The ESR A test which is often sneered at Why ?

E Erythrocyte Red cells S Sedimentation settling The ESR OK, first of all, what is the ESR ? ESR is an acronym E Erythrocyte Red cells S Sedimentation settling R Rate amount in a given time

how much the red cells settle in a given time. The ESR OK, first of all, what is the ESR ? how much the red cells settle in a given time. Measured in mm/hr. Why is the “hr” bit important ?

The ESR Next – how is the test performed? Take a tube

The ESR Next – how is the test performed? Take a tube Fill with blood

The ESR Next – how is the test performed? Take a tube Fill with blood

The ESR Take a tube Fill with blood Leave it for an hour Next – how is the test performed? Take a tube Fill with blood Leave it for an hour

The ESR Take a tube Fill with blood Sedimentation occurs Next – how is the test performed? Take a tube Fill with blood Sedimentation occurs

The ESR Zeta potential What is it actually measuring ? Sedimentation of red cells in a given time Zeta potential Which is dependent on: Red cells carry a net negative charge Which causes them to repel each other

Something often overlooked…. ESRs are Normal - less than 10 (ish) or The ESR What is it actually measuring ? Sedimentation of red cells in a given time Something often overlooked…. ESRs are Normal - less than 10 (ish) or High - more than 10 (ish)

The ESR An ESR is either normal or raised. 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 potential

The ESR A look at acute phase reactions. Albumin The science behind the test A look at acute phase reactions. Albumin Counteracts rouleax formation Decreased in acute phase reactions So ………….? raised ESR

The ESR A look at acute phase reactions. Fibrinogen 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 ESR

The ESR A look at “polycythaemic” conditions The science behind the test A look at “polycythaemic” conditions The more cells, the more space they need to settle Therefore a low result

The ESR Next – how can YOU influence the result? There are a whole range of things that YOU can do to change the result obtained from an ESR

The longer it is left, the more sedimentation occurs The ESR Next – how can YOU influence the result? Time of sedimentation. The longer it is left, the more sedimentation occurs up to a point what point is that ?

If not thoroughly mixed, then it’s already partially sedimented. The ESR Next – how can YOU influence the result? Mixing of the sample If not thoroughly mixed, then it’s already partially sedimented.

The ESR Next – how can YOU influence the result? Temperature. Ever had a thick milk shake ? Why can you drink one quickly in August and why does it takes half an hour at Xmas?

Put some marbles on the bench The ESR Next – how can YOU influence the result? Vibrations. Put some marbles on the bench Drop something heavy. What happens?

The ESR Next – how can YOU influence the result? Angle.

In this tube the cells drop down The ESR Next – how can YOU influence the result? Angle. In this tube the cells drop down

In this tube the cells drop down The ESR Next – how can YOU influence the result? Angle. In this tube the cells drop down

In this tube the cells drop down The ESR Next – how can YOU influence the result? Angle. In this tube the cells drop down “Gravity”

The ESR Next – how can YOU influence the result? Angle. Wot about this tube ?

The ESR Next – how can YOU influence the result? Angle. Wot about this tube ?

Gravity is still the same The ESR Next – how can YOU influence the result? Angle. Wot about this tube ? Gravity is still the same

Gravity is still the same The ESR Next – how can YOU influence the result? Angle. Wot about this tube ? Gravity is still the same

The ESR Next – how can YOU influence the result? Angle. Wot about this tube ? Gravity is still the same but the cells reach the side of the tube and then roll down

The ESR Next - how can YOU cock it up ? Angle. Wot about this tube ? Gravity is still the same but the cells reach the side of the tube and then roll down

Why should a lump of clot in the tube affect sedimentation ? The ESR Next – how can YOU influence the result? Clots. Why should a lump of clot in the tube affect sedimentation ?

The ESR Next – how can YOU influence the result? Sufficiency.

The ESR Next – how can YOU influence the result? Sufficiency.

What’s the highest reading that an ESR can be ? The ESR Next – how can YOU influence the result? Sufficiency. What’s the highest reading that an ESR can be ?

What’s the highest reading that an ESR can be ? The ESR Next – how can YOU influence the result? Sufficiency. What’s the highest reading that an ESR can be ? The PCV

What’s the highest reading that an ESR can be ? The ESR Next – how can YOU influence the result? Sufficiency. What’s the highest reading that an ESR can be ? The PCV ie the ratio of this :

What’s the highest reading that an ESR can be ? The ESR Next – how can YOU influence the result? Sufficiency. What’s the highest reading that an ESR can be ? The PCV ie the ratio of this :

What’s the highest reading that an ESR can be ? The ESR Next – how can YOU influence the result? Sufficiency. What’s the highest reading that an ESR can be ? The PCV ie the ratio of this : to this

What’s the highest reading that an ESR can be ? The ESR Next – how can YOU influence the result? Sufficiency. What’s the highest reading that an ESR can be ? The PCV ie the ratio of this : to this

What’s the highest reading that an ESR can be ? The ESR Next – how can YOU influence the result? Sufficiency. What’s the highest reading that an ESR can be ? The PCV

The ESR Next – how can YOU influence the result? Sufficiency. What’s the highest reading that an ESR can be ? The PCV Packed cell volume is a ratio

The ESR Next – how can YOU influence the result? Sufficiency. What’s the highest reading that an ESR can be ? The PCV Packed cell volume is a ratio An ESR (at one hour) is a measurement.

The ESR Next – how can YOU influence the result? Sufficiency. What’s the highest reading that an ESR can be ? The PCV which is reached much quicker with a small sample

“A test which is often sneered at” Earlier I said “A test which is often sneered at”

Affected by a range of conditions Varies with the menstrual cycle The ESR is: Not specific Affected by a range of conditions Varies with the menstrual cycle Not diagnostic

Why do an ESR?: Two clinical reasons: Monitoring of rheumatoid arthritis Diagnosis of temporal arteritis

BECAUSE it’s so non-specific Why do an ESR?: It’s a marvellous test. BECAUSE it’s so non-specific a one-stop + or - screen. If someone turns up at the G.P., and claims to be unwell, but the G.P. is unconvinced, she will ask for an ESR.