• Erythrocyte Sedimentation Rate

    by
    Shashikiran
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    Erythrocyte sedimentation rate (ESR) is a non-specific test for inflammation. It is easy to perform, widely available and inexpensive making it a widely used screening test. It is also used a monitoring tool for response to treatment in conditions in which it is raised (tuberculosis, autoimmune diseases etc).
    Basics:

    The ESR test in performed in the laboratory by placing anticoagulated blood in an upright tube (Westegren's most often). At the end of an hour of this, the rate of the RBC sedimentation is measured.

    ESR

    Normal value:

    ESR values tend to rise with age and are generally higher in women. ESR is also elevated in the black population and those with anemia.

    A rule of thumb for calculating maximum normal ESR in a person is:

    Normal ESR Formula

    Mechanism:

    ESR is determined by the interaction between factors that promote (fibrinogen) and resist (negative charge of RBCs - that repel each other) sedimentation. Normal RBCs settle slowly as they do not form rouleaux or aggragate together. Instead, they gently repel each other due to the negative charge on their surfaces.

    Increased rouleaux formation contributes to high ESR. Rouleaux are stacks of many RBCs that become heavier and sediment faster. Plasma proteins, especially fibrinogen, adhere to the red cell membranes and neutralize the surface negative charges, promoting cell adherence and rouleaux formation.

    Rouleaux formation

    The aggregated RBCs in the rouleaux formation have a higher ratio of 'mass to surface area' as compared to single RBCs and hence sink faster in plasma.

    ESR of more than 100 mm/hr is strongly associated with serious underlying disorders like connective tissue disease, infections and malignancies.

    Some conditions with very high (>100 mm/hr) ESR:
    1. Multiple myeloma
    2. Connective tissue disorders - SLE, RA and other autoimmune diseases
    3. Tuberculosis
    4. Malignancies
    5. Severe anemia
    Some conditions with low ESR:
    1. Polycythemia
    2. Severe Leukocytosis
    3. Sickle cell disease (anemia)
    4. Hereditary spherocytosis
    5. Congestive cardiac failure
    6. Corticosteroid use
    7. Hypofibrinogenemia
    Note that sickle cell anemia and spherocytosis have low ESR unlike other anemias. This is due to reduced rouleaux formation owing to the abnormally shaped RBCs in this condition.

    IMPORTANT

    Erythrocyte sedimentation rate is a non-specific test and is not diagnostic of any particular disease. It has a high sensitivity but low specificity. Never base a diagnosis solely on an ESR value, either normal or high. Interpretation of the result should always be along with the patient's clinical history, examination findings and results of other tests done.

    If high ESR is encountered without any obvious reasons, patient should be reassured and the test repeated after a reasonable amount of time (a couple of months). There is no need to extensively search for an occult disease without repeating it again.


    This article was originally published in forum thread: Erythrocyte Sedimentation Rate started by Openman View original post
    Comments 139 Comments
    1. suganthi's Avatar
      im studuying for nursing..so can i know more about esr..thank u.
    1. maggie11's Avatar
      I have dreaful pains in my shouler joints / muscles, arms, elbows and wrists. My ESR is 11. What can be causing all this pain and stiffness when my ESR is fine? I am a 51yr old female.
    1. 38tw's Avatar
      Been being tested for lots of things lately~ Ruemy and Dr leaning towards SLE .. but ESR is at 15 Im 38 female and have symptoms that range between extreme fatigue and joint pain.. is 15 normal?
    1. darrel.ludowyke's Avatar
      my son who is 12+ has and esr of 32 and c-reative prot of 15. Should this be a cause to worry?
    1. jasmine's Avatar
      dear sir,
      i'm a 16 yr old nephrotic syndrome sufferer(male) with the ESR=98,are there any correlation?what's the possible cause of this high ESR?thank's for explanation.
    1. saqi_khan's Avatar
      my mother is 38 years old and her ESR level is 31 mm/hr ! and having sever pain in bones .what could b the problem??
    1. ASHISH's Avatar
      Dr., My father is of age 55. he is having swallon in one leg on lower side.We suspect it as Urik acid. But it increased and also get some swallon in second leg. We checked and found that ESR level is 80mm. Request you to please advice what we should do. What precautions we can take. Also my father is having diabities from many years with high blood pressure some time. Please respond as soon as possible.
    1. shah's Avatar
      I am 73 yr old female, my serum C reactive protein level is 23mg/L and ESR is 41 mm/h. Left side of my face hurts when I eat - I have more pain in my shoulders recently. I do suffer from arthritis, previous reading (1yr) CRP was 5 and EPR 12. I would appreciate your response.
    1. unknown's Avatar
      im 23 yr man and my ESR is 24mm/hr is it normal or do i need any short of treatment???
    1. effie's Avatar
      I am 34 years old and my ESR is 33..what does that mean? thanks!
    1. John Richard's Avatar
      I am 69 years old, reasonably fit but have an ESR of 36. My teeth have deteriorated in the last six months and now need extensive replacement and surgery. Do you think that the inflammation involved in this condition would raise my ESR to 36?
    1. arrows98's Avatar
      Just got my lab report but have not seen the Dr yet. My ESC is 74 (High) Creatinie Ration 29 (High). I am 62 years old. Could this be a serious problem?
    1. ms rachel's Avatar
      i have done my ESR test and the result is 90mm/hr. i have fever, flu n cough for 3 weeks. do anything wrong with it?
    1. ms rachel's Avatar
      i'm am 21 years old lady.
    1. Poison's Avatar
      Poison - Hi, I am a 32 year old female. I recently started getting recurrent uti's. I was just in hospital for a int. urethrotomy and ct of the kidney, not currently have an infection. the ct scan picked up kidney stones (small). My blood test showed a Erythrocyte rate of 147, is this normal or what can be the cause of this?
    1. Ely's Avatar
      Hello, I just turned 49 and for the last 24 days have been very sick with cold/flu like symptoms. This week I got very sick with a continuous cough, my blood pressure dropped and while my hands and feet were ice cold I felt my face burning up. One doctor thinks I may have a sinus infection while my general doctor says he doesn't know but is concerned because my SED rate is 36. Does that sound consistent with a sinus infection? Just started antibiotics last night but had a very bad night coughing. None of the prescriptions medications seemed to stop it. Thank you SO much for any thoughts you may have on this. I am sick and tired of being sick and tired. ;-)
    1. NehaS's Avatar
      Hiya I have just been told that from a blood test the result is an ESR of 33mm/hr and it quotes HCT: 0.487 - what does this? Thanks a lot for any guidance. Thanks Neha
    1. suman's Avatar
      what is wintrobe method how is it different from westegren method,why we have to check for first hour and second hour?what is its significance.i am a second year medical student so just curious to know?
    1. lori's Avatar
      I have the opposite issue. I'm 43 year old female and my ESR is 1. I have a CRP of <5 and plenty of other sypmtoms. My doctor has not been able to figure out what is wrong. Thought everything from chronic fatigue to carcinoid tumors. Are these figures at all telling. He seems to think not.
      Thank you in advance.
    1. mireles715's Avatar
      my son esr is 3 yrs old with an esr of 10, his cbc is normal, but his tibc are (iron @ 28 and iron sat @ 7%), he hardly wants to eat with dark circles under eyes and every once an awhile run a fever without any infections.
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