Settling of red blood cells

Settling of red blood cells - speed spontaneous erythrocyte sedimentation in protected from clotting. The widely used term "sed rate" (ROE) inaccurate because there is no reaction. In the current blood erythrocytes, carrying a negative electric charge, repel, which hinders their bonding. Out of the blood vessels, such as in vitro, erythrocytes into force of gravity are beginning to fall, and then are joined in groups (agglomeration), which due to the greater their severity settle more quickly. Agglomeration of red blood cells and, hence, to accelerate the erythrocyte sedimentation helps increase some protein components of plasma (globulins, fibrinogen and mucopolysaccharides). The acceleration of sedimentation is observed in the majority of inflammatory diseases, infections, in the decay of tissue, malignant tumors, collagenoses, nephrosis, etc. For some diseases characterized by the absence of an acceleration of sedimentation at the beginning diseases (typhoid fever, epidemic hepatitis) or deceleration of the erythrocyte sedimentation (heart failure, eritremia).
Settling of red blood cells is rarely self-diagnostic symptom; it is an indicator of the severity of the process, especially for tuberculosis, rheumatism, collagenoses. Settling of red blood cells do not always changing in parallel to other indicators of activity of inflammatory process, for example the acceleration of the erythrocyte sedimentation occurs later than leukocytosis and temperature increase in myocardial infarction, appendicitis, and normal slower them.
Upon detection of normal erythrocyte sedimentation we cannot exclude the disease, which is characterized by its acceleration. Accelerated sedimentation of red blood cells is never healthy.

the Panchenkov's device
The Panchenkov's Device. Installation of the capillary.

Study technique. In the USSR was the most accepted micromethod panchenkova. Graduated per 100 mm capillary panchenkova washed with namasivayam 5% solution of sodium citrate (Doonbeg), trying to enter into it 50 mm of the same solution and blow it on a watch glass or a small tube. After the injection of a finger trying to enter the blood in the same capillary 2 times in 100 mm and blow away in the reagent, mix well and trying to enter in a mix in a capillary to the mark "On" (in skills can be recruited half of the volumes of reagent and blood). Holding the upper end of the capillary finger, paste it into the Panchenkov's device (Fig) strictly vertically. Just after the hour mark results - the height of the column of plasma in millimeters. Norm - 4-10 mm for men, 4-14 mm for women.

Settling of red blood cells - settling of red blood cells at the bottom of the vessel while maintaining blood in nesvertawateisa condition. The blood when standing is divided into two layers. Upper (transparent) - plasma, lower - settled erythrocytes, United in clumps (agglomeration). The division into layers flows at different speeds depending on the state of the body and of changes in the composition of blood.
The reaction mechanism erythrocyte sedimentation (ROE) is complex and not fully understood. The maintenance of red blood cells in suspension due to the presence of electrostatic forces in blood system: same (negative) charged erythrocytes repelled. The importance attached to proteins of blood plasma, the correlation between fibrinogen and globulin (especially gamma globulin), on the one hand, and albumins,on the other. The result is enhanced dissolution cells in various pathological processes this ratio shifted macromolecular proteins, fibrinogen and globulins. Part of them are smaller electric charge than molecules fine albumin, and therefore less intensively repelled from one another. The blood cell, in which a lot of fibrinogen and globulins, easier to stick together and precipitate. Have value and other factors: the level of blood mucopolysaccharides and mukoproteidov, lipoid (value lecithin-cholesterol ratio), bile acids, acid-base balance, blood viscosity, the number of erythrocytes in the study of blood.
The method of setting the reaction erythrocyte sedimentation. Investigation of the sedimentation rate erythrocytapheresis macro - and micro methods. General in addition to the blood of the solution sodium citrate, preventing from clotting.
In the USSR the most common micromethod panchenkova. The Panchenkov's device consists of a tripod, which is installed vertically simultaneously four pipettes (capillary) 1 mm diameter, graded from 0 (top) to 100 (bottom). Moisten the eyedropper to the top 5% solution of sodium citrate, dial up to the mark R (against division 50), then released in a test tube or on a watch glass. Do a shot in the flesh of a finger and the same pipette trying to enter twice blood to the mark (against dividing 0), immediately mixed with a solution of sodium citrate (ratio of blood and solution of sodium citrate 4 : 1) in vitro or in a watch glass. The mixture is trying to enter the eyedropper to 0, put in a tripod and through us look at how many divisions has fallen (settled) erythrocytes (in mm). Norm - from 4 up to 10 mm
Method Westergren from the ulnar vein take 1.6 ml of blood in the syringe, in which pre gaining 0.4 ml of 3.8% solution of sodium citrate. Mix in a Cup and trying to enter into the eyedropper height of 30 cm in diameter 3 mm, the Eyedropper to fill null label and put vertically special tripod. In norm per hour formed a column of plasma 3-7 mm, This method is more accurate, but almost less convenient (drawing blood from a vein).
Fractional investigation of the reaction erythrocyte sedimentation (FREE) (every 15 minutes for 2 hours, followed by drawing a curve) reflects the activity of the pathological process, according to some authors, to a greater degree, than the total number ROHE. In healthy people, the settlement is relatively evenly, and for a number of diseases (tuberculosis, pneumonia) maximum subsidence, as expressed by the bulging curve FREE, noted in the initial moments of reaction curve shifts to the left.
Modified sed rate proposed by A. M. Eminem based on the Appendix to citrate blood various lysates. This way, the values ROHE, allowing to judge which is the competent authority pathologically changed and what is the nature of the pathological process - degenerative or inflammatory.
Sources of error in the formulation and interpretation ROHE. On the erythrocyte sedimentation rate, in addition to the main pathological process, reflected a number of additional factors, medication, physiotherapy treatments and nutrition. Slow O. E. salicylic drugs, calcium, mercury diuretics, quinine, luminal. Accelerate O. E. drugs sulfur, long-term use of sodium bicarbonate (soda), vaccine therapy, serotherapy, blood transfusion. Acceleration ROHE, received on the next day after baths, showers, heliotherapy, massage, no diagnostic value. It is necessary to take into account temperature laboratory premises: fluctuations in 5 degrees already having a marked impact, therefore, not necessary to put a tripod with a pipette about box, heating batteries. Effect on the rate of O. E. negligence in the operation: the remains of alcohol or ether in the needle or syringe; insufficient depth prick of the finger, mixing the blood with a solution of sodium citrate, shaking pipettes etc., Should be taken into account and limit the accuracy of the method - it is ±5%.


Physiological oscillations. Women ROE slightly higher than that of men (3-4 mm). Slight acceleration ROHE observed during menstruation, stronger - at pregnancy. ROHE in newborns slowed (1 to 2 mm), in infancy - 4-8-12 mm in 1 hour. Older people ROHE several accelerates, sometimes up to 20 mm per hour. During the day there are fluctuations in the evening ROHE usually higher. Digestion causes (non-permanent) slight acceleration ROHE.
Clinical value. ROE is a nonspecific reaction of a General nature and as a clinical test plays the same role as the change in temperature of a body or in the number of cells. Acceleration ROHE, depends largely on protein, colloidal shifts can occur for a variety of conditions involving tissue decay or necrosis, inflammation, allergic reactions, immunological changes. Acceleration ROHE in inflammatory processes usually appears later (for a day or more)than the increase in temperature, but is kept for some time at the end of it. Much more diagnostic and prognostic value than a single definition, have re-definition ROHE (in dynamics) for the same patient. Slight acceleration ROHE (especially in a single study) may be marked by fatigue, neurasthenia, ray. ROE is significantly accelerated with severe diseases (tuberculosis, leukemia, persistent septic endocarditis, and others). However, in some cases, should not draw the conclusion about the negative value high numbers ROHE (for example, high ROE accompanied lobar pneumonia, rheumatism in active phase), as the degree of acceleration does not determine the outcome of the disease. More important is the dynamics of numbers ROHE. Indications ROE must be viewed not in isolation but in the context of the General picture of the disease and its dynamics. Normal ROE does not exclude the disease, as it can depend on reaktivnost of the body.
Non-accelerated ROE is characteristic of individual infections, typhoid fever, influenza, hepatitis epidemic. High figures ROHE often marked not in the first hours of clinical manifestations of the disease (for example, in perforating ulcer, acute appendicitis, acute myocardial infarction and other). Diagnostic importance and deceleration of the erythrocyte sedimentation (1-3 mm), which is observed in polycythemia, circulatory failure, emphysema, some allergic States, in exicosis in infants. Not found a direct relationship between temperature increases, changes in the white blood cells and the degree of acceleration ROHE. These indicators reflect different sides of the pathological process and complement each other. Parallelism is celebrated between accelerated ROHE and toxic fraction of neutrophils. In severe emerging diseases preference should be given to the temperature measurement and research of white blood as ROHE not immediately respond to a pathological process. Settling of red blood cells, characterized by stability, becoming no at first, and later-stage disease, and chronic diseases.
The sed rate at separate diseases. Typical changes ROHE, have practical value, observed in tuberculosis, rheumatism, heart attack, cancer, malaria, and other infections, purulent processes. Pulmonary TB is the degree of acceleration ROHE depends on the severity of anatomical process, availability of the collapse, the degree of activity of the process and its compensation. ROHE tuberculosis has prognostic value (in high numbers, the prognosis is poor), and to monitor the effectiveness of treatment. When non-tuberculous pneumonia and pleurisy acceleration ROHE usually disappears faster th is more correct, cyclical in nature. ROHE natural and abruptly increases with such acute infections, like erysipelas, scarlet fever. When typhoid fever ROHE lags for the first week of the disease, reaching a maximum in the third week. In malaria ROHE accelerated in the acute stage, after the attack comes the relative deceleration. Significant acceleration ROHE observed in syphilis. In the active phase of rheumatoid arthritis, especially in articular forms, ROE sharply accelerated. Faltering forms of rheumatic heart disease in decompensated heart disease may not be accompanied by acceleration ROHE. Speedy ROHE celebrated in systemic lupus erythematosus (up to 60-80 mm in 1 hour), rheumatoid (non-infectious) polyarthritis, to a lesser extent in arthritis different etiology, particularly the exchange. With high numbers ROHE flow protracted septic endocarditis, myeloma, principally, uremic state, leukaemia, anaemia. Important diagnostic value has accelerated ROHE in myocardial infarction, which appears on the 2-4th day of illness, as well as in malignant tumors, diabetes. The sharp acceleration ROHE observed in acute meningitis, encephalitis. In surgical practice high figures ROHE observed when introducing infection after surgical interventions, suppurative lung disease, destructive forms of acute cholecystitis. Cm. also the Blood (research methods).