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esrpcvbloodindices-copy-170305110725.pptx
The document outlines the objectives and procedures for performing and interpreting the erythrocyte sedimentation rate (ESR), packed cell volume (PCV), and blood indices used in hematology. It describes methods such as the Westergren and Wintrobe techniques, factors affecting ESR and PCV results, and the significance of red cell indices like mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). Clinical implications of increased or decreased values of ESR, PCV, and red cell indices related to various health conditions are also discussed.
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esrpcvbloodindices-copy-170305110725.pptx
- 1. ESR, PCV ANDBLOOD INDICES
- 2. OBJECTIVES OF THIS CLASS ➢Toperform and interpret ESR ➢To perform and interpret PCV ➢To perform and interpret Blood Indices
- 3. ERYTHROCYTE SEDIMENTATION RATE (ESR) ❖ESRis the measurement of the rate of sedimentation of red cells in anti-coagulated blood. ❖Blood is allowed to stand for 1 hr in an open-ended glass tube mounted vertically on a stand ❖Length of column of plasma above the red cells is measured in mm.
- 4. ❖Anticoagulated blood isdrawn up into a tube of standardized dimensions and left in a vertical position for exactly one hour ❖By that time, the red cells would have separated and settled from the plasma. ❖Upper plasma column is recorded by reading from the scale on the side of the tube. ❖Measures the distance that RBCs will fall in a vertical tube over a given time period ❖Initial screening tool and also as a follow-up test – monitor therapy and progression or remission of disease
- 5. Three definite phases: •First or Lag Phase (10mins) – red cells form a characteristic rouleaux pattern (aggregation) and sedimentation is generally slow. (Pack of coins) • Decantation Phase (40mins) – The rate accelerates in this phase; fast settling or sinking of RBCs • Final Packing Phase (last 10mins) – slows again as red cell aggregates pile up at the base of the tube. There is slow sedimentation.
- 6. FACTORS AFFECTING ESR 1.Plasma factor 2. RBC factor 3. Technical factor
- 7. PLASMA FACTORS Increased fibrinogenincreases 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 throughchanges in number and/or shape Anemia responsible for increased ESR ◦Microcytes – sediment more slowly ◦Macrocytes – sediment faster
- 9. Poikilocytosis retards ESRbecause abnormal shape hampers rouleaux formation Anticoagulants – Sodium citrate & EDTA doesnot affect ESR oxalates & heparin may affect
- 10. TECHNICAL FACTORS ❖Poor temperaturecontrol ❖Length and bore of the tube ❖Vibration ❖Verticality
- 11. METHODS Westergren’s method Wintrobe’s method Micro- ESR Automated systems Zeta sedimentation
- 12. The method formeasuring 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 ❖The recommendedtube is a straight glass or rigid transparent plastic tube 30 cm in length ❖2.55 mm in diameter. ❖Bore must be uniform ❖A scale graduated in mm extends over the lower 20 cm.
- 14. For the diluent,3.8 g/dl Trisodium citrate used Dilution – 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 tubeexactly vertical exactly 60 min, free and leave undisturbed for 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
- 16. ERYTHROCYTE SEDIMENTATION RATE Average ESRvalue by Westergren Method: Male – 3-5mm Female – 4-7mm
- 17. PROCEDURE – WINTROBEMETHOD 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 valueby Wintrobe’s Method: ◦Males: 0 – 9mm/hr ◦Females: 0 – 20mm/hr ◦Children: 0 – 13mm/hr
- 19. Increased ESR •Chronic infectionse.g. Tuberculosis •Extensive/ Chronic inflammation •Collagen vascular disorders o o o Systemic Lupus Erythromatosus Rheumatoid asthritis Systemic Sclerosis •Shock •Active syphilis •Active infectious infections
- 20. Decreased ESR •Newborns •Congestive heartfailure •Polycythemia •Marked leukocytosis •Allergic states •Sickle cell anemia
- 21. ❖Ratio of volumeof RBCs to that of whole blood ❖It indicates relative proportion of red cells to plasma ❖Expressed in percentage. ❖Also called hematocrit or erythrocyte volume fraction PACKED CELL VOLUME
- 22. Methods: 1. Macrohematocrit method(Wintrobe Method) 2. Microhematocrit method 3. Electronic Method
- 23. WINTROBES METHOD •Wintrobe’s tube– 110mm long, internal bore 2.5mm & a flat inner base. Graded 0-10 on both sides.
- 25. Method: 1.Mix the anticoagulantblood 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
- 27. Buffy coat- WBC& PLATELETS. UPPER MOSTLAYER – PLASMA •Yellowish-Jaundice •Pink-haemolysis •Milky-hyperlipidemia
- 29.
- 30. PRECAUTIONS ❑ Use recommendedamount of EDTA ❑ Test done with in 6-8 hours ❑Wintrobe tube should be filled from below upwards so that no air bubble is trapped.
- 31. INCREASED PCV ❑Polycythemia -Newborns, Highaltitude, Hypoxia due to lung and heart diseases. ❑Congestive Heart failure, Burns (loss of plasma), Dehydration, Severe Exercise, Emotional stress DECREASED PCV ❑Anaemia ❑Pregnancy (Hemodilution)
- 32. RED BLOOD CELLINDICES: 1.Mean corpuscular volume(MCV) 2.Mean corpuscular hemoglobin(MCH) 3.Mean corpuscular hemoglobin concentration(MCHC) 4.Red cell distribution width (RDW)
- 33. Mean Corpuscular Volume(MCV ) Average or meanvolume of a single red blood cell Expressed in femto liter (fl)
- 34. Calculation Formula: MCV = PCVin percentage X 10 RBC count per cmm Normal range: 80-100 fl
- 35. INCREASED ❖Megaloblastic anaemia ❖Chronic alcoholism ❖Liverdisease ❖newborns DECREASED ❖Microcytic hypochromic anaemia
- 36. Mean Corpuscular Hemoglobin(MC H) ❖Average hemoglobin content(weight of Hb) in a single red blood cell ❖Expressed in picograms(pg).
- 37. Calculation: Formula: MCH = Hbin gm/dl X 10 RBC count per cmm Normal range: 27 – 32 pg
- 38.
- 39. Mean Corpuscular Hemoglobin Concentration(MCHC) Concentration ofhaemoglobin in 1 dl or 1 liter of packed red cells
- 40. Calculation Formula: MCHC = Hbin gm/dl X 100 PCV in % Normal range: 30 – 35 g/dl
- 41.
- 42. CLINICAL SIGNIFICANCE A) Macrocyticanaemia: ◦MCV slightly increased upto 150 fl ◦MCH is slightly increased ◦MCHC is normal or diminished B) Microcytic anaemia: ◦MCV is diminished up to 50 fl or lower ◦MCH is diminished to 15 pg or lower ◦MCHC is diminished to 20% or less C) Spherocytosis: ◦MCV is diminished ◦MCHC is elevated
- 43. RED CELL DISTRIBUTION WIDTH Measuresthe 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