What is the purpose of an ESR test. How is the erythrocyte sedimentation rate measured. What do high ESR levels indicate. When might a doctor order an ESR test. How are ESR results interpreted. What other tests complement the ESR test. How does inflammation affect erythrocyte sedimentation.

What is the Erythrocyte Sedimentation Rate (ESR) Test?

The erythrocyte sedimentation rate (ESR) test, also known as the sed rate test, is a simple blood test used to detect inflammation in the body. This test measures how quickly red blood cells (erythrocytes) settle at the bottom of a test tube over a period of one hour. The rate at which these cells settle can provide valuable information about the presence and extent of inflammation in a patient’s body.

The ESR test is particularly useful as a screening tool and for monitoring the progress of inflammatory conditions. It serves as one piece of the diagnostic puzzle, often used in conjunction with other tests to help doctors identify and manage various health issues.

How does the ESR test work?

During an ESR test, a blood sample is drawn from the patient and placed in a tall, thin tube. The test measures the distance that red blood cells fall in the tube over one hour. In the presence of inflammation, certain proteins in the blood cause red blood cells to stick together and form heavier clumps. These clumps fall faster than individual cells, resulting in a higher sedimentation rate.

The Science Behind Erythrocyte Sedimentation

Understanding the science behind erythrocyte sedimentation helps explain why this test is such a useful indicator of inflammation. In normal conditions, red blood cells tend to repel each other due to their negative surface charges. However, inflammation in the body leads to the production of acute-phase proteins, such as fibrinogen, which can neutralize these charges and cause the cells to stack together like coins (a phenomenon known as rouleaux formation).

These stacks of red blood cells are denser than individual cells and therefore settle more quickly in the test tube. The rate of this settling is what’s measured in the ESR test, providing a indirect measure of the level of inflammatory proteins in the blood.

Factors affecting ESR results

• Age and gender
• Anemia
• Pregnancy
• Obesity
• Certain medications
• Kidney problems
• Thyroid disorders

It’s important to note that these factors can influence ESR results, which is why the test is typically used in conjunction with other diagnostic tools and clinical observations.

When Is an ESR Test Ordered?

Doctors may order an ESR test for various reasons, primarily when they suspect an inflammatory condition. Some common scenarios include:

1. Persistent unexplained symptoms such as fever, weight loss, or fatigue
2. Joint pain or stiffness that could indicate arthritis
3. Symptoms of autoimmune disorders like lupus or vasculitis
4. Monitoring the progress of inflammatory conditions and their response to treatment
5. Screening for hidden infections or certain types of cancer

The ESR test is particularly valuable when combined with patient history, physical examination, and other laboratory tests to form a comprehensive diagnostic approach.

Common symptoms prompting an ESR test

• Persistent headaches
• Muscle and joint pain
• Unexplained weight loss
• Fever of unknown origin
• Generalized fatigue and malaise

The ESR Testing Procedure: What to Expect

The ESR test is a simple and straightforward procedure that requires minimal preparation from the patient. Here’s what you can expect:

1. A healthcare professional will clean an area of your arm with an antiseptic.
2. A tourniquet may be applied to make the vein more visible.
3. A needle will be inserted into your vein to draw a small amount of blood.
4. The blood sample is collected in a tube and sent to the laboratory for analysis.
5. The entire process usually takes less than five minutes.

After the blood draw, you may experience slight bruising or soreness at the injection site, but this typically resolves quickly. Results are usually available within a few hours to a day, depending on the laboratory.

Preparing for an ESR test

No special preparation is required for an ESR test. However, it’s important to inform your healthcare provider about any medications or supplements you’re taking, as some can affect the results. Additionally, if you’re pregnant or menstruating, this information should be shared as it can influence the interpretation of the results.

Interpreting ESR Test Results

ESR results are reported in millimeters per hour (mm/hr), indicating how far the red blood cells have fallen in one hour. Normal ranges can vary based on age and gender:

• For men under 50: 0-15 mm/hr
• For men over 50: 0-20 mm/hr
• For women under 50: 0-20 mm/hr
• For women over 50: 0-30 mm/hr

Higher values suggest the presence of inflammation, but it’s crucial to understand that ESR results alone are not diagnostic. They provide a general indication of inflammation that must be interpreted in the context of other clinical findings and tests.

What do elevated ESR levels indicate?

Elevated ESR levels can be associated with various conditions, including:

• Infections (bacterial, viral, or fungal)
• Autoimmune disorders (rheumatoid arthritis, lupus, vasculitis)
• Inflammatory bowel diseases
• Certain cancers (lymphoma, multiple myeloma)
• Chronic kidney disease
• Thyroid disorders

It’s important to note that while a high ESR suggests inflammation, it doesn’t pinpoint the exact cause or location of the inflammation in the body. Further diagnostic tests are typically required to determine the underlying condition.

ESR vs. Other Inflammation Markers

While the ESR test is a valuable tool for detecting inflammation, it’s often used in conjunction with other tests to provide a more comprehensive picture of a patient’s health. One commonly paired test is the C-reactive protein (CRP) test, another marker of inflammation.

ESR vs. CRP: What’s the difference?

Both ESR and CRP are acute phase reactants, meaning they increase in response to inflammation. However, they differ in several key aspects:

• Speed of change: CRP levels change more rapidly than ESR in response to inflammation or its resolution.
• Specificity: CRP is more specific to acute inflammation, while ESR can reflect both acute and chronic conditions.
• Influencing factors: ESR is affected by more factors (such as age, gender, and anemia) compared to CRP.

Often, doctors will order both tests to get a more complete understanding of the inflammatory process in a patient’s body. The combination of ESR and CRP can provide valuable insights into the nature and duration of inflammation.

Conditions Associated with Abnormal ESR Levels

A wide range of conditions can cause elevated ESR levels. Understanding these associations helps healthcare providers narrow down potential diagnoses and guide further testing. Some common conditions include:

Autoimmune disorders

• Rheumatoid arthritis
• Systemic lupus erythematosus (SLE)
• Polymyalgia rheumatica
• Vasculitis

Infections

• Tuberculosis
• Endocarditis
• Osteomyelitis
• Chronic urinary tract infections

Cancers

• Lymphoma
• Multiple myeloma
• Metastatic solid tumors

It’s important to remember that while an elevated ESR can suggest these conditions, it is not diagnostic on its own. Conversely, a normal ESR doesn’t completely rule out these conditions, especially in their early stages.

Limitations and Considerations of the ESR Test

While the ESR test is a useful tool in detecting inflammation, it has several limitations that healthcare providers must consider when interpreting results:

• Non-specificity: An elevated ESR indicates inflammation but doesn’t identify its cause or location.
• Time lag: ESR levels may not reflect recent changes in a patient’s condition, as they can take time to rise or fall.
• Influencing factors: Various conditions unrelated to inflammation can affect ESR results, potentially leading to false positives or negatives.
• Limited use in acute situations: Due to its slow response, ESR is less useful in acute inflammatory conditions compared to other markers like CRP.

These limitations underscore the importance of using ESR as part of a comprehensive diagnostic approach, rather than relying on it as a standalone test.

When is ESR most useful?

Despite its limitations, the ESR test remains valuable in certain clinical scenarios:

• Monitoring chronic inflammatory conditions over time
• Screening for occult disease in patients with unexplained symptoms
• Assessing disease activity in conditions like polymyalgia rheumatica
• Supporting the diagnosis of temporal arteritis
• Evaluating patients with suspected multiple myeloma

In these situations, ESR can provide valuable information when interpreted alongside other clinical and laboratory findings.

The Future of Inflammation Testing

As medical science advances, new methods for detecting and measuring inflammation are being developed. While the ESR test remains a valuable tool, researchers are exploring more specific and sensitive markers of inflammation.

Emerging biomarkers and technologies

• High-sensitivity CRP (hs-CRP): Offers more precise measurement of low levels of inflammation
• Procalcitonin: Helps distinguish between bacterial and viral infections
• Cytokine profiling: Provides detailed information about the type and extent of inflammatory response
• Proteomics and metabolomics: Offer comprehensive analysis of inflammatory processes at the molecular level

These advancements may eventually complement or even replace traditional tests like ESR in certain clinical situations. However, the simplicity, cost-effectiveness, and long-standing clinical experience with ESR ensure its continued relevance in medical practice for the foreseeable future.

As our understanding of inflammation and its role in various diseases continues to grow, the importance of accurate and timely detection becomes increasingly apparent. The ESR test, with its long history and well-established clinical utility, remains an important tool in this ongoing effort to better diagnose and manage inflammatory conditions.

ESR Test Results High vs. Low

Written by WebMD Editorial Contributors

• Why You Might Get a Sed Rate
• Taking the Blood Sample
• The Results and What They Mean
• Other Tests You May Need

The sedimentation rate — or “sed rate,” for short — is a blood test that checks for inflammation in your body. It’s one clue for your doctor that you might have a disease linked to inflammation, like arthritis or cancer, or an infection.

The sed rate test measures how fast red blood cells fall to the bottom of a tube. Inflammation creates proteins that make red blood cells fall more quickly.

Another name for this test is erythrocyte sedimentation rate (ESR). Red blood cells are called erythrocytes. Sedimentation is the process by which they fall to the bottom of the tube.

Your doctor might order the sed rate test if you have symptoms like these:

• Headaches
• Stiff, swollen, or painful joints
• Pain in your shoulders, neck, or pelvis
• Appetite loss
• Weight loss without trying

The sed rate test can be part of the process of discovering if you have one of these conditions:

• Infection (including of the bones)
• Cancer
• Arteritis (inflammation of the blood vessels)
• Lupus (an autoimmune disease that damages the skin, joints, and other parts of your body)
• Polymyalgia rheumatica (causes stiff and painful muscles)
• Rheumatoid arthritis (autoimmune disease in which the immune system attacks your joints)
• Systematic vasculitis (inflammation in your blood vessels)

You might also get this test once you’ve started treatment for one of these conditions. The sed rate can help your doctor see how well your body is responding to treatment.

You don’t need to do anything special to prepare. It’s just a basic blood test.

Let your doctor know what medicines (and supplements) you take before you have the test. Certain drugs can affect the results. Also let your doctor know if you are pregnant or are having your period.

A nurse or other health care provider will take a sample of your blood, usually from a vein in your arm. They will first tie a band around the upper part of your arm to make your vein fill with blood and swell up. Then they’ll clean the area with an antiseptic, and place a needle into your vein. Your blood will collect into a vial or tube.

The process should only take a couple of minutes. Afterward, you’ll get a piece of gauze and a bandage over the area to stop the bleeding.

You may feel a slight sting as your blood is drawn. Afterward, you may have a small bruise. You might feel dizzy and sore, and there might be some bleeding.

Your sample will go to a lab. You should have the results in 1 or 2 hours.

A lab technician will place your red blood cells into a tall, thin tube and check how far they fall in 1 hour. When you have inflammation in your body, abnormal proteins in your blood make red blood cells form into clumps. These clumps are heavy, so they fall to the bottom of the tube more quickly than single blood cells.

The faster the blood cells sink, the more inflammation you have in your body.

The sed rate test reports in millimeters (mm) the distance between the clear liquid (plasma) at the top of the tube and your red blood cells after 1 hour. The normal range is:

• 0 to 15 mm/hour in men younger than 50
• 0 to 20 mm/hour in men older than 50
• 0 to 20 mm/hour in women younger than 50
• 0 to 30 mm/hour for women older than 50

A high sed rate is a sign you have a disease that causes inflammation in your body.

Some conditions and medicines can affect the speed at which red blood cells fall, and they may affect your test results. These include:

• Anemia
• Older age
• Kidney problems
• Thyroid disease
• Pregnancy or having your period
• Obesity
• Drugs like birth control pills, methyldopa (Aldomet), theophylline (Theo-24, Theolair, Elixophylline), vitamin A, cortisone, and quinine

The sed rate test can only tell your doctor that you have inflammation somewhere in your body. It can’t show where the inflammation is or what caused it. Your doctor may also test for your erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) to help make a diagnosis. Both are acute phase reactants or inflammatory markers which can help point to a diagnosis or help follow treatment in a diagnosis. You will still need imaging or even biopsyies to make a specific diagnosis.

Talk to your doctor about the results of your sed rate test, and any other tests you have. Make sure you understand what the results mean, and how they’ll affect your treatment.

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ESR Blood Test (Erythrocyte Sedimentation Rate)

Test Quick Guide

The erythrocyte sedimentation rate, also known as ESR, is based on how quickly red blood cells (RBCs) settle inside a test tube.

An ESR test is used to assess inflammation in the body. Many conditions can cause an abnormal ESR, so an ESR test is typically used with other tests to diagnose and monitor different diseases.

About the Test

Purpose of the test

The main purpose of an ESR test is to detect abnormal levels of inflammation in the body. Measuring ESR is primarily used for diagnosis and monitoring of different health conditions:

• Diagnosis is the process of finding the cause of a patient’s symptoms. Because many health problems can cause an ESR test to be abnormal, the test alone cannot diagnose conditions. However, when combined with other tests, an ESR test may help detect infections, autoimmune diseases, blood disorders, kidney disease, and many other health problems.
• Monitoring is the process of periodically assessing a patient’s health after a diagnosis. An ESR test may be used periodically to see how inflammatory health conditions change over time. It can also help assess a patient’s response to treatments for certain disorders.

It is important to talk with your health care provider for more details about the specific purpose of ESR testing in your situation.

What does the test measure?

An ESR test measures how fast RBCs, also known as erythrocytes, fall to the bottom of a test tube. The falling of these cells is called sedimentation, which is measured in millimeters per hour (mm/h).

When should I get an erythrocyte sedimentation test?

An ESR test may be appropriate if you have unexplained symptoms like a fever, muscle or joint pain, or other problems without a clear cause. In these situations, an ESR is usually combined with other tests, such as a complete blood count, comprehensive metabolic panel, and arthritis tests, to evaluate your overall health and look for signs of specific health problems.

Your doctor may also recommend an ESR test to help track your health if you have previously been diagnosed or received treatment for infections, autoimmune diseases, or other inflammatory health conditions.

Finding an Erythrocyte Sedimentation Rate Test

How can I get a test?

An ESR test requires a blood sample and is typically conducted at a doctor’s office, urgent care facility, or hospital. The test usually has to be ordered by a health care provider. The person conducting the test will either be a phlebotomist who is trained to draw blood or another health care professional.

You can also order an ESR test online with the blood draw and testing performed by a Clinical Laboratory Improvement Amendments (CLIA) approved lab.

Can I take the test at home?

An ESR test typically cannot be conducted at home. It has to be done by a trained medical professional in a medical setting where the blood can be quickly analyzed after it has been drawn. It is possible to use a mobile phlebotomy service, but there are no self-collection tests available

How much does the test cost?

The price of an ESR test varies based on where you have the test done and whether you have health insurance. The cost of the test may increase if you have other tests performed along with an ESR.

If you want to know more about the cost of the procedure and how much your insurance covers, contact your insurance company. If you do not have any kind of health insurance coverage, you can ask the testing facility about any available financial assistance programs for the uninsured.

Taking an Erythrocyte Sedimentation Test

The ESR test is performed with a sample of blood that is drawn from a vein in your arm. The blood draw process is typically carried out in a medical office, lab testing site, or hospital.

Before the test

There is no special test preparation required for an ESR test. Before the test, make sure to tell your doctor about any drugs or supplements that you take because some medications may affect your results.

During the test

The blood draw for an ESR test usually only takes a few minutes to perform.

The health professional taking your blood sample will start by using an alcohol wipe to clean a small area of your skin near a vein. A needle will then be inserted into the vein, and blood will be drawn into an attached tube. Once enough blood has been drawn, the needle is removed.

There may be some pain, such as a pinch or sting, when the needle pierces the skin and is removed from your arm.

After the test

Most people do not have any negative reactions to an ESR test, but you may have some bruising or tenderness around the puncture site. There are no activity restrictions after the test, but contact your doctor if you notice any signs of infection such as redness, swelling, or persistent pain.

Erythrocyte Sedimentation Rate Test Results

Receiving test results

An ESR test is usually performed within a couple of hours after your blood is drawn, and the RBCs in the test tube are monitored for one hour to determine the ESR.

Once the results are available, you may receive a test report by mail or electronically. Your doctor may also contact you to discuss your ESR test results.

If multiple tests are being performed along with the ESR test, your doctor may wait for all the results to be available before discussing the results with you. This allows them to interpret the test results together.

Interpreting test results

The ESR is reported in millimeters per hour (mm/h) and reflects how quickly the RBCs in your sample fall toward the bottom of a test tube.

There is no universal definition of a normal ESR. Age, sex, and other factors can influence ESR, so there is no reference range for this test that applies to all people.

Instead, the results of testing are interpreted based on an individual’s situation. This includes considering their symptoms and the results of any other tests that have been performed.

If an ESR is abnormally high, it means that the RBCs fell faster than expected. This usually happens when the RBCs have more protein within them, which causes them to stick together.

Many conditions can cause an ESR to become elevated. Most often, an elevated ESR is related to conditions that cause inflammation, but it can also be caused by other health problems. Examples of conditions that can cause an abnormally high ESR include:

• Infections
• Autoimmune conditions like lupus and rheumatoid arthritis
• Anemia
• Kidney or thyroid disease
• Some types of cancer
• Tissue injury or trauma

It is also possible for the ESR to be lower than expected. This may be caused by conditions such as:

• RBC disorders
• Heart failure
• Some liver and kidney problems

It is important to remember that an ESR test alone cannot diagnose any disease or medical condition. It must be used in conjunction with other tests to detect and monitor health problems. An ESR test should always be interpreted by a doctor who can explain its significance.

When going over your test results with the doctor, the following questions can be helpful:

• Did the test detect any abnormalities?
• If so, what kind of abnormal result was detected?
• What is the most likely explanation for my test result?
• What other tests were conducted along with the ESR?
• Do I need any follow-up testing?

• C Reactive Protein (CRP Blood Test)
  Learn More
• CBC Blood Test (Complete Blood Count)
  Learn More
• CMP Blood Test (Comprehensive Metabolic Panel)
  Learn More

Resources

• National Library of Medicine: Autoimmune Disorders
• National Library of Medicine: Blood Disorders
• National Library of Medicine: Immune Response

Sources

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Erythrocyte sedimentation rate (ESR)

Test that evaluates the rate of separation of blood into plasma and erythrocytes. The rate of separation is mainly determined by the degree of their aggregation, i.e., the ability to stick together with each other.

Russian synonyms

Erythrocyte sedimentation test, ROE, ESR.

Synonyms English

Erythrocyte sedimentation rate, Sed rate, Sedimentation rate.

Test method

Capillary photometry method.

Units

mm/h (millimeter per hour).

What biomaterial can be used for research?

Venous, capillary blood.

How to properly prepare for an examination?

• Eliminate alcohol from the diet for 24 hours prior to the study.
• Do not eat for 2-3 hours before the test (you can drink pure non-carbonated water).
• Stop taking medications 24 hours before the study (as agreed with the doctor).
• Exclude physical and emotional overexertion within 30 minutes prior to the study.
• Do not smoke for 30 minutes before the test.

General information about the study

Erythrocyte sedimentation rate (ESR) is an indirect method for detecting an inflammatory, autoimmune or oncological disease. It is performed on a sample of venous or capillary blood, which has been added to a substance that allows it not to clot (anticoagulant). When analyzing ESR by the Panchenkov method, blood is placed in a thin glass or plastic tube and monitored for an hour. At this time, erythrocytes (red blood cells), as having a large specific gravity, settle, leaving a column of transparent plasma above them. According to the distance from the upper border of the plasma to the erythrocytes, the ESR is calculated. Normally, red blood cells settle slowly, leaving very little pure plasma. For this method, a Panchenkov apparatus is used, consisting of a stand and capillary pipettes with a scale of 100 mm.

Capillary photometry (automatic analyzers ROLLER, TEST1) uses the “stopped jet” kinetic method. At the beginning of the ESR analysis, a programmed mixing of the sample takes place in order to disaggregate the erythrocytes. Ineffective disaggregation or the presence of microclots can affect the final result, since the analyzer actually measures the kinetics of erythrocyte aggregation. In this case, the measurement takes place in the range from 2 to 120 mm / h. The results of measuring ESR by this method have a high correlation with the Westergren method, which is the reference for determining ESR in the blood, and the same reference values.

The results obtained when using the method of capillary photometry, in the region of normal values, coincide with the results obtained when determining the ESR by the Panchenkov method. However, the capillary photometry method is more sensitive to an increase in ESR, and the results in the zone of elevated values ​​are higher than the results obtained by the Panchenkov method.

An increase in the level of pathological proteins found in the liquid part of the blood, as well as some other proteins (the so-called acute phase proteins that appear during inflammation) contributes to the “gluing” of erythrocytes. Because of this, they settle faster and ESR rises. It turns out that any acute or chronic inflammation can lead to an increase in ESR in the blood.

The fewer red blood cells, the faster they settle, so women have a higher ESR than men. The norm of ESR is different depending on gender and age.

What is research used for?

• For the diagnosis of diseases associated with acute or chronic inflammation, including infections, cancers and autoimmune diseases. The determination of ESR is sensitive, but one of the least specific laboratory tests, since an increase in ESR in the blood alone does not allow determining the source of inflammation, in addition, it can occur not only due to inflammation. That is why the ESR analysis is usually used in combination with other studies.

When is the test ordered?

• For diagnostics and monitoring:
  • inflammatory diseases,
  • infectious diseases,
  • oncological diseases,
  • autoimmune diseases.
• When conducting preventive examinations in conjunction with other studies (general blood count, leukocyte formula, etc.).

What do the results mean?

Reference values ​​

The results of this test must be interpreted in the light of clinical findings, medical history, and other tests.

Causes of increased ESR in the blood

• Infectious diseases (usually a bacterial cause). ESR can increase in both acute and chronic infectious diseases.
• Inflammatory diseases.
• Connective tissue diseases (rheumatoid arthritis, systemic lupus erythematosus, systemic scleroderma, vasculitis).
• Inflammatory bowel disease (Crohn’s disease, ulcerative colitis).

1. Oncological diseases:
   1. Myeloma. As a rule, it is accompanied by a very high level of ESR in the blood, because with it pathological proteins are synthesized in large quantities, which cause the formation of erythrocyte “coin columns”.
   2. Hodgkin’s disease is a malignant disease of the lymph nodes. The ESR indicator is usually used not to make a diagnosis, but to monitor the course and effectiveness of treatment of an already diagnosed disease.
   3. Cancer of various localizations, especially hemoblastoses. It is believed that an extremely high level of ESR in the blood indicates the spread of the tumor beyond the primary focus (i. e., metastases).

• Myocardial infarction. With it, damage to the heart muscle occurs, which causes a systemic inflammatory response and, accordingly, an increase in ESR. After a heart attack, ESR peaks about a week later.
• Anemia. A decrease in the number of erythrocytes can lead to an increase in their sedimentation rate.
• Burns, injuries.
• Amyloidosis is a disease associated with the accumulation of an abnormal protein in tissues.

Causes of reduced ESR in the blood

• Diseases accompanied by a change in the shape of red blood cells, such as sickle cell anemia or hereditary spherocytosis (they make it difficult for red blood cells to settle).
• Polycythemia (an increase in the number of red blood cells) and conditions that lead to it, such as, for example, chronic heart failure or lung disease.

What can influence the result?

1. ESR in women tends to increase during pregnancy and menstruation.
2. Oral contraceptives, theophylline, vitamin A supplementation may increase ESR.
3. The administration of corticosteroids and the administration of albumin can reduce the ESR in the blood.

Important notes

• ESR analysis is one of the least specific laboratory tests – an increase in ESR in the blood can be observed in many diseases, and this indicator alone cannot make a diagnosis.
• Sometimes high ESR can be observed in healthy people.
• Normal ESR does not rule out cancer or connective tissue disease.

Also recommended

• C-reactive protein (quantitative)
• Rheumatoid factor
• Complete blood count (without leukocyte formula and ESR)
• Leukocyte formula

Who orders the examination?

Therapist, oncologist, hematologist, infectious disease specialist.

norm for men and women, interpretation of a blood test, increased and decreased values ​​

Medicine and health

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Where can I rent it and how much will it cost

Erythrocyte sedimentation rate (ESR) is an analysis during which blood is poured into a long glass tube with divisions and left for an hour.

And then they measure how many erythrocytes – red blood cells – have managed to settle to the bottom of the tube. Sometimes this analysis is done automatically, but the principle remains the same.

Daniil Davydov

specialist in clinical and laboratory diagnostics

Author profile

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Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don’t write prescriptions, we give recommendations. Relying on our point of view or not is up to you.

When the blood is inside a person, it moves very quickly through the vessels and is constantly mixed. Red blood cells are evenly distributed in plasma, the liquid component of blood, so fresh blood looks like red paint. But if you pour blood into a test tube, after a while it will stratify: yellowish plasma will appear on the surface of the test tube, and erythrocytes will sink to the bottom under the influence of gravity and turn into a red precipitate.

In healthy people, the surface of red blood cells is negatively charged, so they repel each other. And since erythrocytes are very light, they are suspended in the plasma and therefore settle slowly.

Erythrocyte sedimentation rate – an international textbook for laboratory technicians

How ESR works – pediatric journal USA

If there is no inflammation, red blood cells do not stick together and settle slowly

If something is wrong with the body, proteins can appear in the blood plasma, which are not normally there – or are, but very few. For example, with many external and internal injuries, the concentration of protective proteins-immunoglobulins and fibrinogen, a protein that “sews up” wounds, increases in the blood. Fibrinogen and immunoglobulins stick to the surface of red blood cells, causing them to stick together into heavy lumps. As a result, in people with an inflammatory process in their body, red blood cells sink faster than in healthy people.

The method is based on this simple idea: if a red precipitate appeared in the test tube faster than expected, then there was an increase in ESR. There is a lot of excess protein in the blood. This may indicate that somewhere in the body there is a latent inflammation.

If there is inflammation, red blood cells stick together into lumps and quickly go to the bottom

You will find out

• Why ESR is prescribed
• How ESR is done: analysis methods
• ESR norms
• What does ESR mean: decoding analysis
• How to take an ESR test

Why ESR is prescribed

To detect inflammation. As a rule, doctors prescribe an analysis if a person has symptoms that make it possible to suspect a latent inflammatory process:

1. headache;
2. temperature above 37°C;
3. joint stiffness;
4. neck or shoulder pain;
5. unexplained weight loss;
6. loss of appetite.

Why ESR is prescribed – MedlinePlus 9 International Medical Encyclopedia0003

In addition, ESR is prescribed if tests reveal anemia – when the number of erythrocytes or the concentration of the main respiratory protein, hemoglobin, decreases in the blood.

An article that high ESR is rarely wrong – Pubmed

Features of ESR as a research method – Association of Clinical Laboratory Diagnostics Specialists (AACC)

At the same time, ESR does not help to figure out what caused the inflammation. In international medical practice, this analysis is used as an auxiliary method in the diagnosis of only three inflammatory diseases, in which ESR increases very much – more than 100 mm / h:

1. Temporal arteritis – chronic inflammation of the large arteries of the face and head.
2. Systemic vasculitis – inflammation of the blood vessels throughout the body.
3. Polymyalgia rheumatica – muscle inflammation.

In all other cases, ESR can only hint that something is wrong with health – and perhaps the cause is inflammation.

The fact is that the erythrocyte sedimentation rate, in addition to inflammation, is affected by many other conditions: from changes in the size and shape of erythrocytes, as is the case with sickle cell anemia, to pregnancy, diabetes mellitus and cardiovascular diseases, in which the level also increases fibrinogen in the blood.

To avoid such confusion, in modern laboratory practice, ESR is increasingly supplemented or even replaced by direct measurement of specific proteins that appear in the midst of an inflammatory response, such as C-reactive protein. So there is less chance of confusing inflammation with the characteristics of the body.

When ESR works worse than C-reactive protein

To see if treatment helps. In most cases, ESR is prescribed not so much for diagnosis, but for monitoring the treatment of inflammatory diseases. If the ESR decreases, then the treatment is helping.

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How ESR is done: methods of analysis

ESR is one of the oldest laboratory tests in the world. Back in the late 18th century, British military surgeon John Hunter discovered that sick people develop blood sediment faster than healthy people. Why this happens, the doctor did not know, but he wrote about it in an article that was published after his death.

History of ESR – an international library for physicians StatPearls Publishing

In the 19th century, the idea was picked up and developed by the Polish physician Edmund Bernacki. He suggested that it could be a change in the protein composition of the blood. And at the beginning of the 20th century, two Swedish doctors – Robert Fareus and Alf Westergren – found that ESR helps predict the outcome of tuberculosis, and proposed a method for measuring erythrocyte sedimentation, which is still used almost unchanged by laboratories around the world.

ICSH Guidelines for the Measurement of Erythrocyte Sedimentation Rate – Latest Edition 1993

Several other methods for measuring the erythrocyte sedimentation rate are used in laboratory diagnostics. They all take an hour, but their results differ from each other.

Westergren method . 2 ml of venous blood is taken from the patient into a special vacuum tube, mixed with an anticoagulant and sucked into a graduated thirty-centimeter glass tube – for analysis, blood is collected up to the mark of 200 mm, that is, ⅔ of the tubes are filled. Then the tube is placed vertically in a special stand and left for an hour. The result is fixed either manually or automatically in special analyzers.

The International Council for Standardization in Hematology (ICSH) has recognized the Westergren method as the reference method for measuring ESR. Most of the international clinical guidelines and textbooks are based on the results obtained by this particular method, also because the study is done on venous blood.

GOST R 53079.4-2008 – how to get the best test results

Blood from a vein is considered the most suitable for laboratory testing, because when capillary blood is taken, microclots can form that can affect the test results.

Wintrobe method. This is a modified Westergren method, in which the blood is not diluted, but 10 cm long tubes are used for analysis.

The Wintrobe method is used mainly abroad and is much less common than the Westergren method, because it is considered less accurate.

Panchenkov’s method. Approximately 100 µl of blood is taken from a patient from a finger directly into a thin glass tube 17.2 cm long, pre-washed with an anticoagulant. Then the blood is poured onto the glass, mixed with an anticoagulant and sucked back into the tube to a level of 10 cm – and so on four times. In the end, the tube is placed vertically in the rack and left for an hour.

The Panchenkov method uses capillary blood and is therefore considered less accurate than the Westergren method. Applicable only on the territory of Russia and the CIS countries. Some private laboratories indicate that they do analysis according to the Westergren method, but from capillary blood – so, most likely, this is a modification of the Panchenkov method.

ESR norms

The ESR norms obtained by the Westergren and Panchenkov methods are similar – however, in the zone of increased values, the ESR measurements are slightly different. The tube used in the Westergren ESR measurement is longer than the tube used in the Panchenkov method. So when using the first method, the results can also be higher.

Why the results obtained by different methods may differ – the post of the clinic of evidence-based medicine “Rassvet”

ESR norms according to Panchenkov and Westergren

ESR norms

According to the Panchenkov method

ESR – the norm in children under 11 years old

4-11 mm / h 90 003

ESR – the norm for men under 50 years old

1-10 mm/h

Over 50 years old

1-10 mm/h

ESR – norm in women up to 50 years old

2-15 mm/h

Older than 50 years

2-15 mm/ h

Westergren

Children under 11

2-10 mm/h

Men under 50

2-15 mm/h

Men over 50

2-20 mm/h

Women under 50

2-20 mm/h

Women over 50

2-30 mm/h

Before donating blood, it makes sense to ask what method the selected laboratory plans to measure ESR. It will be necessary to repeat the analysis either in the same laboratory or in another, where the ESR is measured in the same way.

What does ESR mean: analysis decoding

ESR is too “vague” analysis to draw any conclusions about the state of health based on it. Doctors call such tests non-specific, and it makes sense to decipher the results only in conjunction with the results of other studies, for example, with a general blood test.

How to understand the results of the ESR analysis – Mayo Clinic

However, the result of the analysis may lead the doctor to certain suspicions.

Causes of increased ESR. The indicator increases in diseases and conditions when the amount of protein in the plasma increases. This occurs with any inflammation, as a rule, due to immunoglobulins – immune proteins that protect the body from microbes and cancer cells. The number of immunoglobulins also increases with immune system errors, that is, with autoimmune diseases.

Therefore, high ESR values ​​may indicate, for example, the following problems:

• bacterial infection;
• oncological diseases, such as multiple myeloma or Waldenström’s macroglobulinemia;
• autoimmune diseases such as lupus, rheumatoid arthritis or polymyalgia rheumatica.

What to do if the reasons for the increase are not determined. ESR is a non-specific indicator. It can change in many different diseases: from anemia and coronary heart disease to diseases of the kidneys and thyroid gland.

Therefore, if the ESR is very abnormal, it makes sense to discuss the results with a doctor, for example, with a therapist. If necessary, the specialist will prescribe additional tests and examinations that will help identify the cause. It is impossible to make an accurate diagnosis based only on ESR.

Causes of ESR decrease. The indicator may decrease:

1. For physiological reasons, for example, in athletes with moderate and high physical exertion.
2. With polycythemia – when there are so many red blood cells in the blood that it becomes too viscous.
3. For hemoglobinopathies that cause red blood cells to change shape, such as sickle cell anemia, when the red blood cell becomes like a crescent, or macrocytic anemia, when the red blood cell resembles a ball.
4. People who use certain medications, such as non-steroidal anti-inflammatory drugs or statins.

How to lower the ESR in the blood. When the treatment is directed at the cause of the disease that led to an increase in ESR, the level of protein in the blood will return to normal. You don’t need to do anything special for this.

How to take an ESR test

How to prepare . Abroad, it is believed that it is not necessary to prepare for a blood test for ESR. Domestic laboratory assistants believe that the analysis will be more accurate if you donate blood in the morning on an empty stomach or at any time during the day, but at least three hours after eating. You can drink clean water before analysis.

How much does it cost. You can take a blood test for ESR free of charge under the CHI policy – it is usually prescribed together with a detailed general (clinical) blood test. The alternative is a private laboratory.

You have the right to free tests according to compulsory medical insurance

Almost all laboratories take blood for ESR. The price in the network laboratory will depend on the region: it will cost more for residents of Moscow and the Moscow Region. We indicate prices together with the taking of biomaterial.

Citylab Laboratory Westergren method:

1. Moscow and Moscow Region — 270 R.
2. Samara — 180 R.
3. Novosibirsk — 120 R. 9004 2

KDL Westergren:

1. Moscow and Moscow Region — 270 R.
2. Novosibirsk — 155 R.
3. Voronezh — 105 R.

Invitro Laboratory by Panchenkov’s method:

90 041 Moscow and MO – 295 R.