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Practical physiology 2nd year -2012 Dr.BAN DOSH ESR The erythrocyte sedimentation rate (ESR), is the rate at which red blood cells sediment in a period of 1 hour. It is a common hematology test that is a non-specific measure of inflammation. The ESR is governed by the balance between pro-sedimentation factors, mainly fibrinogen, and those factors resisting sedimentation, namely the negative charge of the erythrocytes (zeta potential). When an inflammatory process is present, the high proportion of fibrinogen in the blood causes red blood cells to stick to each other. The red cells form stacks called 'rouleaux, Normal values Males : 2-8 mm/hr Females: 4-10 mm/hr Procedures:1. Draw 0.2 ml of venous blood and transfer it to a container of anticoagulant. Mix the content gently ,don’t shake as it will cause frothing. 2. Using the Pasteur pipette fill the wintrobe tube from below upwards . 3. Transfer the tube to its stand and adjust the screws so that it will remain vertical. Leave the tube undisturbed for one hour, at the end of which read the mm of clear plasma above red cells. Practical physiology 2nd year -2012 Dr.BAN DOSH Physiological variations in ESR 1. Age. ESRis low in infants (0.5mm/hr) .it is gradually increases to adult levels in the next few years. 2. Sex. It is higher in females,due to lower hematocrit. 3. High altitude. People living at high altitudes have relatively higher ESR (polycythemia due to hypoxia actually should decrease ESR. 4. Pregnancy. The ESR begins to rise after about 3rd month of pregnancy and return to normal a few weeks after delivery, this is because of hemodilution during pregnancy and increased fibrinogen:albumin ratio are probably the cause of increased rouleaux formation. 5. Body temperature. ESR varies with body temp, because it affect the viscosity. Pathological increased in ESR:1. All acute and chronic infections ,e.g TB,pneumonia. 2. All anemias except spherocytosis, sickle cell anemia and pernicious anemia. 3. Bone diseases ,TB,osteomyelitis. 4. Connective tissue diseases ,systemic lupus erythematosis,rheumatoid arthritis. 5. All malignant diseases. 6. Acute non- infective inflammation ,gout. 7. Trauma,surgery. Practical physiology 2nd year -2012 Dr.BAN DOSH Pathological Decrease in ESR . 1. Polycythemia,high red cell counts associated with hyoxia due to heart and lung diseases, such as congestive heart failure, cong. Heart dis,show low ESR. 2. Anemia, spherocytosis, pernicious anemia and sickle cell anemia. 3. Afibrinogenemia, decrease or absence of fibrinogen in plasma ,which is genetic disorder, show low ESR. 4. Sever allergic reactions.