logging in or signing up ESR bashirbashir Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: Embed: Flash iPad Dynamic Copy Does not support media & animations Automatically changes to Flash or non-Flash embed WordPress Embed Customize Embed URL: Copy Thumbnail: Copy The presentation is successfully added In Your Favorites. Views: 864 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: December 16, 2012 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript ESR: ESR Presented by: Bashir A. Bashir Mohamed, MS.c University of Gezira 2012PowerPoint Presentation: ESR is an acronym E Erythrocyte Red cells S Sedimentation settling R Rate amount in a given timeHistory: History The phenomenon now recognised as the erythrocyte sedimentation rate was first observed by ancient Greeks. They observed the relationship between the sedimentation of red blood cells and fibrinogen, and used it as a means of detecting bad bodily.History: The test used today was introduced in 1918 by Robin Fahraeus , when he recorded the erythrocytes of pregnant women settled more quickly than the erythrocytes of non pregnant women. HistoryDefinition: Definition Erythrocyte sedimentation rate (ESR) is a non-specific test for inflammation. It is easy to perform, widely available and inexpensive making it a widely used screening test It is also used a monitoring tool for response to treatment in conditions in which it is raised (tuberculosis, autoimmune diseases etc (Definition: Definition The ESR is a measure of the degree of settling of erythrocytes in an anticoagulated blood specimen during a specified period of time.Methodology: Methodology ESR can be carried out by one of three methods: 1- Westergren method 2- Wintrobe method 3- Automated method.Specimen: Specimen Whole blood is collected in Tri Na C anticoagulant. 4 parts of this anticoagulated blood is mixed well with one part of 3.2% W/v (109 M) trisodium citrate and tested within 2 hours. EDTA anticoagulated blood diluted in sodium citrate can be used.Basics:: Basics: The ESR test is performed in the laboratory by placing anticoagulated blood in an upright tube (Westegren's most often). At the end of an hour of this, the rate of the RBC sedimentation is measuredPrinciple of test: Principle of test When citrated blood in a vertically positioned Westergren pipette is left undisturbed, red cells aggregate, stack together to form rouleaux, and sediment through the plasma. The ESR is the rate at which this sedimentation occurs in 1 hour as indicated by the length of the column of clear plasma above the red cells, measured in mm.Westergren method: Westergren method This is the most recommended method for routine work. Requirements : 1- Westergren tube: Made of disposable glass or plastic. Graded from 200 mm at the bottom to 0 mm near the top with 1 mm divisions.PowerPoint Presentation: The internal diameter not less than 2.55 mm. 2- ESR rack. 3- Stop watchTest Method: Test Method Next – How the test is performed? Take a tube Take a tubeTest Method: Next – How the test is performed? Test Method Take a tube Fill with bloodTest Method: Next – How the test is performed? Test Method Take a tube Fill with bloodTest Method: Next – How the test is performed? Test Method Take a tube Fill with blood Leave it for an hourTest Method: Next – How the test is performed? Test Method Take a tube Fill with blood Sedimentation occursWhat is it actually measuring ?: What is it actually measuring ? Sedimentation of red cells in a given time Which is dependent on: Zeta potential Red cells carry a net negative charge Which causes them to repel each otherMechanism: Mechanism ESR is determined by the interaction between factors that promote (fibrinogen) and resist (negative charge of RBCs - that repel each other) sedimentation. Normal RBCs settle slowly as they do not form rouleaux or aggragate together. Instead, they gently repel each other due to the negative charge on their surfaces .Mechanism: Mechanism Increased rouleaux formation contributes to high ESR. Rouleaux are stacks of many RBCs that become heavier and sediment faster. Plasma proteins, especially fibrinogen, adhere to the red cell membranes and neutralize the surface negative charges, promoting cell adherence and rouleaux formationThe science behind the test: The science behind the test An ESR is either normal or raised . If raised, it’s because the cells sediment faster because they stick together ( rouleaux ). More sticking together implies less electrostatic repulsion So the disease process is affecting the zeta potentialThe science behind the test: The science behind the test A look at acute phase reactions. Albumin Counteracts rouleaux formation Increased in acute phase reactions So ………….? low ESRThe science behind the test: The science behind the test A look at acute phase reactions. Fibrinogen Increased in “acute phase” reactions So as it’s raised, albumin levels are relatively lowered So …………? raised ESRThe science behind the test: The science behind the test A look at “ polycythaemic ” conditions The more cells, the more space they need to settle Therefore a low resultFactors affecting the ESR: Factors affecting the ESR A - Effect of plasma protein : Increased in the concentration of fibrinogen and Immunoglobulins due to tissue injury will increase rouleaux formation and hence the rate of sedimentation. plasma albumin retards sedimentation of RBCs .Factors affecting the ESR: B - RBC size and number : The size and number of RBCs that show alterations in their bioconcavity , like spherocyte and sickle cells, usually do not exhibt increase rate, unless there is severe anemia. Increase red cell mass will retard the sedimentation rate e.g. polycythemia . Factors affecting the ESRFactors affecting the ESR: C - Technical factors Perpendicularity of sedimentation tube, slight deviations from the absolute. Vertical can increase the result . Temperature (RT 18-25 C) higher temperature cause false high results due to reduction in plasma viscosity (direct sun light) . Vibration cans reduce the ESR . Factors affecting the ESRTechnical factors: Technical factors Next – how can YOU influence the result? Angle.Technical factors: Next – how can YOU influence the result? Technical factors Angle. In this tube the cells drop downTechnical factors: Next – how can YOU influence the result? Technical factors Angle. In this tube the cells drop downTechnical factors: Next – how can YOU influence the result? Technical factors Angle. In this tube the cells drop down “Gravity”Technical factors: Next – how can YOU influence the result? Technical factors Angle. What about this tube ?Technical factors: Next – how can YOU influence the result? Technical factors Angle. Wot about this tube ? Gravity is still the sameTechnical factors: Next – how can YOU influence the result? Technical factors Angle. Wot about this tube ? Gravity is still the sameTechnical factors: Next – how can YOU influence the result? Technical factors Angle. What about this tube ? Gravity is still the same but the cells reach the side of the tube and then roll downTechnical factors: Next - how can YOU cock it up ? Technical factors Angle. what about this tube ? Gravity is still the same but the cells reach the side of the tube and then roll downTechnical factors: Next – how can YOU influence the result? Technical factors Clots. Why should a lump of clot in the tube affect sedimentation ?Sedimentation Phases: Sedimentation Phases The initial lag phase .(10m) The phase of rapid RBC falling(40m) The packing phase (10m) .Reference Range: Reference Range Adult females 0 - 20 mm/h Adult males 0 -15 mm/hr Children (<10) 0 -10 mm/hrReference Range: Reference RangeESR: ESR ESR of more than 100 mm/hr is strongly associated with serious underlying disorders like connective tissue disease, infections and malignanciesConditions with very high ESR >100 mm/hr: Multiple myeloma Connective tissue disorders - SLE, RA and other autoimmune diseases Tuberculosis Malignancies Severe anemia Conditions with very high ESR > 100 mm/hrPowerPoint Presentation: Drugs such as dextran , methyldopa ( Aldomet ), oral contraceptives, penicillamine procainamide , theophylline , and vitamin A can increase ESR, while aspirin, cortisone, and quinine may decrease it .Conditions with low ESR: Conditions with low ESR Polycythemia Severe Leukocytosis Sickle cell disease (anemia) Hereditary spherocytosis Congestive cardiac failure Corticosteroid use HypofibrinogenemiaESR: ESR Note that sickle cell anemia and spherocytosis have low ESR unlike other anemias . This is due to reduced rouleaux formation owing to the abnormally shaped RBCs in this conditionIMPORTANT: IMPORTANT Erythrocyte sedimentation rate is a non-specific test and is not diagnostic of any particular disease. It has a high sensitivity but low specificity . Never base a diagnosis solely on an ESR value, either normal or high . Interpretation of the result should always be along with the patient's clinical history, examination findings and results of other tests done .ESR: ESR ESR and C-reactive protein (CRP) are both markers of inflammation . Generally, ESR does not change as rapidly as does CRP, either at the start of inflammation or as it goes away. CRP is not affected by as many other factors as is ESR, making it a better marker of inflammation. However, because ESR is an easily performed test, many doctors still use ESR as an initial test when they think a patient has inflammation .What changes in ESR mean?: What changes in ESR mean? The ESR is an indicator in your body. Like pain, it is giving you a warning that something is wrong. In most cases, the ESR will decrease over time once the underlying inflammation is addressed. If you have a chronic inflammatory disease, the ESR may fluctuate with the degree of activity your condition .PowerPoint Presentation: العبادة الخفيةPowerPoint Presentation: Thank you You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.