Westergren pipette and wintrobe tube difference
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Westergren pipette vs Wintrobe tube ESR differences comparison
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Westergren Pipette vs. Wintrobe Tube - Full Comparison
Both are used to measure ESR (Erythrocyte Sedimentation Rate), but they differ significantly in design, technique, and clinical utility.
1. Physical Dimensions
| Feature | Westergren Pipette | Wintrobe Tube |
|---|---|---|
| Length | 300 mm (30 cm) | 110 mm (11 cm) |
| Internal diameter | 2.55 mm | 2.5-3 mm |
| Calibration | 0 to 200 mm, top to bottom | 0 to 100 mm, bottom to top (ascending) AND top to bottom (descending) |
| Ends | Open at both ends | Closed at one end (bottom) |
| Volume | ~1 mL | ~1 mL |
2. Anticoagulant and Blood Preparation
| Feature | Westergren Pipette | Wintrobe Tube |
|---|---|---|
| Anticoagulant | Sodium citrate (0.105 M) | EDTA (from standard CBC tube) |
| Dilution | Blood is diluted - 2 mL blood + 0.5 mL sodium citrate (4:1 ratio) | Undiluted blood |
| Blood volume needed | 2.5 mL (2 mL + 0.5 mL citrate) | 1 mL |
In the modified Westergren method (now widely used), EDTA-anticoagulated blood is used with 0.5 mL of 3.8% sodium citrate or 0.85% saline diluent - making it compatible with routine CBC tubes.
3. Technique
| Step | Westergren | Wintrobe |
|---|---|---|
| Filling | Pipette filled to the 0 mark at top (suction or pressure method) | Tube filled from bottom up using a Pasteur pipette to 0 mark at top |
| Position | Strictly vertical in Westergren rack | Strictly vertical in Wintrobe rack |
| Reading time | 60 minutes | 60 minutes |
| Reading | Distance (mm) from 0 mark to top of RBC column | Distance (mm) RBCs have fallen from the top |
4. Key Differences Summary
| Parameter | Westergren | Wintrobe |
|---|---|---|
| ICSH recommendation | YES - recommended as reference method | Not recommended as reference |
| Sensitivity for high ESR | Better - can detect ESR up to 200 mm/hr | Limited to 100 mm/hr maximum |
| Dual purpose | ESR only | Can also measure PCV (hematocrit) after centrifugation |
| Sensitivity for anemia | Corrects by dilution; less affected | More affected by anemia (no dilution) |
| Normal range (men <50 yr) | Up to 15 mm/hr | Up to 9 mm/hr |
| Normal range (women <50 yr) | Up to 20 mm/hr | Up to 20 mm/hr |
| Anticoagulant effect | Citrate does not alter ESR | EDTA does not alter ESR |
| Heparin | Cannot be used (alters zeta potential and increases ESR) | Cannot be used |
5. Advantages and Disadvantages
Westergren:
- Advantages: More sensitive for high ESR values; ICSH reference method; dilution reduces hematocrit effect; widely validated
- Disadvantages: Requires blood dilution with citrate (unless using modified method); longer tube is more fragile; separate blood collection traditionally needed
Wintrobe:
- Advantages: Uses undiluted blood; dual-purpose (ESR + PCV); smaller tube; easier to handle; uses standard EDTA blood from CBC
- Disadvantages: Cannot detect ESR >100 mm/hr (tube too short); undiluted blood means anemia-related false elevations are more common; no longer recommended as reference method; results tend to be slightly lower than Westergren values
6. Sources of Error (Common to Both)
- Tilting the tube by even 3 degrees can increase ESR by up to 30%
- Temperature must be 20-25°C
- Test must be performed within 2 hours (or 12 hours if refrigerated at 4°C with EDTA)
- Air bubbles in the tube affect results
- Hemolysis modifies sedimentation
Reference Values (Westergren Method)
| Group | Upper Normal Limit |
|---|---|
| Men <50 years | 15 mm/hr |
| Women <50 years | 20 mm/hr |
| Men >50 years | 20 mm/hr |
| Women >50 years | 30 mm/hr |
| Above 85 years | 30-42 mm/hr |
(Source: Henry's Clinical Diagnosis and Management by Laboratory Methods)
Bottom line: The Westergren method is the internationally recommended (ICSH) reference standard for ESR measurement. The Wintrobe tube is older, dual-purpose (also measures PCV), but is limited by its shorter length and inability to detect ESR beyond 100 mm/hr, making it inadequate when ESR is markedly elevated.
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