1. The ESR
A test which is often sneered at Why ?

2. 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

3. 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 ?

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

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

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

7. 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

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

9. 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

10. 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)

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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 ?

17. 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.

18. 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?

19. 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?

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

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

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

23. 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”

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

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

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

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

28. 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

29. 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

30. 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 ?

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

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

33. 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 ?

34. 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

35. 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 :

36. 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 :

37. 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

38. 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

39. 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

40. 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

41. 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.

42. 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

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

44. 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

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

46. 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.