EXERCISE 1: Erythrocyte Sedimentation Rate

MLAB 1315 Hematology Page 1

ERYTHROCYTE SEDIMENTATION RATE

LAB OBJECTIVE The student will able to perform, within 2 mm/hr accuracy compared with the instructors value, three erythrocyte sedimentation rates using the Westergren method. PRINCIPLE The erythrocyte sedimentation rate (E !", also called the sed rate, measures the settling of erythrocytes in diluted human plasma over a specified time period. This numeric value is determined (in millimeters" by measuring the distance from the bottom of the surface meniscus to the top of erythrocyte sedimentation in a vertical column containing diluted whole blood that has remained perpendicular to its base for #$ minutes. %arious factors affect the E !, such as !&' si(e and shape, plasma fibrinogen, and globulin levels, as well as mechanical and technical factors. The E ! is directly proportional to the !&' mass and inversely proportional to plasma viscosity. )n normal whole blood, !&'s do not form rouleau*+ the !&' mass is small and therefore the E ! is decreased (cells settle out slowly". )n abnormal conditions when !&'s can form rouleau*, the !&' mass is greater, thus increasing the E ! (cells settle out faster". The Westergren method is preferred by ,''- standards because of its simplicity and greater distance of sedimentation measured in the longer Westergren tube. The straight tube is .$ cm long, 2./ mm in internal diameter, and calibrated in millimeters from $02$$. 1ppro*imately 2 m- of blood is re3uired. The method it replaces is called the Wintrobe method. SPECIMEN 4resh anticoagulated blood collected in E5T1. &lood should be at room temperature and should be no more than 2 hours old. )f anticoagulated blood is refrigerated, the test must be set up within # hours. 6emoly(ed specimens cannot be used. REAGENTS, SUPPLIES, AND EQUIPMENT

LAB EXERCISES

MLAB 1315

EXERCISE 1: Erythrocyte Sedimentation Rate Hematology 2. 2. .. 8. /. #. Westergren tubes Westergren rac7 5isposable pipets $./ ml sodium chloride in puncture ready vials -eveling plate for holding the Westergren rac7 Timer

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QUALITY CONTROL 'ommercial controls are available for this procedure. They will not be used for this e*ercise. PROCEDURE

LAB EXERCISES MLAB 1315

EXERCISE 1: Erythrocyte Sedimentation Rate Hematology 2. 2. .. 8. /. #. ;. 9.

MLAB 1315

Page . 'ollect whole blood anticoagulated with E5T1. -abel the puncture ready vial with the patients name. !emove cap from the puncture ready vial and add well mi*ed blood up to the line (see illustration". !eplace cap and invert 9 times ma7ing sure the blood and saline mi* well. 'arefully insert the Westergren tube into plungeable vial cap of blood/diluent mi*ture twisting as you push the tube down. :lace the tube in the Westergren rac7 to a vertical position and leave undisturbed for e*actly 2 hour. et timer for 2 hour. 1fter 2 hour has passed, read the distance in millimeters from the bottom of the plasma meniscus to the top of the sedimented erythrocytes. 5o not include the buffy coat in this measurement. (The buffy coat is the layer of white cells and platelets at the interface of red cells and plasma. )t is usually negligible, but may be noticeable in cases of leu7ocytosis or thrombocytosis."

REPORTING RESULTS ,ormal values 1dult male $02/ mm/hr 1dult female $02$ mm/hr PROCEDURE NOTES ources of error

LAB EXERCISES MLAB 1315

EXERCISE 1: Erythrocyte Sedimentation Rate Hematology 2. 2. .. 8. /. #. ;.

MLAB 1315

! 1ge of specimen 0 must be less than 2 hours at room temperature, less thanPage # hours refrigerated. Temperature 0 must be between 2$02/ ' and blood must be at room temperature. temperatuare will cause a false E !. )ncorrect ratio of blood to diluent &ubbles in the Westergren tube Tilting of the Westergren tube (accelerates the fall of the erythrocytes+ an angle of even . degrees from vertical can accelerate sedimentation by as much as .$<" %ibration such as from a nearby centrifuge will cause a false E !.

=sefulness of the E ! The E ! is not a specific test therefore it is used for screening for certain disease conditions. )t can be used to differentiate among diseases with similar symptoms or to monitor the course of an e*isting disease. 4or e*ample, early in the course of an uncomplicated viral infection, the E ! is usually normal, but it may rise later with a superimposed bacterial infection. Within the first 28 hours of acute appendicitis, the E ! is not elevated, but in the early stage of acute pelvic inflammatory disease or ruptured ectopic pregnancy, it is elevated. The E ! is elevated in established myocardial infarction but normal in angina pectoris. )t is elevated in rheumatic fever, rheumatoid arthritis, and pyogenic arthritis, but not in osteoarthritis. The E ! can be an inde* to disease severity. &iological factors affecting the E !

LAB EXERCISES MLAB 1315

EXERCISE 1: Erythrocyte Sedimentation Rate Hematology 2.

MLAB 1315

2.

Page 5 :lasma factors )ncreased plasma concentration of fibrinogen, along with immunoglobulin, will result in rouleau* formation and an increased E !. )t can therefore be e*pected that disease states that are characteri(ed by hyperfibrinogenemia or elevated immunoglobulin levels will result in an increased E !. !&' factors When rouleau* formation cannot occur, owing to the shape or si(e of the !&', a decreased or low E ! is e*pected. This is observed with sic7le cells and spherocytes. The E ! is of little diagnostic value in severe anemia or in hematologic states evidenced by poi7ilocytosis. 4actors affecting the E ! )ncrease !ouleau* formation Elevated fibrinogen E*cess immunoglobulin 5ecrease >icrocytes ic7le cells pherocytes

REFERENCES 6armening., 5enise, 'linical 6ematology and 4undamentals of 6emostasis, .rd edition, pp. #$.0#$/. Turgeon, >ary -ouise, 'linical 6ematology 0 Theories and :rocedures, .rd edition, pp .2#.

LAB EXERCISES MLAB 1315

EXERCISE 1: Erythrocyte Sedimentation Rate Hematology

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Erythrocyte Se !"e#t$t!o# R$te Re%ort For" &or L$' E(erc!)e

tudents name?@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@5ate?@@@@@@@@@@@@@@@@ Westergren 7it lot A?@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ 5ate?@@@@@@@@@@@@@@ E*piration

:atient name

)5 A

E ! position on rac7

E ! result mm/hr

)nstructor result

Within normal rangeB C/,

LAB EXERCISES MLAB 1315

EXERCISE 1: Erythrocyte Sedimentation Rate Hematology

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STUDY QUESTIONS

,ame@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ 5ate@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@

LAB EXERCISES MLAB 1315

EXERCISE 1: Erythrocyte Sedimentation Rate Hematology 2. tate the principle of the E !. (2 pt."

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2.

What is the normal range for E ! in (state reporting units" (2 pts." >enB @@@@@@@@@ WomenB @@@@@@@@@@@@@@

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tate the specimen re3uirement for E ! and time limits for performing the test. (. pts."

8. /.

4or how long do you time a sed rateB (2 pt." tate four (8" sources of error when performing an E !. (8 pts."

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The E ! can be used to differentiate appendicitis from? (8 pts." @@@@@@@@@@@@@@@@@@@@@@ and @@@@@@@@@@@@@@@@@@@@@@@@@ 'ircle or highlight the conditions(s" in which the E ! is elevated in the first 28 hours.

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The E ! can be used to differentiate anginia pecoris from? (2 pt." @@@@@@@@@@@@@@@@@@@@@@@@@@. 'ircle or highlight the condition in which the

LAB EXERCISES MLAB 1315

EXERCISE 1: Erythrocyte Sedimentation Rate Hematology E ! is elevated. 9. Which arthritis does not cause an elevated E !B (2 pt."

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D.

)s the E ! E or F in the following conditionsB (/ pts." 1. &. '. 5. E. ic7le cells present )ncreased room temperature =nlevel E ! rac7 ,earby centrifuge in use Elevated plasma immunoglobulin

2$. What is the name of the E ! method that the Westergren method replacesB (2 pt."

LAB EXERCISES MLAB 1315

EXERCISE 1: Erythrocyte Sedimentation Rate Hematology

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LAB EXERCISES MLAB 1315

EXERCISE 1: Erythrocyte Sedimentation Rate

MLAB 1315 Hematology Page 22

LAB EXERCISES

MLAB 1315