ESR by westergreen method: reason high or low ESR, ESR normal value

Causes of high and low ESR value. ESR procedure: Normal Value

ESR can be done in two ways

1. Westergreen method
2. Wintrobe method

ESR by Westergreen Method:

Materials required:

ESR Pipette
ESR Stand
ESR Fluid (3.8% Sodium Citrate)
Clean and dry Penicillin test tube (Wester green ESR Pipette 300 mm long and inner diameter of Pipette 2.55 mm

Procedure for ESR:

1. Take 0.4ml or 40µl ESR fluid in a clean test tube or penicillin bottle.
2. Add1.6ml blood in the same test tube by collecting blood from patients and mix well with ESR fluid.
3. ESR stand a by pulling blood up to 0 spots of ESR pipette You have to put it properly. (To draw blood up to 0 spots, ESR Pipette should be pulled with a rubber boot at the end of the 0 spots, many people draw blood by mouth which should not be accepted.)
4. Reading should be taken after one hour, to see how many spots of ESR pipette the RBCs are sinking or how many spots of ESR pipette RBC and plasma are divided. As far as the RBC is concerned, the ESR is mm.

Westergreen ESR tube cleaning method:

ESR tube should be washed with water to remove blood from the tube.
The ESR tubes should be immersed in clean water for 12 hours.
The ESR tubes should be kept at 37'C in the incubator or dried in any way and then used. (It is better to don't use washing powder, acid, ethanol for cleaning)

Normal Value of ESR:

Male: 0-10 mm At the End of 1st Hour.
Female: 0-20 mm At the End of 1st Hour.

The reasons why ESR may be incorrect:

• If the ESR Pipette is dirty and wet.
• If anticoagulant + blood does not mix well.
• If the ESR stand is not flat or the ESR pipette is tilted in any direction.
• With the blood in the ESR pipette, after placing it in the ESR stand, if additional movement is done.
• If you put ESR too late after blood collection.
• After blood collection, mix anticoagulant with blood late.
• If there is air bubble inside the ESR pipette
• If you draw blood in dehydrated condition

ESR fluid Preparation:

Sodium citrate: 3.8 gm
Distilled water: 100 ml

Causes of increase ESR rate?

1. In any chronic infection. eg, Tuberculosis (Maximum in milliary tuberculosis)
2. Any extensive inflammation, cell destruction or toxemia
3. Pregnancy, after the 2nd month
4. Active rheumatic fever
5. Acute myocardial infarction
6. Acute rheumatoid arthritis
7. Nephrosis (Blood albumin reduced, anemia)
8. All type of shock
9. Post operative states
10. Any active infectious disease, acute or chronic
11. Infected, necrotic or malignant tumors
12. Liver disease (depend upon blood protein).

Causes of decrease ESR rate

1. New born infants
2. Congestive heart failure
3. Sickle cell anemia
4. Hypofibrinogenemia.
5. Polycythemia
6. Allergic states
7. Spherocytosis