This document discusses erythrocyte sedimentation rate (ESR), packed cell volume (PCV), and red blood cell indices. It defines these tests and provides the normal ranges. ESR is measured using the Westergren or Wintrobe method and measures how fast red blood cells fall in a tube. PCV measures the ratio of red blood cells to whole blood. Red blood cell indices include mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration which provide information about the size and hemoglobin content of red blood cells. The document discusses factors that affect the tests and their clinical significance.
1. ESR, PCV AND BLOOD
INDICES
DR. JANANI MATHIALAGAN
1ST
YEAR POSTGRADUATE
PATHOLOGY
2. OBJECTIVES OF THIS
CLASS
ïTo perform and interpret ESR
ïTo perform and interpret PCV
ïTo perform and interpret Blood Indices
3. ERYTHROCYTE SEDIMENTATION
RATE (ESR)
ï¶ESR is the measurement of the rate of sedimentation of red cells
in anti-coagulated blood.
ï¶Blood is allowed to stand for 1 hr in an open-ended glass tube
mounted vertically on a stand
ï¶Length of column of plasma above the red cells is measured in
mm.
4. ï¶Anticoagulated blood is drawn up into a tube of standardized
dimensions and left in a vertical position for exactly one hour
ï¶By that time, the red cells would have separated and settled
from the plasma.
ï¶Upper plasma column is recorded by reading from the scale
on the side of the tube.
ï¶Measures the distance that RBCs will fall in a vertical tube
over a given time period
ï¶Initial screening tool and also as a follow-up test â monitor
therapy and progression or remission of disease
5. Three definite phases:
âą First or Lag Phase (10mins) â red cells form a characteristic
rouleaux pattern (aggregation) and sedimentation is generally
slow. (Pack of coins)
âą Decantation Phase (40mins) â The rate accelerates in this phase;
fast settling or sinking of RBCs
âą Final Packing Phase (last 10mins) â slows again as red cell
aggregates pile up at the base of the tube. There is slow
sedimentation.
7. PLASMA FACTORS
Increased fibrinogen increases rouleaux formation
thereby increasing ESR
S. haptoglobulin , C - reactive protein & cholesterol
also increases ESR
Albumin and lecithin decreases sedimentation i.e.
decreasing ESR
8. RBC FACTORS
Primarily through changes in number and/or shape
Anemia responsible for increased ESR
âŠMicrocytes â sediment more slowly
âŠMacrocytes â sediment faster
12. The method for measuring the ESR recommended
by the International Council for Standardization in
Haematology (ICSH)
Based on that of Westergren, who developed the
test in 1921 for studying patients with pulmonary
tuberculosis.
13. CONVENTIONAL WESTERGREN
METHOD
ï¶The recommended tube is a straight
glass or rigid transparent plastic tube
30 cm in length
ï¶2.55 mm in diameter.
ï¶Bore must be uniform
ï¶A scale graduated in mm extends
over the lower 20 cm.
14. For the diluent, 3.8 g/dl Trisodium citrate used
Dilution â 1:4
0.25ml trisodium citrate : 1ml blood
Mix the blood sample thoroughly and then draw it up into
the Westergren tube to the 200 mm mark by means of a
rubber teat or a mechanical device
15. Place the tube exactly vertical
and leave undisturbed for
exactly 60 min, free from
vibrations and draughts and
not exposed to direct
sunlight.
Then read to the nearest 1
mm the height of the clear
plasma above the upper limit
of the column of sedimenting
cells.
Westergren pipette filled with blood
and placed vertically on the rubber
cork in the rack
17. PROCEDURE â WINTROBE METHOD
1. Add well mixed double oxalate / EDTA blood to the zero mark of
the Wintrobe tube, using a pipette
Avoid air bubbles
2. Place in vertical position in a rack and let sit for 60 minutes
3. Read and record results in millimeter (distance which the cells
have settled)
18. Average ESR value by Wintrobeâs Method:
âŠMales: 0 â 9mm/hr
âŠFemales: 0 â 20mm/hr
âŠChildren: 0 â 13mm/hr
19. Increased ESR
âąChronic infections e.g. Tuberculosis
âąExtensive/ Chronic inflammation
âąCollagen vascular disorders
o Systemic Lupus Erythromatosus
o Rheumatoid asthritis
o Systemic Sclerosis
âąShock
âąActive syphilis
âąActive infectious infections
21. ï¶Ratio of volume of RBCs to that of whole blood
ï¶It indicates relative proportion of red cells to plasma
ï¶Expressed in percentage.
ï¶Also called hematocrit or erythrocyte volume fraction
PACKED CELL VOLUME
25. Method:
1.Mix the anticoagulant blood sample thoroughly
2.Draw blood in a Pasteur pipette
3.Fill the tube upto 10 mark
4.Centrifuge the sample at 2000-2300 rpm for
30mins
5.Take the reading of the length of the column of
red cells
30. PRECAUTIONS
ï± Use recommended amount of EDTA
ï± Test done with in 6-8 hours
ï± Wintrobe tube should be filled from below upwards
so that no air bubble is trapped.
31. INCREASED PCV
ï±Polycythemia
-Newborns, High altitude,
Hypoxia due to lung and
heart diseases.
ï±Congestive Heart failure,
Burns (loss of plasma),
Dehydration, Severe
Exercise, Emotional stress
DECREASED PCV
ï±Anaemia
ï±Pregnancy
(Hemodilution)
42. CLINICAL SIGNIFICANCE
A) Macrocytic anaemia:
âŠMCV slightly increased upto 150 fl
âŠMCH is slightly increased
âŠMCHC is normal or diminished
B) Microcytic anaemia:
âŠMCV is diminished up to 50 fl or lower
âŠMCH is diminished to 15 pg or lower
âŠMCHC is diminished to 20% or less
C) Spherocytosis:
âŠMCV is diminished
âŠMCHC is elevated
43. RED CELL
DISTRIBUTION WIDTH
Measures the degree of variation of red cell size in
a blood sample.
Increased in iron deficiency anaemia
Decreased in beta- thalassemia trait
Normal value: 9.0-14.5