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Hematology sed rate westergren. Erythrocyte Sedimentation Rate (ESR): Understanding the Sed Rate Test

by alexxlab

What is the erythrocyte sedimentation rate test. How is the ESR test performed. What do high and low sed rate results indicate. When might a doctor order an ESR test. What conditions can the sed rate test help diagnose. How does inflammation affect ESR results. What factors can influence sed rate test results.

The Basics of Erythrocyte Sedimentation Rate (ESR)

The erythrocyte sedimentation rate (ESR), commonly known as the “sed rate” test, is a valuable diagnostic tool used to detect inflammation in the body. This simple blood test measures how quickly red blood cells (erythrocytes) settle at the bottom of a test tube over a period of one hour.

Why is this important? In the presence of inflammation, certain proteins in the blood cause red blood cells to clump together, making them heavier and causing them to fall faster. Thus, a faster sedimentation rate can indicate the presence of an inflammatory condition in the body.

How is the ESR test performed?

The ESR test is a straightforward procedure:

  1. A blood sample is drawn from a vein, typically in the arm.
  2. The blood is placed in a tall, thin tube.
  3. After one hour, the distance the red blood cells have fallen is measured in millimeters.

The results are reported as millimeters per hour (mm/hr). Normal ranges vary based on age and gender:

  • Men under 50: 0-15 mm/hr
  • Men over 50: 0-20 mm/hr
  • Women under 50: 0-20 mm/hr
  • Women over 50: 0-30 mm/hr

Clinical Applications of the Sed Rate Test

The ESR test is a non-specific marker of inflammation, meaning it can’t pinpoint the exact location or cause of inflammation. However, it serves several important purposes in clinical practice:

Diagnosing inflammatory conditions

An elevated ESR can be an early indicator of various inflammatory conditions, including:

  • Rheumatoid arthritis
  • Lupus
  • Polymyalgia rheumatica
  • Giant cell arteritis
  • Systemic vasculitis

Monitoring disease activity

For patients with known inflammatory conditions, the ESR test can help track disease progression and response to treatment. A decreasing ESR often indicates that inflammation is subsiding and treatment is effective.

Detecting hidden infections or malignancies

In some cases, an unexpectedly high ESR can alert doctors to the presence of an underlying infection or even certain types of cancer that might otherwise go unnoticed.

Interpreting ESR Results: What Do They Mean?

While the ESR test is valuable, it’s crucial to interpret results in the context of a patient’s overall clinical picture. A high ESR alone is not diagnostic of any specific condition.

High ESR results

An elevated ESR suggests the presence of inflammation but requires further investigation to determine the cause. Potential reasons for a high ESR include:

  • Acute or chronic infections
  • Autoimmune disorders
  • Certain cancers, particularly lymphoma and multiple myeloma
  • Pregnancy
  • Anemia

Low ESR results

While less common, abnormally low ESR results can also occur. Conditions associated with low ESR include:

  • Polycythemia (increased red blood cell count)
  • Sickle cell anemia
  • Hypofibrinogenemia (low levels of fibrinogen in the blood)

It’s important to note that a normal ESR doesn’t definitively rule out inflammation or disease. Some conditions may not significantly affect the ESR, and individual variations can occur.

Factors Influencing ESR Results

Several factors can affect ESR results, potentially leading to falsely elevated or lowered values. Understanding these influences is crucial for accurate interpretation:

Age and gender

ESR tends to increase with age and is generally higher in women than in men. This is why reference ranges are adjusted based on these factors.

Medications

Certain medications can affect ESR results, including:

  • Oral contraceptives
  • Vitamin A
  • Cortisone
  • Quinine

It’s essential for patients to inform their healthcare providers about all medications they’re taking before the test.

Physiological states

Pregnancy and menstruation can cause temporary elevations in ESR. Obesity may also lead to slightly higher values.

Technical factors

The accuracy of ESR results can be affected by factors such as the angle of the test tube, room temperature, and the time between blood collection and testing. Standardized procedures help minimize these variables.

ESR vs. Other Inflammatory Markers

While the ESR test is valuable, it’s often used in conjunction with other tests to provide a more comprehensive picture of inflammation in the body.

C-Reactive Protein (CRP)

CRP is another acute phase reactant that rises in response to inflammation. Compared to ESR, CRP levels change more rapidly, making it more sensitive to acute inflammation. CRP can also return to normal more quickly as inflammation resolves.

When to use ESR vs. CRP?

The choice between ESR and CRP often depends on the specific clinical situation:

  • ESR is preferred for monitoring chronic conditions like rheumatoid arthritis or giant cell arteritis.
  • CRP is more useful for detecting acute inflammation, such as in bacterial infections.
  • In many cases, both tests are ordered together to provide complementary information.

Limitations and Considerations of the ESR Test

While the ESR test is widely used and valuable, it’s important to understand its limitations:

Non-specificity

The ESR test cannot identify the specific cause or location of inflammation. It merely indicates the presence of an inflammatory process.

Delayed response

ESR can take longer to rise at the onset of inflammation and may remain elevated even after the acute phase has passed. This delay can sometimes lead to misinterpretation of a patient’s current inflammatory status.

False negatives and positives

Some conditions, such as rheumatoid arthritis in its early stages, may not always cause an elevated ESR. Conversely, factors like age or pregnancy can lead to falsely elevated results.

Need for follow-up testing

An abnormal ESR result typically requires additional testing to determine the underlying cause. This may include imaging studies, more specific blood tests, or even biopsies in some cases.

The Future of Inflammatory Markers in Medicine

As our understanding of inflammation and its role in various diseases continues to evolve, so too does the landscape of diagnostic tools available to clinicians.

Emerging biomarkers

Researchers are continuously investigating new biomarkers that may offer more specific or sensitive measures of inflammation. Some promising areas include:

  • Cytokine profiling
  • Proteomics-based approaches
  • MicroRNA signatures

Personalized medicine

The future of inflammatory markers likely lies in more personalized approaches. By combining multiple biomarkers and considering individual patient factors, clinicians may be able to create more tailored and accurate inflammatory profiles.

Point-of-care testing

Advancements in technology are making it possible to perform rapid ESR and other inflammatory marker tests at the point of care. This could lead to faster diagnosis and treatment decisions, particularly in emergency settings.

Despite these advancements, the ESR test remains a valuable tool in the diagnostic arsenal. Its simplicity, low cost, and long history of clinical use ensure that it will continue to play a role in medical practice for the foreseeable future.

Practical Implications for Patients and Healthcare Providers

Understanding the nuances of the ESR test is crucial for both patients and healthcare providers to ensure its appropriate use and interpretation.

For patients

If you’re scheduled for an ESR test, keep these points in mind:

  • No special preparation is typically required for the test.
  • Inform your healthcare provider about all medications and supplements you’re taking.
  • If you’re pregnant or menstruating, let your provider know as this can affect results.
  • Remember that an abnormal ESR result alone is not a diagnosis. Further testing may be needed.

For healthcare providers

When ordering and interpreting ESR tests, consider the following:

  • Always interpret ESR results in the context of the patient’s clinical presentation and other test results.
  • Be aware of factors that can influence ESR results, such as age, gender, and medications.
  • Consider ordering both ESR and CRP tests for a more comprehensive assessment of inflammation.
  • Use trending of ESR values over time to monitor disease activity and treatment response in chronic conditions.

By understanding the strengths and limitations of the ESR test, both patients and healthcare providers can make more informed decisions about diagnosis and treatment.

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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Erythrocyte Sedimentation Rate – PubMed

Book

Kevin Tishkowski 
1
, Vikas Gupta 
2

In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.

.

Affiliations

Affiliations

  • 1 Garden City Hospital
  • 2 South Carolina Dept of Mental Health

  • PMID:

    32491417

  • Bookshelf ID:

    NBK557485

Free Books & Documents

Book

Kevin Tishkowski et al.

Free Books & Documents

In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.

.

Authors

Kevin Tishkowski 
1
, Vikas Gupta 
2

Affiliations

  • 1 Garden City Hospital
  • 2 South Carolina Dept of Mental Health

  • PMID:

    32491417

  • Bookshelf ID:

    NBK557485

Excerpt

The erythrocyte sedimentation rate (sedimentation rate, sed rate, or ESR for short) is a commonly performed hematology test that may indicate and monitor an increase in inflammatory activity within the body caused by one or more conditions such as autoimmune disease, infections, or tumors. The ESR is not specific for any single disease but is used in combination with other tests to determine the presence of increased inflammatory activity. The ESR has long been used as a “sickness indicator” due to its reproducibility and low cost. Over many decades, several methods have evolved to perform the test. However, the reference method for measuring the ESR proposed by the International Committee for Standardization in Haematology (ICSH) is based on the findings described by Westergren a century ago. Newer automated systems using closed blood collection tubes and automatic readers have been introduced into laboratories to decrease the biohazardous risk to operators and decrease the time it takes to perform the ESR.

The Westergren method measures the distance (in millimeters) at which red blood cells in anticoagulated whole blood fall to the bottom of a standardized, upright, elongated tube over one hour due to the influence of gravity. The tube used for the test is called the Westergren tube. Today, these tubes are made of either glass or plastic, with an internal diameter of 2.5 mm and lengths of 190 to 300 mm.

Perhaps the first to notice a change in blood sedimentation due to illness was a British surgeon John Hunter (1728–93), in his posthumous publication, A Treatise on the Blood, Inflammation, and Gun-Shot Wounds. A Polish physician, Edmund Faustyn Biernacki (1866–1911), later refined the clinical use of the ESR near the end of the 19th century. Biernacki detailed his findings in two articles in 1897 (the Gazeta Lekarska in Poland and the Deutsche Medizinische Wochenschrift in Germany) and developed his test for measurements. These findings were not widely propagated in the English-speaking medical communities. Because of his work, the ESR is occasionally called the Biernacki Reaction worldwide.

The applied use of ESR in clinical diagnostics by Biernacki was refined by Dr. Robert Fahraeus in 1918 and Dr. Alf Vilhelm Albertsson Westergren in 1921. Dr. Westergren defined the standard measurement of the ESR that is still in use today. Together, Robert Fahraeus and Alf Vilhelm Albertsson Westergren are often remembered for the test, historically called the Fahraeus-Westergren test (FW test or Westergren test), which uses a standardized tube and sodium citrate anticoagulated blood.

The Westergren method for measuring the ESR proposed by the International Committee for Standardization in Haematology (ICSH) has allowed reproducibility for almost a century. Over time, this same method has established comparable reference values within the same laboratory and even between different facilities across the globe. The ICSH adopted the Westergren method as the gold standard for ESR measurement in 1973. Even after the advent of automated machines used to analyze the ESR, the Westergren method was still confirmed as the gold standard in 2011 by both the ICSH and the Clinical and Laboratory Standards Institute (CLSI).

Copyright © 2023, StatPearls Publishing LLC.

Conflict of interest statement

Sections

  • Introduction

  • Pathophysiology

  • Specimen Requirements and Procedure

  • Diagnostic Tests

  • Interfering Factors

  • Results, Reporting, and Critical Findings

  • Clinical Significance

  • Quality Control and Lab Safety

  • Enhancing Healthcare Team Outcomes

  • Review Questions

  • References

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References

    1. ICSH recommendations for measurement of erythrocyte sedimentation rate. International Council for Standardization in Haematology (Expert Panel on Blood Rheology). J Clin Pathol. 1993 Mar;46(3):198-203.

      –

      PMC

      –

      PubMed

    1. Plebani M, De Toni S, Sanzari MC, Bernardi D, Stockreiter E. The TEST 1 automated system: a new method for measuring the erythrocyte sedimentation rate. Am J Clin Pathol. 1998 Sep;110(3):334-40.

      –

      PubMed

    1. Reference method for the erythrocyte sedimentation rate (ESR) test on human blood. Br J Haematol. 1973 May;24(5):671-3.

      –

      PubMed

    1. Madrenas J, Potter P, Cairns E. Giving credit where credit is due: John Hunter and the discovery of erythrocyte sedimentation rate. Lancet. 2005 Dec 17;366(9503):2140-1.

      –

      PubMed

    1. Amezcua-Guerra LM, Castillo-Martinez D, Bojalil R.