Sunday, October 21, 2007
Erythrocyte Sedimentation Rate – ESR
via Tapval and Sedi-rate System
Erythrocyte Sedimentation Rate is helpful in the diagnosis of conditions associated with acute and chronic inflammation, including infections, cancer, and autoimmune diseases. ESR is nonspecific because the increase in ESR does not indicate exactly where the inflammation is or what is the causative agent, it just shows there is inflammation in the body. Therefore, ESR is typically used in conjunction with other tests. ESR is helpful in diagnosing two specific inflammatory diseases, temporal arteritis and polymyalgia rheumatica. Also, ESR test is used for the diagnosis and monitoring of children with rheumatoid arthritis.
Blood is collected via veni-puncture and sent to the laboratory in EDTA tube. After inserting the blood into the EDTA tube, it should be homogenously mixed to ensure all of the blood is exposed to the anti-coagulant to prevent clotting. Clotted blood is rejected as it causes increased ESR.
Materials
Tapval tube with stopper containing Trisodic Citrate (Sodium Citrate)
Pressured Pipette with inner diameter of 1.25mm
Normal Pipette
Pipette Tips
Digital Timer
Methods
1. Patient’s particulars on the test request form are matched with the name on the blood tube.
2. Blood tube is inverted a few times to homogenously mix the blood
3. 320ml of blood is aliquot into the Tapval tube
4. The tube is flickered to attain homogenous mixture of blood with trisodic citrate
5. Pressured pipette is inserted into the tube. This must be done gently to prevent the blood from shooting up the pipette
6. After the pipette is in the tube, it further lowered into the blood until it travels to the top of the pipette
7. After ensuring there is no bubble or gap along the pipette, timer is set at 60 minutes and the pipette stands for the duration..
8. Patient’s label is then stuck to the pipette so as to prevent confusion when there’s a lot of ESR going on.
9. After 60 minutes, the level of red cells is read from its meniscus and recorded in the ESR logbook.
a
Sedimentation takes place in 3 stages:
A preliminary stage where rouleaux occurs and aggregates form.
Sinking of aggregates, which takes place at a constant speed.
Rate of sedimentation slows as the aggregated cells pack at the bottom of the tube.
Reference Values
1. Neonates
1-2 day = 0mm to 4mm
3days - 1month = 0mm to 10mm
2. Paediatric
2 months – 12 years old = 0mm to 12mm
3. Adult
> 12 years old = 0mm to 12mm
Discussion
Elevated ESR may be indicative of:
· Connective tissue diseases: systemic lupus erythematosus (SLE), giant cell arteritis and systemic sclerosis.
· Polymyalgia rheumatica (PMR): a condition particularly common among elderly women which causes chronic aching and stiffness of the muscles, especially in the shoulders and upper arms.
· Cancer
· Rheumatoid arthritis.
· Kidney disease.
· Sarcoidosis : disease of unknown cause in which inflammation occurs in the lymph nodes, lungs, liver, eyes, skin, or other tissues.
· Severe or chronic infection.
However, there are some factors that contribute to increased ESR which are independent of inflammation or infection. For example, increased fibrinogen, increased globulin, anaemia, decreased albumin and packed cell volume.
Also, females tend to have higher ESR, menstruation and pregnancy can cause temporary elevations. 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.
via Tapval and Sedi-rate System
Erythrocyte Sedimentation Rate is helpful in the diagnosis of conditions associated with acute and chronic inflammation, including infections, cancer, and autoimmune diseases. ESR is nonspecific because the increase in ESR does not indicate exactly where the inflammation is or what is the causative agent, it just shows there is inflammation in the body. Therefore, ESR is typically used in conjunction with other tests. ESR is helpful in diagnosing two specific inflammatory diseases, temporal arteritis and polymyalgia rheumatica. Also, ESR test is used for the diagnosis and monitoring of children with rheumatoid arthritis.
Blood is collected via veni-puncture and sent to the laboratory in EDTA tube. After inserting the blood into the EDTA tube, it should be homogenously mixed to ensure all of the blood is exposed to the anti-coagulant to prevent clotting. Clotted blood is rejected as it causes increased ESR.
Materials
Tapval tube with stopper containing Trisodic Citrate (Sodium Citrate)
Pressured Pipette with inner diameter of 1.25mm
Normal Pipette
Pipette Tips
Digital Timer
Methods
1. Patient’s particulars on the test request form are matched with the name on the blood tube.
2. Blood tube is inverted a few times to homogenously mix the blood
3. 320ml of blood is aliquot into the Tapval tube
4. The tube is flickered to attain homogenous mixture of blood with trisodic citrate
5. Pressured pipette is inserted into the tube. This must be done gently to prevent the blood from shooting up the pipette
6. After the pipette is in the tube, it further lowered into the blood until it travels to the top of the pipette
7. After ensuring there is no bubble or gap along the pipette, timer is set at 60 minutes and the pipette stands for the duration..
8. Patient’s label is then stuck to the pipette so as to prevent confusion when there’s a lot of ESR going on.
9. After 60 minutes, the level of red cells is read from its meniscus and recorded in the ESR logbook.
a
Sedimentation takes place in 3 stages:
A preliminary stage where rouleaux occurs and aggregates form.
Sinking of aggregates, which takes place at a constant speed.
Rate of sedimentation slows as the aggregated cells pack at the bottom of the tube.
Reference Values
1. Neonates
1-2 day = 0mm to 4mm
3days - 1month = 0mm to 10mm
2. Paediatric
2 months – 12 years old = 0mm to 12mm
3. Adult
> 12 years old = 0mm to 12mm
Discussion
Elevated ESR may be indicative of:
· Connective tissue diseases: systemic lupus erythematosus (SLE), giant cell arteritis and systemic sclerosis.
· Polymyalgia rheumatica (PMR): a condition particularly common among elderly women which causes chronic aching and stiffness of the muscles, especially in the shoulders and upper arms.
· Cancer
· Rheumatoid arthritis.
· Kidney disease.
· Sarcoidosis : disease of unknown cause in which inflammation occurs in the lymph nodes, lungs, liver, eyes, skin, or other tissues.
· Severe or chronic infection.
However, there are some factors that contribute to increased ESR which are independent of inflammation or infection. For example, increased fibrinogen, increased globulin, anaemia, decreased albumin and packed cell volume.
Also, females tend to have higher ESR, menstruation and pregnancy can cause temporary elevations. 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.
# posted by Star team @ 10:54 PM 
Comments:
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hey
What does the trisodic citrate
do??? why do u hav to use that when the tube is flickered to attain t homogenous mixture of blood ??
Vino
TGO2
What does the trisodic citrate
do??? why do u hav to use that when the tube is flickered to attain t homogenous mixture of blood ??
Vino
TGO2
Hey Phui yuen
U said that 'there is no bubble or gap along the pipette, timer is set at 60 minutes and the pipette stands for the duration', wat if I allow it to stand for a longer period of time, how will it affect the interpretion of results? see ya =-)
Eugene Wong
TG02
U said that 'there is no bubble or gap along the pipette, timer is set at 60 minutes and the pipette stands for the duration', wat if I allow it to stand for a longer period of time, how will it affect the interpretion of results? see ya =-)
Eugene Wong
TG02
HELLO
My family doctor told me that alcohol consumption can also cause an increase in ESR reading. Is that true?
Tang Jiaxin
TG01
My family doctor told me that alcohol consumption can also cause an increase in ESR reading. Is that true?
Tang Jiaxin
TG01
Hello,
Are there no separate ESR reference ranges for different genders in your lab?
Thanks.
-Alex Tg02
Are there no separate ESR reference ranges for different genders in your lab?
Thanks.
-Alex Tg02
Hey py,
Just one question for you.
From your 'materials' & 'methods', mention a 'Pressured pipette'. What exactly is a pressured pipette and how different is it from a normal pipette.
Thanks,
Azhar
TG01
Just one question for you.
From your 'materials' & 'methods', mention a 'Pressured pipette'. What exactly is a pressured pipette and how different is it from a normal pipette.
Thanks,
Azhar
TG01
Hi (^_^)!!
you mention that ESR is helpful in diagnosing two specific inflammatory diseases,the temporal arteritis and polymyalgia rheumatica.May i ask how ESR help to diagnose these diseases( since it is non-specific) and how it identify whether the patients is suffering from the temporal arteritis or polymyalgia rheumatica?
Avery
TG02
you mention that ESR is helpful in diagnosing two specific inflammatory diseases,the temporal arteritis and polymyalgia rheumatica.May i ask how ESR help to diagnose these diseases( since it is non-specific) and how it identify whether the patients is suffering from the temporal arteritis or polymyalgia rheumatica?
Avery
TG02
Hey..
You mentioned that females who are menstruating or pregnant can cause temporary elevations. Does this mean it can cause false positive results? If it is, are these patients required to do a re-test?
Ying Ying
TG01
You mentioned that females who are menstruating or pregnant can cause temporary elevations. Does this mean it can cause false positive results? If it is, are these patients required to do a re-test?
Ying Ying
TG01
hey,
why do you do manually for ESR instead of using a analyzer? in my lab, we uses "ESR auto plus" analyzer. it only took 31 mins
elaine
why do you do manually for ESR instead of using a analyzer? in my lab, we uses "ESR auto plus" analyzer. it only took 31 mins
elaine
Vino
trisodic citrate is actually sodium citrate. i'm not sure of the main usage of trisodic citrate. I've checked the manual and even asked the supervisor, seems that no one knows. i guess its a 'trade secret'. this is what i guess: when trisodic citrate is added to the blood, it help the RBCs to settle so that the level can be measured. hmm, as for homogenous mixture, its a common practice to 'mix-well' when blood is added to trisodic citrate. i hope i answered your question.
Eugene
if the pipette stood for the duration more that the stipulated timing given by the manufacturer, the RBCs will continue to settle and the reading will be lowere thus giving rise to false positive results.
Jiaxin
yep, alcohol does increase ESR reading as alcohol consumption casuse a syndrom call 'alcoholic neuropathy' aka Peripheral neuropathy, due to an inflammatory condition . Inflammation increases ESR.
Peripheral neuropathy is a problem with the nerves that carry information to and from the brain and spinal cord. This produces pain, loss of sensation, and inability to control muscles.
Alex
As our lab deals mostly with women and paediatrics, the classification of results are usually of these 2 categories instead of gender.
Azhar
A normal pipette involves suction of fluid up the pipette via some hand e.g releasing bulb of the pasteur pipette. Pressured pipette has pressure built up within it, so when it is pushed into the fluid, the fluid will automatically travel up the pipette.
Avery
Though ESR is non-specific but its results AID in the diagnosis of these diseases, most of the time biospy is required to confirm their conditions.
Most patients affected with temporal arteritis demonstrate an ESR greater than 80 mm/h while patient with ESR > 40 mm/h is more likely to suffer from polymyalgia rheumatica.
Temporal arteritis is inflammation of the temporal artery, causing temporal-located headaches. In addition, findings from biopsy of the superficial temporal artery assist in establishing the diagnosis
however, pathologic alterations encountered with temporal arteritis may also occur in other conditions, most notably polymyalgia rheumatica (PMR). PMR coexists with other disorders but ONLY 20% of patients with PMR reveal positive findings in
biopsies of temporal arteries
trisodic citrate is actually sodium citrate. i'm not sure of the main usage of trisodic citrate. I've checked the manual and even asked the supervisor, seems that no one knows. i guess its a 'trade secret'. this is what i guess: when trisodic citrate is added to the blood, it help the RBCs to settle so that the level can be measured. hmm, as for homogenous mixture, its a common practice to 'mix-well' when blood is added to trisodic citrate. i hope i answered your question.
Eugene
if the pipette stood for the duration more that the stipulated timing given by the manufacturer, the RBCs will continue to settle and the reading will be lowere thus giving rise to false positive results.
Jiaxin
yep, alcohol does increase ESR reading as alcohol consumption casuse a syndrom call 'alcoholic neuropathy' aka Peripheral neuropathy, due to an inflammatory condition . Inflammation increases ESR.
Peripheral neuropathy is a problem with the nerves that carry information to and from the brain and spinal cord. This produces pain, loss of sensation, and inability to control muscles.
Alex
As our lab deals mostly with women and paediatrics, the classification of results are usually of these 2 categories instead of gender.
Azhar
A normal pipette involves suction of fluid up the pipette via some hand e.g releasing bulb of the pasteur pipette. Pressured pipette has pressure built up within it, so when it is pushed into the fluid, the fluid will automatically travel up the pipette.
Avery
Though ESR is non-specific but its results AID in the diagnosis of these diseases, most of the time biospy is required to confirm their conditions.
Most patients affected with temporal arteritis demonstrate an ESR greater than 80 mm/h while patient with ESR > 40 mm/h is more likely to suffer from polymyalgia rheumatica.
Temporal arteritis is inflammation of the temporal artery, causing temporal-located headaches. In addition, findings from biopsy of the superficial temporal artery assist in establishing the diagnosis
however, pathologic alterations encountered with temporal arteritis may also occur in other conditions, most notably polymyalgia rheumatica (PMR). PMR coexists with other disorders but ONLY 20% of patients with PMR reveal positive findings in
biopsies of temporal arteries
hey phuiyuen,
is the waiting time of 60 minutes specific only for this kit? or for every ESR kit out in the market?
thanks
randall
tg02
is the waiting time of 60 minutes specific only for this kit? or for every ESR kit out in the market?
thanks
randall
tg02
YingYing
i guess if the woman is menstruating, she would not be fit to take this test. The doctor will then request this test to be done when her period is over. Yup, it gives rise to false positive result and a re-test is required in order to get a accurate ESR result.
Elaine,
We do ESR manually b'cos the samples coming in daily in not a lot, the average per day is less than 10 sometimes we dun even get any. So, there doesn't seem to be a need to invest in a analyser =)
Randall
There are a few differnt kit that uses the same timing to attain the ESR reading (i found the info online). Like elaine says her lab's analyser uses only 31 minutes so i guess some kit uses the same timing while some others like the automated analysers uses shorter time.
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i guess if the woman is menstruating, she would not be fit to take this test. The doctor will then request this test to be done when her period is over. Yup, it gives rise to false positive result and a re-test is required in order to get a accurate ESR result.
Elaine,
We do ESR manually b'cos the samples coming in daily in not a lot, the average per day is less than 10 sometimes we dun even get any. So, there doesn't seem to be a need to invest in a analyser =)
Randall
There are a few differnt kit that uses the same timing to attain the ESR reading (i found the info online). Like elaine says her lab's analyser uses only 31 minutes so i guess some kit uses the same timing while some others like the automated analysers uses shorter time.
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