Anticoagulation
Key additive: 3.2%–3.8% Sodium Citrate.
Blood-to-anticoagulant ratio: 4:1 (e.g., fill to "2mL" mark = 1.6mL blood + 0.4mL anticoagulant).
Mechanism: Chelates calcium ions → blocks coagulation cascade → maintains blood liquidity.
Standardized Testing
Specialized dimensions (Ø 2.5mm × 200mm) → Complies with Westergren method (ICSH standard).
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) |
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.
ESR (mm/h) | Clinical Implication |
---|---|
<20 (M) / <30 (F) | Normal |
20–50 | Mild elevation (e.g., chronic inflammation) |
>50 | Significant elevation (active infection/tumor) |
Fill volume deviation:
±10% error → ESR deviation up to 30% (Must fill exactly to the mark!).
Time sensitivity:
Test >4h post-collection → RBC morphology alters → Falsely ↓ESR.
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 |