ESR by the LANDAU Method

Mr. Topesh Patle

AIM: Determination of ESR (Erythrocyte Sedimentation Rate) by the LANDAU Method

Principles

  • The Erythrocyte Sedimentation Rate (ESR) is a non-specific test used to measure the rate at which red blood cells (erythrocytes) settle in a vertical column of anticoagulated blood over a specific period of time, typically one hour.
  • The rate is influenced by various factors, including the plasma protein content, especially fibrinogen and immunoglobulins.
  • The LANDAU method is one of the common techniques to determine the ESR.
  • In this method, blood is drawn into a specialised tube and placed in a vertical position.
  • The rate of erythrocyte sedimentation (the distance the red blood cells fall in the plasma) is measured after one hour.
  • The rate is measured in millimetres per hour (mm/hr).

Methods

The LANDU method is based on Wintrobe’s tube but uses a standardised procedure to enhance accuracy. Here’s how it works:

  • Blood Collection: Blood is drawn using an anticoagulant like sodium citrate.

  • Preparation: The blood is introduced into a specific type of Landau tube, a straight glass tube of uniform diameter.

  • Positioning: The tube is kept in a vertical position, usually at room temperature.

  • Time Measurement: The time taken for the red blood cells to fall is measured in mm over the course of 1 hour. The distance the red blood cells fall within this hour is used to calculate the ESR.

Requirements

  1. Blood sample with anticoagulant (such as sodium citrate or EDTA).

  2. Landu ESR tubes – uniform diameter and marked graduations.

  3. Timer – to monitor the one-hour sedimentation process.

  4. Clear and stable working surface for vertical placement of the tubes.

  5. Incubator (optional) – if temperature control is necessary, though usually, ESR is performed at room temperature.

  6. Microscope – occasionally used for checking the clarity of the plasma layer.

Procedure

  1. Collection of blood: Draw the blood using a sterile technique into a tube containing the anticoagulant.

  2. Mixing: Gently mix the blood sample to prevent clotting.

  3. Filling the tube: Fill the Landau tube with the blood sample up to the marked level.

  4. Positioning the tube: Place the tube vertically, ensuring no disturbances in the environment.

  5. Measurement: After exactly 1 hour, measure the distance the erythrocytes have fallen, using the millimeter markings on the tube.

  6. Recording the result: The distance measured in millimeters (mm) represents the ESR in mm/hr.

Results

The results of the ESR test are recorded as the distance in millimeters that the erythrocytes have fallen after one hour. A higher ESR usually indicates the presence of inflammation or infection, while a low ESR may suggest that there are fewer or no significant inflammatory processes. However, ESR is a non-specific test and can be influenced by many factors, including:

  • Age and sex: ESR may be higher in older adults and females.

  • Pregnancy: ESR is generally higher during pregnancy.

  • Anaemia: People with anaemia tend to have a higher ESR.

Normal ESR values typically range:

  • Men: 0-15 mm/hr

  • Women: 0-20 mm/hr

  • Children: 0-10 mm/hr

Values outside of these ranges may indicate a variety of conditions that need further investigation.

Clinical Significance

The ESR test is widely used to detect and monitor:

  • Inflammation: ESR increases in conditions like rheumatoid arthritis, systemic lupus erythematosus (SLE), and vasculitis.

  • Infection: It can help identify infections like tuberculosis or bacterial endocarditis.

  • Cancer: Certain cancers, especially lymphomas and multiple myeloma, show increased ESR.

  • Anaemia: In some cases of anaemia, particularly in cases of chronic diseases, ESR might be elevated.

  • Chronic kidney disease: ESR can increase in patients with renal disease due to systemic inflammation.

  • Post-surgery or trauma: ESR can remain elevated after surgery, indicating ongoing tissue healing or possible complications.

The ESR is often used in conjunction with other tests to determine the presence and severity of various conditions. Since it is a non-specific test, it should not be used in isolation but as part of a broader diagnostic and monitoring strategy.

Clinical Significance Summary:

  • Increased ESR: Can suggest conditions like infection, inflammation, autoimmune diseases, or malignancies.

  • Decreased ESR: May be seen in conditions like sickle cell anaemia or polycythemia.