What is the erythrocyte sedimentation rate test. How is the Westergren method performed. What do ESR results indicate about inflammation in the body. When might a doctor order an ESR test. How do ESR levels differ between men and women of various ages. What factors can affect ESR test results.

Understanding the Erythrocyte Sedimentation Rate (ESR) Test

The erythrocyte sedimentation rate (ESR) test, also known as the sed rate or Westergren method, 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 vertical tube of blood over a period of one hour.

In the presence of inflammation, proteins in the blood cause red blood cells to clump together and fall more rapidly. Thus, a faster sedimentation rate can indicate higher levels of inflammation, which may be associated with various medical conditions.

How is the ESR test performed?

The ESR test procedure is straightforward:

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.

This measurement provides the ESR value, which is reported in millimeters per hour (mm/hr).

Interpreting ESR Test Results: Normal Ranges and Elevated Levels

ESR results can vary based on age and gender. Normal ranges typically fall within:

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

Elevated ESR levels may indicate the presence of inflammation in the body. However, it’s important to note that the ESR test alone cannot diagnose a specific condition. It serves as a general marker of inflammation that may prompt further investigation.

What can cause elevated ESR levels?

Higher than normal ESR values may be associated with various conditions, including:

• Infections (bacterial, viral, or fungal)
• Autoimmune disorders (e.g., rheumatoid arthritis, lupus)
• Inflammatory conditions (e.g., polymyalgia rheumatica)
• Cancers
• Chronic kidney disease
• Anemia

Clinical Applications of the ESR Test

The ESR test serves several purposes in clinical practice:

When might a doctor order an ESR test?

Healthcare providers may recommend an ESR test when patients present with symptoms suggestive of inflammation or specific medical conditions. These symptoms may include:

• Unexplained fever
• Joint pain or stiffness
• Muscle aches
• Headaches
• Weight loss
• Fatigue

How is the ESR test used in diagnosis and monitoring?

The ESR test can be valuable in:

1. Screening for inflammatory conditions
2. Supporting a diagnosis when combined with other clinical findings
3. Monitoring disease activity and response to treatment
4. Detecting disease recurrence

For example, in patients with rheumatoid arthritis, regular ESR testing can help assess disease activity and guide treatment decisions.

Factors Influencing ESR Test Results

While the ESR test is useful, several factors can affect its results, potentially leading to false positives or negatives.

What can cause falsely elevated ESR levels?

Factors that may artificially increase ESR values include:

• Pregnancy
• Menstruation
• Advanced age
• Obesity
• Anemia
• Certain medications (e.g., oral contraceptives, vitamin A)

What can cause falsely low ESR levels?

Conversely, some factors may lead to lower than expected ESR results:

• Polycythemia (increased red blood cell count)
• Sickle cell anemia
• Extreme leukocytosis (high white blood cell count)
• Certain medications (e.g., aspirin, cortisone)

Due to these potential influences, healthcare providers interpret ESR results in conjunction with other clinical findings and laboratory tests.

Comparing ESR to Other Inflammatory Markers

While the ESR test is valuable, it’s not the only marker of inflammation used in clinical practice. Understanding how it compares to other tests can provide a more comprehensive picture of a patient’s inflammatory status.

How does ESR compare to C-reactive protein (CRP)?

C-reactive protein (CRP) is another commonly used inflammatory marker. Key differences include:

• ESR changes more slowly in response to inflammation compared to CRP
• CRP is more sensitive to acute inflammation
• ESR can be affected by factors unrelated to inflammation (e.g., anemia), while CRP is less influenced by these factors

In many cases, doctors may order both ESR and CRP tests to gain a more complete understanding of the inflammatory process.

Are there other tests used alongside ESR?

In addition to CRP, other tests that may be used in conjunction with ESR include:

• Complete blood count (CBC)
• Rheumatoid factor (RF)
• Antinuclear antibody (ANA) test
• Imaging studies (e.g., X-rays, MRI)

The combination of these tests helps healthcare providers form a more accurate diagnosis and treatment plan.

Limitations and Considerations of the ESR Test

While the ESR test is widely used, it’s important to understand its limitations and consider them when interpreting results.

Why is ESR considered a non-specific test?

The ESR test is non-specific because:

• It can be elevated in various conditions, not just inflammation
• It doesn’t pinpoint the location or cause of inflammation
• Normal ESR values don’t necessarily rule out the presence of disease

Due to these limitations, ESR results should always be interpreted in the context of a patient’s clinical presentation and other diagnostic findings.

Are there situations where ESR might not be reliable?

ESR may be less reliable in certain circumstances:

• In the early stages of inflammation, as ESR can take time to rise
• In conditions that affect red blood cell shape or count
• When patients are on certain medications that can influence results

In these cases, alternative or additional tests may be necessary to accurately assess inflammation.

Future Directions in Inflammatory Marker Testing

As medical science advances, new approaches to detecting and measuring inflammation are being developed. These advancements may complement or potentially replace traditional tests like ESR in certain situations.

What new inflammatory markers are being researched?

Emerging inflammatory markers include:

• Procalcitonin (PCT): More specific for bacterial infections
• Interleukin-6 (IL-6): Involved in the acute phase response
• Serum amyloid A (SAA): Another acute phase protein

These markers may offer more specific or rapid detection of inflammation in certain clinical scenarios.

How might technology improve inflammatory marker testing?

Technological advancements are enhancing inflammatory marker testing through:

• Point-of-care testing devices for rapid results
• Multiplex assays that can measure multiple inflammatory markers simultaneously
• Artificial intelligence algorithms to interpret complex patterns of inflammatory markers

These innovations may lead to more precise and personalized approaches to diagnosing and monitoring inflammatory conditions.

In conclusion, the erythrocyte sedimentation rate (ESR) test remains a valuable tool in detecting and monitoring inflammation. While it has limitations, its simplicity and long-standing use in clinical practice make it a staple in many diagnostic workups. As our understanding of inflammation grows and technology advances, the ESR test will likely continue to evolve, potentially becoming part of a more comprehensive panel of inflammatory markers. Healthcare providers will need to stay informed about these developments to provide the best care for their patients with 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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Erythrocyte Sedimentation Rate – PubMed

Book

Kevin Tishkowski 
¹
, Vikas Gupta 
²

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

2023 Apr 23.

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.

2023 Apr 23.

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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