• Erythrocyte Sedimentation Rate

    by
    Shashikiran
         Number of Views: 63190  
    139 Comments Comments
    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. C Sanw's Avatar
      Dear Sir,

      My CBC report says SNS mm/hr in front of Erythrocyte Sedimentation Rate ? What does it mean ?
    1. Unregisted user's Avatar
      36 year old white female see rate of 29 with sudden hearing loss to my right ear frequent and severe miagraines and muscle aches is this normal? ???
    1. JAB's Avatar
      My sed rate is 108, but I have Chrons...taking Remicade...but I am concerned that my rbc,wbc,hgb,hct are low,and mcv,mch,rdw, and now my monocyte are high. I am 59 and I am concerned that something else may be going on. I have had cancer twice...so I am a little paranoid.
    1. HELLO's Avatar
      hi i had tb when i was young, recently i got esr checked which is 35 now, but my doctor says that i am fine, but these days i am loosing a little weight, is everything ok or i have any disease..
    1. VVN's Avatar
      Hi .. I am 32 yers Male and my Erythrocyte sedimentation rate (ESR) rate is 106. I am not loosing any weight and no cough. Rest every thing in the blood test is very normal. I have given for CBP. No idea what is going wrong in me. Any help would be appreciated.
    1. Mahmoud's Avatar
      sir,i am 20yrs old my ESR is 44 for 1st hr and 88 for the second i have ahydronefrosis is there arelation betwwen the two findings
    1. sadia's Avatar
      sit i m 35 years female nd haveing problem of cervical spondylosis, my ESR is 28mm is it normal or how should i interpret that

      sadia
    1. satya swarup dash's Avatar
      sir, my mother is about 50 year old and her E..S.R is 62 and she feeling like symptoms vomiting ,nausea highly unconscious during vomiting so plz suggest
    1. Very Sick Undiagnosed's Avatar
      Sed rate at 117 to 140. C -Reactive Protein high. One year later, doctors have no diagnosis. We expect medical science to know everything about everything. That's not the way it is. Still very sick.
    1. Lacy's Avatar
      I recently saw my PCP for severe pains in my legs, my lower back, and my arms. I am a 28 yeard old female. They are all sporatic, and can have no pain for 5 days and it comes and goes. I am in a lot of pain. When I saw my PCP about 5 weeks ago my SED rate was 32, and I just went to see a Rheumatologist and my SED rate is now 34. He ran more tests and I am supposed to have those back in 7-10 days. I am nervous! My mother was just recently diagnosed with Sjogrens disease. HELP!
    1. Judy's Avatar
      My ESR is 46. I am currently taking 20 mg. of Lipitor. Is this a dangerous level of ESR? Could this be
      a result of the statin?
    1. Empressofq's Avatar
      Dear Sir,
      I am a 49 yr. old female with Chronic pain longer than 6 years. DX'ed with Severe Fibromyalgia, DDD, DJD, carpal tunnel, hypothyroidism, HBP, Menopause, FCH and 1 Rheum. DX'ed Possible Lupus SLE and prescribed Plaquenil (I have been on it for about 2 years). ANA was positive & 1:80, and nucleolar pattern. Several joint surgeries over last 5 years and had to have a heart ablation due to heart rate exceding 200 more than once. Was diagnosed SVT. Severe joint pain all over and aching. Have had symptoms of Raynaud's Syndrome but in warm weather also. I have been on a Fentanyl Patch for almost 4 years (after weeks of trying other things. 1st stage kidney disease but stable (always have a little protein and blood in my urine). Have had multiple kidney stones, gallstones (gallbladder removed with 15 stones), colon polyps, benign breast tumor, ovarian cysts, multiple thyroid nodules and breast fibroids. All of this started 6 years ago after I fell and damaged my knees. Sed rate and c-reactive protein are always elevated. New tests revealed ANA and RA negative. Low levels of protein and blood in urine. High Sed rate by mod. Westergren of 25, Vit. D low@25, C-Reactive Prot.High @1.20, uric acid high @8.0. Sorry so long but necessary for you to see the whole picture. Do you see all of this pointing towards another diagnosis other than Lupus?
    1. saleema's Avatar
      hello please I want to know if patient got high ESR due to infection when we expect it to decrease after treatment as I know CRP short half life so rapidly decrease with tretment what about ESR?
    1. rajtheja's Avatar
      why is esr low in polycythemia....as there are many cells it must be increased but why is it lower..?
      and in anemia why is it high anemia is lowering of hemoglobin concentration..rbc number is same physiology is normal...but why is esr increased...?
    1. sineesh's Avatar
      am a 17 aged indian boy,am having continous cold for last weeks,so am nw not able to attend my 11th biology class.when by the advise of my doctor i tested my blood,it is having a ESR count of 10,is it any prblm with this count?
    1. Worried dad's Avatar
      I have a 3 year old boy who was born with bi-lateral club feet and at his last check up his feet were good but they were concerned with what looked like calcification on the lower portion of both his femurs. Many test were run and his esr is 22 and c-reactive protien is 0.5. Thoughts?
    1. redcajun's Avatar
      My ESR is 30 and I am a 48 year old female is there cause for concern? Very Worried, anyone has any information about this.

      Thanks,
      K
    1. brad's momma's Avatar
      i am 23 years old and have a sed rate of 41. I have no idea what i may have. i got a bone condition called osteochondroma and recently had a bad fever for 5 days and i can bearly walk it really affected my legs. seemed weird but i figured i just had the flu or something.
    1. TY2000's Avatar
      Hello,

      My SED rate has been steadily increasing for months now; it is now up to 88 mm/hr. My globulin is also high (4.4 gm/dL) while my Rheumatoid Factor is low (<10). I have low-grade fevers nearly every day and live in a constant state of moderate to severe discomfort. My grandmother has autoimmune liver disease; however, my doctors seem unconcerned about this fact. I am 32 years old. Can you provide some advice on ways to at least make myself more comfortable?

      Thank you.
    1. Rati's Avatar
      I am 41 year old female. My ESR is 62. My Haemoglobin is 13.6, Platlet count is 254. I have sometimes numbness in my left arm and left leg. Please advise the kind of care and treatment that I should undertake.
    Page 4 of 7 FirstFirst ... 2 3 4 5 6 ... LastLast
    Comments Leave Comment

    Click here to log in; if you want to get a notification about replies, please register.

© 2007 - 2012 MEDiscuss: User Driven Healthcare and Education.
Powered by vBulletin® | vB4 skin by CompleteVB | Search Engine Optimization by vBSEO
The information provided on MEDiscuss is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician