reading (the distance red cells have fallen or
the extent of plasma column) after one hour.
Male: 0–5 mm after Ist hour. Female: 0–8 mm after Ist hour.
The zeta sedimentation rate (ZSR) is performed using a
special small-bore capillary tube that is filled with blood
and span for 3–4 minutes in a centrifuge called Zetafuge
(Beckman Coulter). This centrifuge alternately compacts
and disposes the RBCs under standardized centrifugal
force. The tube is then read on a special reader to obtain a
value called the Zetacrit, which represents the percentage
of sedimented erythrocytes. The Zetacrit value is divided
into the hematocrit value (also a percentage) and the
result in the ZSR expressed as percentage.
The ZSR’s advantages are that it is rapid, correct for
anemia, and requires only a small blood sample which
is desirable for pediatric patients. However, a special
centrifuge and reader are needed to perform the test.
Many other automated systems/devices are also
Sources of Error for any ESR Method
2. Tube not vertical, an inclination of 3° raises ESR by
4. Bubbles caused by too vigorous mixing.
6. Prolonged storage of blood after withdrawing it, the
test should be performed within 3 hours.
7. Pipette/tube kept on a vibrating surface (vibration
The value of ESR is that it indicates the possible presence
of organic disease, or to follow the course of disease. Its
main use is as a prognostic tool. It is used as a diagnostic
criterion (minor) in rheumatic fever only.
1. In any chronic infection, e.g. tuberculosis (maximum
in miliary tuberculosis), has prognostic value.
2. Any extensive inflammation, cell destruction or
3. Pregnancy, after the second month.
4. Puerperium, returns to normal within 2 months.
5. Active myocardial infarction (rapid rise).
6. Acute myocardial infarction (rapid rise).
7. Active rheumatoid arthritis (not much elevated in
8. Nephrosis (low blood albumin, anemia).
10. Active syphilis (moderate acceleration).
11. Postoperative states (for variable periods).
12. Any active infectious disease, acute or chronic.
13. Salpingitis, appendicitis (often normal), due to
absorption of purulent necrotic material.
FIG. 9.9: Wintrobe’s ESR tube with stand
15. Liver disease (depends upon blood proteins).
16. Menstruation (slight acceleration).
5. Sickle cell anemia (poikilocytosis).
Factors that Play a Role in ESR
¾ An accelerated ESR is favored by elevated levels of
No comments:
Post a Comment
اكتب تعليق حول الموضوع