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Hematology sed rate westergren. Understanding Erythrocyte Sedimentation Rate (ESR): A Comprehensive Guide to the Westergren Method

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What is the Erythrocyte Sedimentation Rate test. How is the ESR test performed using the Westergren method. What can ESR results indicate about a patient’s health. When might a doctor order an ESR test. How do ESR levels differ between men and women of various ages.

The Basics of Erythrocyte Sedimentation Rate (ESR)

The Erythrocyte Sedimentation Rate (ESR), also known as the sed rate, is a simple yet informative blood test that measures the rate at which red blood cells settle in a tube over a specific period. This test serves as a non-specific marker of inflammation in the body, providing valuable insights into various medical conditions.

ESR is typically measured using the Westergren method, which involves placing a sample of anticoagulated blood in a tall, thin tube and measuring the distance the red blood cells fall in one hour. The results are reported in millimeters per hour (mm/hr).

How does the ESR test work?

When inflammation is present in the body, certain proteins in the blood, particularly fibrinogen, cause red blood cells to stick together and form clumps. These clumps are heavier than individual cells, causing them to settle more quickly in the test tube. Therefore, a higher ESR indicates more inflammation in the body.

Indications for ESR Testing

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

  • Unexplained fever
  • Joint pain or stiffness
  • Muscle pain
  • Headaches
  • Unexplained weight loss
  • Loss of appetite

ESR can be particularly useful in diagnosing and monitoring conditions such as:

  1. Rheumatoid arthritis
  2. Temporal arteritis
  3. Polymyalgia rheumatica
  4. Systemic lupus erythematosus
  5. Infections (bone, joint, or systemic)
  6. Some types of cancer

The ESR Testing Procedure

The ESR test is a simple blood test that requires minimal preparation from the patient. However, it’s essential to inform your healthcare provider about any medications or supplements you’re taking, as some can affect the results.

What happens during the blood draw?

A healthcare professional will draw blood from a vein, typically in your arm. They will:

  1. Clean the area with an antiseptic
  2. Apply a tourniquet to make the vein more visible
  3. Insert a needle to collect the blood sample
  4. Remove the needle and apply pressure to stop any bleeding
  5. Place a bandage over the site

The entire process usually takes only a few minutes. You may feel a slight sting when the needle is inserted, and some people experience minor bruising or soreness afterward.

Interpreting ESR Results

ESR results are typically available within 1-2 hours after the blood sample is taken. The normal ranges for ESR can vary depending 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

What do elevated ESR levels indicate?

An elevated ESR suggests the presence of inflammation in the body. However, it’s important to note that ESR is a non-specific test, meaning it can’t pinpoint the exact location or cause of inflammation. Further diagnostic tests are usually required to determine the underlying condition.

Factors Affecting ESR Results

Several factors can influence ESR results, potentially leading to falsely elevated or lowered values. These include:

  • Age (ESR tends to increase with age)
  • Pregnancy
  • Anemia
  • Obesity
  • Certain medications (e.g., oral contraceptives, vitamin A)
  • Kidney disease
  • Thyroid disorders

Healthcare providers consider these factors when interpreting ESR results to ensure accurate diagnosis and treatment planning.

ESR vs. Other Inflammatory Markers

While ESR 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 status.

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

C-reactive protein (CRP) is another commonly used marker of inflammation. Unlike ESR, CRP levels can change more rapidly in response to inflammation, making it more sensitive to acute changes. Both tests are often ordered together to provide complementary information:

  • ESR: Reflects chronic inflammation and changes more slowly
  • CRP: More sensitive to acute inflammation and changes quickly

The combination of ESR and CRP can help healthcare providers differentiate between acute and chronic inflammatory conditions, as well as monitor treatment effectiveness.

Limitations and Considerations of ESR Testing

While ESR is a useful diagnostic tool, it’s important to understand its limitations:

  1. Non-specificity: ESR can’t identify the exact cause or location of inflammation
  2. Slow response: ESR changes more slowly than other inflammatory markers
  3. Susceptibility to various factors: Age, gender, and certain medical conditions can affect results
  4. Limited usefulness in some conditions: ESR may not be elevated in all inflammatory conditions

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

The Role of ESR in Disease Monitoring and Treatment

Beyond initial diagnosis, ESR plays a crucial role in monitoring disease progression and treatment effectiveness for various inflammatory conditions.

How is ESR used in rheumatoid arthritis management?

In rheumatoid arthritis (RA), ESR is often used alongside other tests to:

  • Assess disease activity
  • Monitor treatment response
  • Predict long-term outcomes

Regular ESR testing can help healthcare providers adjust treatment plans and detect disease flares early. However, it’s important to note that ESR doesn’t always correlate perfectly with clinical symptoms in RA, and other assessment tools are typically used in conjunction.

ESR in cancer monitoring

For certain types of cancer, particularly those associated with significant inflammation, ESR can be a useful tool for:

  1. Assessing tumor burden
  2. Monitoring treatment response
  3. Detecting recurrence

However, ESR is not specific to cancer and is not used as a primary screening or diagnostic tool for malignancies.

Future Perspectives and Emerging Research

While ESR has been in use for nearly a century, research continues to explore its potential applications and limitations.

What new developments are occurring in ESR testing?

Recent advancements and areas of research include:

  • Automated ESR analyzers: Improving accuracy and reducing turnaround time
  • ESR in cardiovascular risk assessment: Exploring its potential as a predictor of cardiovascular events
  • Combining ESR with other biomarkers: Enhancing diagnostic accuracy for specific conditions
  • ESR in personalized medicine: Investigating its role in tailoring treatment approaches

These developments may expand the utility of ESR testing and refine its interpretation in various clinical scenarios.

In conclusion, the Erythrocyte Sedimentation Rate test remains a valuable tool in modern medicine, providing important insights into inflammatory processes within the body. While it has limitations, when used in conjunction with other diagnostic methods and clinical assessment, ESR continues to play a crucial role in diagnosing, monitoring, and managing a wide range of medical conditions. As research progresses, we may see even more applications for this simple yet informative test in the future of healthcare.

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

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Kevin Tishkowski 
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, Vikas Gupta 
2

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

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Affiliations

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

  • PMID:

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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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