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    A Comparitive Study of Esr by Modified Westergren Method and Vesmatic Cube 30 TM

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    Arindam Mondal
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    A Comparitive Study of Esr by Modified Westergren Method and Vesmatic Cube 30 TM

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    Arindam Mondal
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    articlr

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    61 views2 pages

    A Comparitive Study of Esr by Modified Westergren Method and Vesmatic Cube 30 TM

    Uploaded by

    Arindam Mondal
    articlr

    Copyright:

    © All Rights Reserved
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    wjpmr, 2017,3(9), 343-344 SJIF Impact Factor: 4.

    103
    Research Article
    WORLD JOURNAL OF PHARMACEUTICAL
    Mahato et al. World Journal
    AND MEDICAL RESEARCH of Pharmaceutical and Medical ISSN 2455-3301
    Research
    www.wjpmr.com WJPMR

    A COMPARITIVE STUDY OF ESR BY MODIFIED WESTERGREN METHOD AND


    VESMATIC CUBE 30 TM

    Dr. Malabika Mahato*1 and Dr. P. Karkuzhali2


    1
    Post Graduate, Department of Pathology, Sree Balaji Medical College, Chennai, Tamilnadu.
    2
    Professor & HOD Department of Pathology, Sree Balaji Medical College, Chennai, Tamilnadu.

    *Corresponding Author: Dr. Malabika Mahato


    Post Graduate, Department of Pathology, Sree Balaji Medical College, Chennai, Tamilnadu.

    Article Received on 16/08/2017 Article Revised on 07/09/2017 Article Accepted on 28/09/2017

    ABSTRACT
    Aims: The aim of study is to compare the ESR values by VesMATIC cube30™ against the modified Westergren
    method. Materials and Methods: This is a cross-sectional study conducted at pathology laboratory in SBMCH,
    Chrompet. The samples taken were as per the recommendations charted out by International Council for
    Standardization in Hematology (ICSH) for comparing automated and modified Westergren method. Results and
    Conclusions: The analysis revealed a low degree of agreement between the manual and automated method. Over
    all whole ESR data analysis shows, mean difference 1.2±3.032 (95% limits agreement,-4.742 to 7.142) for 1 hour.
    The fully automated system VesMATIC cube30™ for ESR measurement and manual ESR readings are very close
    and also satisfying the 95% agreement limit. Hence, both methods can be used, but automated erythorocyte
    sedimentation rate analyzer improve work flow, turnover time and laboratory safety by minimizing contact with
    blood samples. So it is preferable to use automated method.

    KEYWORDS: erythrocyte sedimentation rate, VesMATIC cube30™, Westergren method.

    INTRODUCTION complete blood counts can also be used for ESR analysis
    by this automated machine.
    Erythrocyte sedimentation rate (ESR) is used as a
    parameter for prognostication and even diagnosis of
    MATERIALS AND METHODS
    certain clinical conditions. It is still widely used in
    clinical practice as an indicator of inflammation, It was a cross-sectional study done on routine hemogram
    infection, trauma, or malignant disease. Apart from samples over a period of one week at SBMCH. A venous
    complete blood counts (CBC) and peripheral smear, ESR blood sample was obtained from 100 random patients
    is often preferred by clinicians in the requisition forms in who had a requisition form, marked for ESR; arriving at
    almost all laboratories. The most satisfactory method of the sample collection centre. All the samples were
    performing the test was introduced by Westergren in evaluated using the 2 methods in our clinical laboratory
    1921. The original method recommended by as per the methodology for each of the individual
    International Council for Standardization in Hematology methods. All the ESR tests were carried out within 3
    (ICSH) is based on that of Fahraeus and Westergren. hours from the time of collection.
    Subsequently, modifications of this reference method
    were made and ICSH guidelines now allow for the use of Inclusion Criteria
    alternative ESR techniques provided that comparability Patients from both sexes and all age groups were
    with the Westergren method is achieved. included in the study.

    Over the last few years, newer and safer methods have Exclusion Criteria
    evolved to determine ESR accurately without added Blood collected by venipuncture taking more than 30
    risks. The VesMatic cube30™ analyzer is a new seconds and with excessive venous stasis were excluded
    automated instrument for measuring ESR. The advantage from the study. Blood samples which were not in proper
    conferred by this automated method is that it can proportions to the anticoagulant, strongly lipemic,
    generate the ESR readings in 30 minutes of 30 patients hyperbilirubinemic and hemolyzed samples were also
    with all the temperature corrections at 18°C. excluded.
    Additionally, the same EDTA sample collected for

    www.wjpmr.com 343
    Mahato et al. World Journal of Pharmaceutical and Medical Research

    Samples Bland &Altman analysis of whole samples ESR data


    Under all aseptic precautions, samples were collected values {95% limit of agreement [Mean+/-1.96 x SD]-
    from the antecubital vein using a 10-ml syringe with 24G (-4.472 to 7.142)}
    needle. Four milliliter of blood sample was drawn in the
    two special 2-ml EDTA vacutainers containing 1.5 The results obtained with the reference method were
    mg/ml of EDTA and mixed immediately five times. plotted against the difference between the reference and
    the automated method for 1 hour values. The mean
    Conventional Westergren Method difference between the two methods and 95% limits of
    In this method, a disposable, plastic tube with a bore size agreement at 1 hour for whole data was found to be
    of 2.55 mm and a length of 230 mm, vertically aligned, 1.2±3.032 (95% limits of agreement,–4.742 to 7.142).
    open at both ends was used. The pipette was filled with
    K3 EDTA anticoagulated venous blood to a height of at DISCUSSION
    least 200 mm. The sedimentation occurring at 60 minutes The results obtained with the Vesmatic cube30™
    from the beginning of the test was noted in mm/hour analyzer were compared with the modified Westergren
    equivalent to the Westergren ESR. method using the agreement analysis of Bland and
    Altman. Agreement analysis is a more sensitive method
    VesMatic cube30™ instrument than the correlation coefficient for comparison between
    The vesMatic cube 30 is a benchtop analyzer designed & the two methods. Over all whole ESR data analysis
    programmed to determine the sedimentation rate one shows, mean difference 1.2±3.02 (95% limits agreement,
    hour on primary EDTA tubes. The loading samples per ˗4.742 to 7.142) for 1 hour. The use of Bland and Altman
    set of tubes 1 to 30 is carried out manually in a specific analysis for evaluating the agreement between the two
    rack. The stirred vesMatic cube samples and a first methods, not only assesses the mean of the difference (d)
    optical measurement of the level of blood through the between the two methods (i.e., bias) but also the limits of
    labels is carried out. 15min latter a second measurement agreement by calculating the standard deviation of the
    time evaluates the level of sedimentation. 3 matrices differences (d ± 1.96SD). Only when the difference (d ±
    calculations interprets 2 readings is then extrapolated to 1.96SD) does not affect the clinical interpretation, the
    1 hr & finally adjusted to the temperatures at which the two methods can be used interchangeably.
    analysis was performed. Then the results get printed out.
    CONCLUSIONS
    Statistical Analysis
    The fully automated system Vesmatic cube30™ for ESR
    Evaluation of method was done as described by Bland
    measurement and modified westergren ESR readings are
    and Altman. Modified Westergren method was
    very close and also satisfying the 95% agreement limit.
    considered as the reference method. Therefore mean
    So both methods can be used. But automated
    value for ESR with both the methods is plotted against
    erythorocyte sedimentation rate analyzer improve work
    the difference between the Westergren and the
    flow, turnover time and laboratory safety by minimizing
    VesMATIC cube30™. The 95% limits of agreement
    contact with blood samples. Hence, it is preferable to use
    were calculated as d ± 1.96 SD where d = mean
    automated analyzation.
    difference between the two measurements; and SD =
    standard deviation of differences.
    REFERENCES
    RESULTS 1. Westergren A. Studies of the suspension stability of
    the blood in pulmonary tuberculosis. Acta Med
    Sample statistics
    Scand, 1921; 54: 247-282.
    95% Limit of 2. Fahraeus R. The suspension stability of blood. Acta
    No. of
    BIAS SD Agreement Med Scand, 1921; 55: 1-228.
    Sample
    From To 3. International council for Standardization in
    100 1.2 3.032 -4.742 7.142 hematology. ICSH recommendation for
    measurement of ESR. J ClinPathol, 1993; 46: 198-
    203.
    4. Arikan S, Akalin N. Comparison of the erythrocyte
    sedimentation rate measured by the Micro Test 1
    sedimentation analyzer and the conventional
    Westergren’s method. Ann Saudi Med, 2007; 27:
    362-5.
    5. Plebani M, Piva E. Erythrocyte sedimentation rate:
    Use of fresh blood for quality control. Am J Clin
    Pathol, 2002; 117: 621- 6
    6. User manual. Monitor 100. Forli, Italy: Electra Lab
    s.r., 2005; 1.

    www.wjpmr.com 344

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