The erythrocyte sedimentation rate (ESR), also called a sedimentation rate, sed rate or 'Biernacki Reaction', is a non-specific measure of inflammation that is commonly used as a medical screening test. An abscess on the skin, showing the redness and swelling characteristic of inflammation. ...

To perform the test, anticoagulated blood is placed in an upright tube, known as a Westergren tube and the rate at which the red blood cells fall is measured and reported in mm/h. Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... “Red cell” redirects here. ...

When an inflammatory process is present, the high proportion of fibrinogen in the blood causes red blood cells to stick to each other. The red cells form stacks called 'rouleaux' which settle faster. Rouleau formation can also occur in association with some lymphoproliferative disorders in which one or more immunoglobulins are secreted in high amounts. Rouleau formation is however a physiological finding in some equidae and can be as such in felidae and suidae species, namely the horse, cat and pig respectively. Fibrin is a protein involved in the clotting of blood. ... Rouleaux (singular is rouleau) are stacks of red blood cells formed because of the unique discoid shape of these cells in vertebrate body. ... Schematic of antibody binding to an antigen An antibody is a protein complex used by the immune system to identify and neutralize foreign objects like bacteria and viruses. ...

The ESR is increased by any cause or focus of inflammation. The ESR is decreased in sickle cell anemia, polycythemia, and congestive heart failure. The basal ESR is slightly higher in females. Sickle-cell disease is a group of genetic disorders caused by sickle hemoglobin (Hgb S or Hb S). ... Polycythemia is a condition in which there is a net increase in the total number of red blood cells in the body. ... Congestive heart failure (CHF), also called congestive cardiac failure (CCF) or just heart failure, is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood through the body. ...

History

This test was invented in 1897 by the Polish doctor Edmund Biernacki.^[1] In 1918 the Swedish pathologist Robert Sanno Fåhræus declared the same and along with Alf Vilhelm Albertsson Westergren are eponymously remembered for the Fåhræus-Westergren test (in the UK, usually termed Westergren test),^[2] which uses sodium citrate-anticoagulated specimens.^[3] Edmund Faustyn Biernacki (b. ...

Uses

Although it is frequently ordered, the erythrocyte sedimentation rate (ESR) is not a useful screening test. It is only useful for diagnosing three diseases: myeloma, temporal arteritis and polymyalgia rheumatica (in which it may exceed 100 mm/hour). Multiple myeloma (also known simply as myeloma or plasma cell myeloma) is a hematological malignancy of plasma cells, the cells of the immune system that produce antibodies. ... Temporal arteritis, also called giant cell arteritis (GCA) is an inflammatory disease of blood vessels (most commonly large and medium arteries of the head). ... Polymyalgia Rheumatica (PMR) - is a disorder associated with pain in the shoulder and hip. ...

It is commonly used for a differential diagnosis for Kawasaki's Disease and it may be increased in some chronic infective conditions like tuberculosis and infective endocarditis. It is a component of the PDCAI, an index for assessment of severity of inflammatory bowel disease in children. Kawasaki disease, also known as mucocutaneous lymph node syndrome, mucocutaneous lymph node disease, infantile polyarteritis and Kawasaki syndrome, is a poorly-understood illness that affects the mucous membranes, lymph nodes, blood vessel walls, and the heart. ... Tuberculosis (abbreviated as TB for tubercle bacillus or Tuberculosis) is a common and deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis. ... Endocarditis is an inflammation of the inner layer of the heart, the endocardium. ...

The clinical usefulness of erythrocyte sedimentation rate (ESR) is limited to monitoring the response to therapy in certain inflammatory diseases such as temporal arteritis, polymyalgia rheumatica and rheumatoid arthritis. It can also be used as a crude measure of response in Hodgkin's lymphoma. Additionally, ESR levels are used to define one of the several possible "adverse prognostic factors" in the staging of Hodgkin's lymphoma. Rheumatoid arthritis (RA) is traditionally considered a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. ... Hodgkins lymphoma, also known as Hodgkins disease, is a type of lymphoma first described by Thomas Hodgkin in 1832. ...

The use of the ESR as a screening test in asymptomatic persons is limited by its low sensitivity and specificity. When there is a moderate suspicion of disease, the ESR may have some value as a "sickness index."

An elevated ESR in the absence of other findings should NOT trigger an extensive laboratory or radiographic evaluation.

Normal Values

Note: mm/hr. = millimeters per hour.

Values are increased in states of anemia,^[4] and in black populations.^[5]

Adults

ESR reference ranges from a large study:^[6]

As an alternative the following formula may be used to give predicted values for ESR based on age and gender:^[7]

Children

• Newborn: 0 to 2 mm/hr.
• Neonatal to puberty: 3 to 49 mm/hr.

1. Newborn: 0-5 mm/hr.
2. Neonatal to puberty: 0-15 mm/hr.

See also

• C-reactive protein

C-reactive protein (CRP) is a plasma protein, an acute phase protein produced by the liver. ...

Footnotes