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ESR; Normal Value, Procedures, Results, Treatment

ESR (Erythrocyte sedimentation rate) is a type of blood test that measures how quickly erythrocytes (red blood cells) settle at the bottom of a test tube that contains a blood sample. Normally, red blood cells settle relatively slowly. A faster-than-normal rate may indicate inflammation in the body. Inflammation is part of your immune response system.The erythrocyte sedimentation rate (ESR or sed rate) is the rate at which red blood cells sediment in a period of one hour. It is a common hematology test, and is a non-specific measure of inflammation. To perform the test, anticoagulated blood was traditionally placed in an upright tube, known as a Westergren tube, and the rate at which the red blood cells fall was measured and reported in mm at the end of one hour.

Stages in erythrocyte sedimentation (ESR)

When anticoagulated blood is allowed to stand in a narrow vertical glass tube, undisturbed for a period of time, the RBCs – under the influence of gravity- settle out from the plasma. The rate at which they settle is measured as the number of millimeters of clear plasma present at the top of the column after one hour(mm/hr). This mechanism involves three stages:

Stage of aggregation – It is the initial stage in which piling up of RBCs takes place. The phenomenon is known as Rouleaux formation. It occurs in the first 10-15 minutes.
Stage of sedimentation – It is the stage of actual falling of RBCs in which sedimentation occurs at constant rate. This occurs in 30-40 minutes out of 1 hour, depending upon the length of the tube used.
Stage of packing – This is the final stage and is also known as stationary phase. In this, there is a slower rate of falling during which packing of sedimented RBCs in column occurs due to overcrowding. It occurs in final 10 minutes in 1 hour.

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Methods of ESR

There are two main methods to determine ESR

Wintrobe’s method
Westergren’s method

Each method produces slightly different results. Mosely and Bull (1991) concluded that Wintrobe’s method is more sensitive when the ESR is low, whereas, when the ESR is high, the Westergren’s method is preferably an indication of patient’s clinical state.

Normal Value of ESR

For males : 0-9 mm/hr
For females 0-20 mm/hr

mm / hour. (Wintrobe method)
Male
- < 50 years of age = 0 to 9 mm/hour.
- >50 years of age = 0 to 20 mm/hour.
Female
- <50 years of age = 0 to 20 mm/hour.
Children = 0 to 13 mm/hour.

High ESR/Low CRP	Low ESR/High CRP
Systemic lupus erythematosisBone and joint infections Ischemic stroke Waldenstrom’s macroglobulinemia Multiple myeloma IgG4 related disease Renal insufficiency Low serum albumin	Urinary tract, GI, lung and bloodstream infectionsMyocardial infarction Venous thromboembolic disease Rheumatoid arthritis Low serum albumin

How to do ESR (Procedure)

ESR should be done within 2 hours of the collection of the blood.
Blood can be kept at 4 C for 6 hours. Now bring the blood to room temperature.
Take 0.2 mL of ESR solution + 1.8 mL of oxalate blood or blood in EDTA.
Fill the Wintrobe ESR tube. (mix the blood thoroughly before filling the tube).
Mount in the ESR stand.
Start the clock for one hour.
Record the result after one hour.
That is the ratio of settled cells and above clear plasma.
The temperature should be kept between 20 to 25 C.

ESR Test Results Means

Test results may vary depending on your age, gender, health history, the method used for the test, and other things. Your test results may not mean you have a problem. Ask your healthcare provider what your test results mean for you.

ESR is measured in millimeters per hour (mm/h). The normal values are

0 to 10 mm/h in children
0 to 15 mm/h in men younger than 50
0 to 20 mm/h in men older than 50
0 to 20 mm/h in women younger than 50
0 to 30 mm/h in women older than 50

ESR above 100 mm/h is most likely caused by an active disease. For instance, you may have

High ESR Test Results

There are multiple causes of a high ESR test result. Some common conditions associated with high rates include:

Infection
Rheumatoid arthritis
Rheumatic fever
Vascular disease
Inflammatory bowel disease
Heart disease
Kidney disease
Certain cancers
Anemia
Bone infection
Heart infection
Heart valve infection
Skin infection
Systemic infection
Tuberculosis
Multiple myeloma
Nephritis
Pulmonary embolism
Rheumatic fever
matoid arthritisSubacute bacterial endocarditis
Temporal arteritis
Lymphoma
Pregnancy
Temporal arteritis
Thyroid disease
Waldenstrom’s macroglobulinemia
Drugs like birth control pills, methyldopa (Aldomet), theophylline (Theo-24, Theolair, Elixophylline), vitamin A, cortisone, and quinine

ESR test results that are higher than normal are also associated with autoimmune disorders, including:

systemic lupus erythematosus
rheumatoid arthritis
giant cell arteritis
polymyalgia rheumatica
primary macroglobulinemia
too much fibrinogen in your blood, or hyperfibrinogenemia
allergic or necrotizing vasculitis

Low ESR Test Results

A low ESR test result may be due to

Congestive heart failure
Hypofibrinogenemia
Leukocytosis
Low plasma protein
Polycythemia
Sickle cell anemia
Urinary tract, GI, lung and bloodstream infections
Myocardial infarction
Polycythemia
Sickle cell anemia
Leukocytosis, an abnormal increase in white blood cells
Venous thromboembolic disease
Low serum album

Factors influencing ESR

Plasma protein

In normal blood RBCs suspended in the plasma from few aggregates of RBCs. So the rate of sedimentation is slow.
If there is a rouleaux formation that will give a false value. So acute phase protein affects the ESR.

Number of RBCs

ESR depends upon the number of RBCs like in anemia decreased the number of RBCs settles down rapidly.
In the case of polycythemia, RBCs settles slowly and ESR will be low.

Shape of RBCs