ESR & Erythrocyte Sedimentation Rate & Anticoagulation & Standardized Testing
Core Functions
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Anticoagulation
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Key additive: 3.2%–3.8% Sodium Citrate.
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Blood-to-anticoagulant ratio: 4:1 (e.g., fill to "2mL" mark = 1.6mL blood + 0.4mL anticoagulant).
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Mechanism: Chelates calcium ions → blocks coagulation cascade → maintains blood liquidity.
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Standardized Testing
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Specialized dimensions (Ø 2.5mm × 200mm) → Complies with Westergren method (ICSH standard).
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Primary Applications
1. Monitoring Inflammatory Diseases
| Condition | Clinical Utility |
|---|---|
| Infections | Bacterial TB → ESR ↑↑ >100 mm/h |
| Autoimmune diseases | Active RA → ESR ↑ (combined with CRP) |
| Malignancies | Multiple myeloma → Persistent ESR ↑ (therapy monitor) |
2. Procedure (ICSH Protocol)
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Fill blood to the calibration mark → 2. Invert mix 8 times → 3. Place vertically in Westergren rack → 4. Stand undisturbed at RT for 60 min → 5. Measure plasma interface drop (mm) = ESR value.
3. Result Interpretation
| ESR (mm/h) | Clinical Implication |
|---|---|
| <20 (M) / <30 (F) | Normal |
| 20–50 | Mild elevation (e.g., chronic inflammation) |
| >50 | Significant elevation (active infection/tumor) |
Critical Notes
1. Error Control
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Fill volume deviation:
±10% error → ESR deviation up to 30% (Must fill exactly to the mark!).
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Time sensitivity:
Test >4h post-collection → RBC morphology alters → Falsely ↓ESR.
2. Interfering Factors
| Factor | ESR Effect | Solution |
|---|---|---|
| Anemia (Hct<30%) | Falsely ↑ | Corrected ESR = ESR × [0.73+Hct] |
| Refrigerated sample | Falsely ↓ | Equilibrate to RT for 30 min |
| Underfilled tube | Clot formation | Discard and recollect |
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