erythrocyte sedimentation rate (ESR)

Introduction

Westergren:

Reference interval

• male: 0-15 mm/hr, age < 50 years
• female: 0-20 mm/hr, age < 50 years
• male: 0-20 mm/hr, age > 50 years
• female: 0-30 mm/hr, age > 50 years

Men: < age/2, women: < (age + 10)/2

Corrected ESR for anemia: ESR - [A - Hct] x 1.75

A is 45 for males, 42 for females

Clinical significance

The ESR correlates with the fibrinogen plus immunoglobulin level & depends upon rouleaux formation of erythrocytes. Poikilocytosis tends to inhibit sedimentation; obstructive liver disease which tends to flatten erythrocytes enhances sedimentation.

The ESR should not be used to screen asymptomatic patients for disease. The ESR is often normal in patients with neoplasms, infection, & connective tissue disease.

ESR is useful & is indicated for the diagnosis & monitoring of temporal arteritis & polymyalgia rheumatica. Values in excess of90 mm/hr are observed with these disorders. The ESR is of little diagnostic value in rheumatoid arthritis, but may be useful in monitoring disease activity when the clinical findings are equivocal.

The zeta sedimentation ratio (ZSR) is not affected by anemia, whereas the Westergren method is affected.

Do NOT use Wintrope sedimentation rate. Plateau effect at a value of about 55.

Also see C-reactive protein in serum/plasma

Increases

• rheumatic diseases
  • rheumatoid arthritis
  • systemic lupus erythematosus
  • acute rheumatic fever
  • vasculitis
  • cryoglobulinemia
  • polyarteritis nodosa
  • polymyalgia rheumatica
  • temporal arteritis
  • Sjogren's syndrome
  • spondyloarthropathies
  • inflammatory bowel disease
  • septic arthritis
  • gout
  • pseudogout
• malignancies
  • multiple myeloma
  • hypernephroma
  • malignant lymphoma
  • bronchogenic carcinoma
  • metastases (colon cancer, breast cancer)
• infections
  • tuberculosis
  • active hepatitis
  • pelvic inflammatory disease
  • pneumonia
  • subacute bacterial endocarditis
  • osteomyelitis
  • meningococcemia
• other
  • acute myocardial infarction
  • postoperative
  • ruptured ectopic pregnancy
  • menstruation
  • 3rd trimester of pregnancy
  • tissue trauma or necrosis
  • hyperthyroidism, hypothyroidism
  • acute hemorrhage
  • arsenic poisoning, lead poisoning
  • pharmaceuticals
    • dextran/heparin/polyvinyl chloride, fat emulsions, hepatitis B vaccine, oral contraceptives, vitamin A
  • diabetic nephropathy
  • glomerulonephritis with azotemia
  • hypoalbuminemia
  • macrocytic anemia
  • hypercholesterolemia
  • obesity
  • normal aging*
  • elevated ambient temperature performing ESR testing

* upper limit of reference interval = (age + 10)/2

Decreases

• hyperviscosity
• extreme leukocytosis
• trichinosis
• other
  • polycythemia
  • hyperviscosity
  • abnormal red blood cell shape
    • sickle cell, microcytosis, spherocytosis
  • congestive heart failure
  • hypofibrinogenemia
  • bile salts
  • cachexia
  • pharmaceuticals:
    • corticosteroids, cyclophosphamide, corticotropin
  • clotted blood
  • 2 hour delay in processing
  • chemical interferences
    • fluoride, glucose, oxalate, quinine

Specimen

• Whole blood (citrate). Stable for 2 h at 25 C, 12h at 4 C.

Notes

ESR generally normal with:

• rheumatic diseases
  • osteoarthritis
  • chondrocalcinosis
• most malignancies
• infections
  • typhoid fever
  • undulant fever
  • infectious mononucleosis
  • uncomplicated viral infection
  • acute appendicitis (1st 24 hours)
• other
  • angina
  • peptic ulcer disease
  • acute allergic reaction
  • unruptured ectopic pregnancy

More general terms

• clinical hematology test

Additional terms

• C-reactive protein (CRP) in serum/plasma

Component of

• inflammatory markers (iAGE)
• connective tissue disease panel; collagen disease panel; SLE panel
• arthritis panel
• anemia panel

Patient information

erythrocyte sedimentation rate (ESR) patient information