• Erythrocyte Sedimentation Rate

    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.

    Westergren's tubes testing 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:



    At birth, the ESR is generally low, 1-2 mm/hr, rising to up to 20 mm/hr by puberty.

    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.



    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 148 Comments
    1. Unregistered's Avatar
      Unregistered -
      I am 48yrs.old and my sed rate was 15- Does this indicate inflammation or infection somewhere in my body?
    1. Shashikiran's Avatar
      Shashikiran -
      For a 48 year-old person, up to 24mm/Hr (if male, or 29mm/Hr if female) ESR is considered normal. If you have an ESR of 15mm/Hr, it is normal.
    1. eyemamamic@aol.com's Avatar
      eyemamamic@aol.com -
      I am a 52 yr old female with C-reactive protein of 7.5, sed rate of 36. What should I be ruling out?
    1. Lizzykin's Avatar
      Lizzykin -
      My ESR is 27 - I am a 31 (almost 32 year old) African American female. Should I be concerned? It should only be about 22, based on the calculations...
    1. Shashikiran's Avatar
      Shashikiran -
      @eyemamamic: Nothing much really, if just based on the tests. If you have any symptoms, then it may help to know those before I can suggest something. Your CRP is normal (anything less than 10 mg/dl is normal) and ESR is also okay (36 instead of an upper limit of 31 is really fine).

      @Lizzykin: Same as above, nothing really to worry about unless you have some symptoms.

      Please remember that ESR is a non-specific test and without being aware of the symptoms it is not possible to interpret it accurately.
    1. jodesa's Avatar
      jodesa -
      im 21 years old my ERS is 20.can you tell me is this condition a bad one? regards
    1. Shashikiran's Avatar
      Shashikiran -
      @jodesa: ESR of 20 does not have much clinical significance.
    1. Unregistered's Avatar
      Unregistered -
      I am a 31 yr old black female. My ESR value is 29. My test result page says that the normal range is 0-20. Does this result indicate inflammation or infection?
    1. Shashikiran's Avatar
      Shashikiran -
      @31 yr female with ESR 29: Do you have any symptoms (problems)?
    1. Unregistered's Avatar
      Unregistered -
      I am a 22 yr old.My ESR is 46!I am having a burning sensation inside the right side of my chest since 5 days.It become worse when I try to eat or drink,My home physician has suspected Oesophagial Spasm.Will u be kind enough to you help me to diagnose?
    1. Shashikiran's Avatar
      Shashikiran -
      @22 yr with ESR 46: Your family physician seems correct. Additional differential diagnosis include oesophagitis and gastro-oesophageal reflux disease. May be you can request your doctor to consider adding a proton pump inhibitor for a few days and if there is no improvement, plan oesophageal manometry and upper GI endoscopy.
    1. Unregistered's Avatar
      Unregistered -
      I am 33 year old male. I had severe pain in my right big toe finger for 2 days. Doc suggested uric acid level testing and esr. UA level is 6.7 mg/dl and esr is 1mm/hr. What does that indicate?
    1. Shashikiran's Avatar
      Shashikiran -
      Severe pain in the big toe usually raises the suspicion of acute gouty arthritis. While serum uric acid levels and ESR are the first tests done to look for clues (both of which are expected to be elevated, but normal in your case) it is often a clinical diagnosis or based on synovial fluid aspiration from the joint. A normal UA level does not rule out gout. He will treat you with analgesics, preferably with along with colchicine.
    1. Unregistered's Avatar
      Unregistered -
      Quote Originally Posted by Unregistered View Post
      I am a 22 yr old.My ESR is 46!I am having a burning sensation inside the right side of my chest since 5 days.It become worse when I try to eat or drink,My home physician has suspected Oesophagial Spasm.Will u be kind enough to you help me to diagnose?
      Thank u sir.
      Can u suggest me a diet I should follow at this moment.
    1. Shashikiran's Avatar
      Shashikiran -
      This is becoming a bit difficult to handle with many showing as 'Unregistered'
      Just avoid taking spicy food and food with high temperature. Avoiding coffee and tea also helps.
    1. sasankha's Avatar
      sasankha -
      i am having a ESR as 10mm for ist hour
      ESR as 28mm for second hour
      what does this really mean,I am pretty healthy?
      kindly answer sir.
    1. Shashikiran's Avatar
      Shashikiran -
      @sasankha: Yes, your results are normal.
    1. varsha's Avatar
      varsha -
      dear sir
      i am a 24 yr old woman and got my tests done today .. my esr level came out to be 41 .. i am suffering from mild fever since the past 4 days .. is this normal ? everything else was normal .. including the haemoglobin which came as 13.5 .. i would really appriciate your response ..
    1. Shashikiran's Avatar
      Shashikiran -
      @Varsha: ESR of 41 in the presence of fever is expected (due to the inflammation that is causing the fever). It is not very high to suggest any serious causes.

      Even if the cause is viral fever, this ESR is usual. However, if the fever continues beyond 7-8 days, you need to get yourself examined by a physician.
    1. varsha's Avatar
      varsha -
      thanks for your reply sir ..
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