Erythrocyte Sedimentation Rate (ESR)

Erythrocyte Sedimentation Rate (ESR)

Introduction

ESR is the rate at which RBC's settle down when blood, to which anticoagulant is added, is allowed to stand in a narrow tube for one hour expressed in millimeters of clear plasma at the end of 1st hour. Sedimentation rate depends on various factors like; rouleaux formation (Rouleaux formation is directly proportional to concentration of fibrinogen and globulin in plasma. It is retarded by albumin); viscosity of plasma (ESR decreases if viscosity increases); ratio of cells to plasma (decreased ratio leads to increase Rouleaux formation); nature of anticoagulant used.

 

 

Normal Range (mm in 1 hr)
Westergren		Wintrobe's
Males	Females	Males	Females	Children	Newborns
0 –13	0 –20	0 –10	0 -15	0 – 13	0 -2

 

Increased in

Tissue damage or inflammation, anemia, any toxic or infective condition (acut or chronic), malignancies, nephrosis, physiological increase in females, pregnancy increase in temperature.

            Decreased in

Polycythemia, leukemia, hypofibrinogenemia, pernicious anemia, congestive heart failure (CHF), Protein shock (e.g. burns, severe allergic reactions), physiological decrease in newborns, decrease in temperature.

Reticulocyte Count (RC)

Reticulocyte Count (RC)

Introduction

The reticulocyte count is a fairly accurate reflection of erythropoietic activity therefore their number increases whenever red blood cells (RBCs) are being rapidly manufactured.

Normal Range

Adults: 0.5 – 1.85 % of erythrocytes, absolute count – 29,000 – 87, 000/cu.mm.

Newborn: 2.5 – 6.5 %, falls to adult range by second week of life.

Indications

·        Diagnosis of inffective erythropoiesis or decreased RBC formation

·        Increase indicates effective RBC production used as: Index of therapeutic response to iron, folate or vitamin B12 therapy and blood loss; monitor treatment response after bone marrow suppression and transplantation; monitor response to erythropoietin therapy.

Increased in

 After blood loss or increased RBC destruction, after iron therapy, after specific therapy for megaloblastic anemia and other hematologic conditions like polycythemia, metastatic carcinoma in bone marrow.

 Decreased in   

Ineffective erythropoiesis or decreased RBC formation (severe autoimmune type  of hemolytic disease, megaloblastic disorders), alcoholism, myxedema.

Abnormally shaped RBCs Spiculated

Abnormally shaped RBCs

Spiculated – Acanthocytes (abetalipoproteinemia, post – splenectomy, fulminating liver disease); Burr cells (stomach cancer, GI bleeding, uremia); Bite cells (hemolysis due to drugs); RBC fragmentation (cytotoxic chemotherapy, autoimmune hemolytic anemia, deficiency anemias, acute leukemia, inherited structural abnormality of RBC membrane protein spectrin).