Erythrocytes Sedimentation

Rate (ESR; VSH-abv. Romanian)

Principle:
From the collected sample, some blood is mixed with
anticoagulant (sodium citrate 3.8%), then aspirated into a
pipette (Westergreen pipette) and allowed to stand in a
vertical position; red blood cells settle with variable speed.
Westergreen technique:
Required materiale:
- necessary materials for drawing venous blood;
- anticoagulant: sodium citrate 3,8%;
-Westergreen pipette with milimetrical engravings from 0 to
200;
-stand;
-stopwatch.

Technique
After drawing venous blood and anticoagulation(1,6ml of
blood and 0,4ml sodium citrate 3,8%;20% overall dilution), it
is aspirated in the Westergreen pipette up to its 0 engraving.
The pipette is placed on the stand, perfectly vertical. After
precisely one hour the engraving corresponding to the border
between the formed plasma and erythrocytes columns is
read. The two columns appear due to the difference of
density between the plasma and erythrocytes: 1027 and
1039.
The sedimentation rate is influenced by the red blood
cells ability to group up in rolls (fact which depends on the
erythrocytes surface attraction, or zeta potential). The
forming of rolls will be influenced by plasmatic and
erythrocyte factors.

Serum factors (plasmatic factors) are represented by the ratio of

plasma proteins: the ratio of albumin and globulin and plasma
concentration of fibrinogen in the sample. Elevated plasma
asymmetric molecules greatly reduces the forces of repulsion
between RBCs, thus increasing the concentration of globulin and
fibrinogen will ease the layout of erythrocytes in rolls (columns)
and accelerating the sedimentation.
Erythrocyte factors are represented by the number of red blood
cells and by red blood cells and plasma ratio(hematocrit), but also
by the changes of erythrocyte surface or shape. Reducing the
number of red blood cells will exacerbate ESR while increasing their
number, as in polyglobulia, reduce ESR value. Microcytes will settle
more slowly than macrocytes and red blood cells of sickle cell
disease, sickle-shaped will determine hard rolls and a low ESR.

ESR physiological values: 15mm/hour (M) and

20 mm/hour (F).
ESR is considered a nonspecific indicator of the state
of inflammation, accompanying it is always the altering
ratio of albumin and globulin and/or plasma
concentration of fibribogen increases. It should be noted
that normal ESR does not exclude, however, a level of
inflammation. Acute or chronic inflammatory conditions
like neoplastic conditions are accompanied by high
values of this parameter. Very high values, about 100
mm/hour may suggest the diagnosis of multiple
myeloma, collagen diseases, tuberculosis, or cancer.