Brief introduction of erythrocyte sedimentation rate

Directory 1 pinyin 2 English reference 3 overview 4 erythrocyte sedimentation rate alias 5 medical examination 5. 1 examination name 5.2 classification 5.3 determination principle of erythrocyte sedimentation rate 5.4 reagent 5.5 operation method 5.6 normal value 5.7 clinical significance of test results 5.8 precautions 5.9 related diseases 1 pinyin hó hóng xìbāo chén Jianglǜǔ ǜ

2 English reference red blood cell volume rate

3 Overview Put anticoagulant into a special erythrocyte sedimentation tube, and observe the distance of erythrocyte sedimentation in a certain period of time, which is called erythrocyte sedimentation rate (ESR). There are many methods to determine erythrocyte sedimentation rate. Vestergren method is recommended by WHO (LAB/86.3), and is introduced as follows.

4 erythrocyte sedimentation rate alias erythrocyte sedimentation rate

5. Medical examination of erythrocyte sedimentation rate 5. 1 examination name erythrocyte sedimentation rate

5.2 classified clinical blood test >: red blood cells

5.3 Determination principle of erythrocyte sedimentation rate Anticoagulant is placed in a special erythrocyte sedimentation tube and stands vertically for 65438±0h hours. The erythrocyte sedimentation rate was observed, which was expressed by the height of plasma segment (mm). There are many factors affecting erythrocyte sedimentation rate, the most important of which is the formation of red blood cells. Because the total area of red blood cells is reduced after they form money-shaped or aggregated, the plasma resistance they bear is also reduced, which is much faster than that of a single dispersed red blood cell. The main factors affecting the formation of money are:

(1) Proportion of various protein in plasma: It is generally believed that the acceleration of ESR is mainly due to the change of the proportion of various protein components in plasma, and has nothing to do with the total protein concentration. Albumin is negatively charged while globulin and fibrinogen are positively charged. Under normal circumstances, the positive and negative charges of plasma protein are in equilibrium, while red blood cells are negatively charged due to sialic acid on the surface of cell membrane, and the mutual repulsion distance is about 25nm, which is relatively stable. For example, the increase of fibrinogen or globulin content or the decrease of albumin content in plasma changes the charge balance, leading to the decrease of negative charge on the surface of red blood cells, which is easy to make red blood cells form money samples and accelerate the sedimentation rate of red blood cells. On the contrary, if plasma fibrinogen decreases or albumin increases, the erythrocyte sedimentation rate slows down. It has been recognized that fibrinogen, an asymmetric macromolecular substance with positive charge in plasma, is the strongest substance to promote money accumulation, followed by γ globulin and α and β globulin. In addition, cholesterol and triglycerides can also promote the formation of red blood cells. Albumin and lecithin have inhibitory effects.

(2) Number and shape of red blood cells: Under normal circumstances, erythrocyte sedimentation rate and plasma reflux resistance keep a certain balance. If the number of red blood cells is reduced, the total area is reduced, and the plasma reverse resistance is reduced, so the erythrocyte sedimentation rate is accelerated. But if the amount is too small, it will affect the accumulation of money, so that the acceleration of erythrocyte sedimentation rate is out of proportion to the degree of erythrocyte reduction. On the contrary, when red blood cells increase, the erythrocyte sedimentation rate slows down. The larger the diameter of red blood cells, the faster the erythrocyte sedimentation rate, and the spherical red blood cells are not easy to aggregate into money, so the erythrocyte sedimentation rate slows down.

(3) Location of the ESR tube: When the ESR tube is tilted, red blood cells sink along one side of the tube wall and plasma rises along the other side to accelerate ESR.

5.4 reagent (1) 109mmol/L sodium citrate (32g/l na3c6h5o7 2h2o, AR).

(2) Wechsler sedimentation tube: the length is 300 1.5mm, the inner diameter is 2.5 ~ 2.7 mm (the error shall not exceed 0.05mm), and the tube is engraved with a scale of 200mm, which can hold about 1ml of blood.

(3) erythrocyte sedimentation rate pipe rack.

5.5 Operation Method (1) Take 0.4ml of sodium citrate anticoagulant and add it to the glass bottle.

(2) Take 1.6ml venous blood, immediately add it into a glass bottle and mix it evenly.

(3) Use Webster's erythrocyte sedimentation tube to draw blood to the scale of "0", and there should be no bubbles in the tube.

(4) Fix the ESR tube vertically on the ESR frame, and read the number of millimeters of ESR after 1h, which is the ESR rate.

5.6 Vestergren method: male 0 ~15 mm/h.

Female 0 ~ 20mm/h

Pan Shi method (∏aHueHKOB): male 0 ~10 mm/h.

Female 0 ~12mm/h

Culter method: male 0 ~ 8 mm/h

Female 0 ~10mm/h

5.7 The clinical significance of the test results (1) increased rapidly:

① Acute infection.

② Local inflammation.

③ Active tuberculosis, peritoneal tuberculosis and renal tuberculosis.

④ Collagen diseases: rheumatic fever, rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis and Behcet's disease.

⑤ Myocardial infarction.

⑥ Chronic nephritis.

⑦ Severe anemia.

August menstrual period and pregnancy.

Pet-name ruby old man.

Attending malignant tumor.

(2) slow down:

① Low fibrinogen.

② polycythemia vera.

③ Spherical polycythemia.

④ Allergic diseases.

⑤ The room temperature is too low or it is left for too long after blood collection.

5.8 Note that the clinical significance of erythrocyte sedimentation rate determination has considerable limitations. The following are the principles for mastering the application of ESR.

(1) ESR test is not used to screen asymptomatic people.

(2) It is selectively used for those who have some clinical symptoms, but the medical history and physical examination are normal.

(3) If the ESR increases rapidly and cannot be explained, it should be repeated several times in a few months. Transient acceleration may be a sign of recessive disease, and careful medical history and physical examination can partly explain the reason for the acceleration.

(4) ESR can be used for the diagnosis, monitoring and follow-up of temporal arteritis (generally more than 30mm/h, with an average of more than 90mm/h, which will lead to blindness if not treated in time) and rheumatic polymyalgia. Normal ESR can generally rule out temporal arteritis, but if ESR is normal, patients with typical symptoms should still be treated.

(5) It is only helpful to differentiate rheumatoid arthritis.

(6) It may have certain significance for Hodgkin's disease being treated. In untreated patients, 87% of ESR increased rapidly (63% in stage I, 89% in stage II, 9 1% in stage III and 100% in stage IV), with a sensitivity of 87%( 13% false negative) and a specificity of 79%.

5.9 Related diseases