Erythrocyte Sedimentation Rate

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Contents 1 Introduction 2 Reference-interval 3 Clinical-significance 4 Increases 5 Decreases 6 Specimen 7 Notes 8 More General Terms 9 References

Introduction

• Westergren:

Reference-interval

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

• Men: < age/2, women: < (age + 10)/2
• Corrected ESR for anemia: ESR - [A - Hct] x 1.75
• A is 45 for males, 42 for females

Clinical-significance

• The ESR correlates with the fibrinogen plus immunoglobulin level & depends upon rouleaux formation of erythrocytes. Poikilocytosis tends to inhibit sedimentation; obstructive liver disease which tends to flatten erythrocytes enhances sedimentation.
  
• The ESR should not be used to screen asymptomatic patients for disease. The ESR is often normal in patients with neoplasms, infection, & connective tissue disease.
  
• ESR is useful & is indicated for the diagnosis & monitoring of temporal arteritis & polymyalgia rheumatica. Values in excess of 90 mm/hr are observed with these disorders. The ESR is of little diagnostic value in rheumatoid arthritis, but may be useful in monitoring disease activity when the clinical findings are equivocal.
  
• The zeta sedimentation ratio (ZSR) is not affected by anemia, whereas the Westergren method is affected.
  
• Do NOT use Wintrope sedimentation rate. Plateau effect at a value
• of about 55.

Increases

• rheumatic diseases

• rheumatoid arthritis
• systemic lupus erythematosus
• acute rheumatic fever
• vasculitis
• cryoglobulinemia
• polyarteritis nodosa
• polymyalgia rheumatica
• temporal arteritis
• Sjogren's syndrome
• spondyloarthropathies
• inflammatory bowel disease
• septic arthritis
• gout
• pseudogout

• malignancies

• multiple myeloma
• hypernephroma
• malignant lymphoma
• bronchogenic carcinoma
• metastases ( colon cancer, breast cancer)

• infections

• tuberculosis
• active hepatitis
• pelvic inflammatory disease
• pneumonia
• subacute bacterial endocarditis
• osteomyelitis
• meningococcemia

• other

• acute myocardial infarction
• postoperative
• ruptured ectopic pregnancy
• menstruation
• 3rd trimester of pregnancy
• tissue trauma or necrosis
• hyperthyroidism, hypothyroidism
• acute hemorrhage
• arsenic poisoning, lead poisoning
• pharmaceuticals

• dextran/ heparin/ polyvinyl chloride, fat emulsions, hepatitis B vaccine, oral contraceptives, vitamin A

• diabetic nephropathy
• glomerulonephritis with azotemia
• hypoalbuminemia
• macrocytic anemia
• hypercholesterolemia
• elevated ambient temperature performing ESR testing

Decreases

• hyperviscosity
• extreme leukocytosis
• trichinosis
• other

• polycythemia
• hyperviscosity
• abnormal red blood cell shape

• sickle cell, microcytosis, spherocytosis

• congestive heart failure
• hypofibrinogenemia
• bile salts
• cachexia
• pharmaceuticals:

• corticosteroids, cyclophosphamide, corticotropin

• clotted blood
• 2 hour delay in processing
• chemical interferences

• fluoride, glucose, oxalate, quinine

Specimen

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

Notes

• ESR generally normal with:

• rheumatic diseases

• osteoarthritis
• chondrocalcinosis

• most malignancies
• infections

• typhoid fever
• undulant fever
• infectious mononucleosis
• uncomplicated viral infection
• acute appendicitis (1st 24 hours)

• other

• angina
• peptic ulcer disease
• acute allergic reaction
• unruptured ectopic pregnancy

More General Terms

• clinical hematology test

References

1. Clinical Guide to Laboratory Tests, 3rd edition, NW Tietz ed, WB Saunders, Philadelphia, 1995
2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
3. Brahn E, Scoville CD Biochemical markers of disease activity. Baillieres Clin Rheumatol 1988 2:153 PMID: [1]

erythrocyte sedimentation rate (ESR)