Erythrocyte Sedimentation Rate (ESR) Explained
The erythrocyte sedimentation rate (ESR) measures how quickly red blood cells settle in a test tube. It is a key non-specific marker of inflammation used in medical diagnostics.
Things worth knowing about "Erythrocyte Sedimentation Rate"
The erythrocyte sedimentation rate (ESR) measures how quickly red blood cells settle in a test tube. It is a key non-specific marker of inflammation used in medical diagnostics.
What is the Erythrocyte Sedimentation Rate?
The erythrocyte sedimentation rate (ESR) is a simple blood test that measures how quickly red blood cells (erythrocytes) settle to the bottom of a vertical test tube over the course of one hour. The result is expressed in millimetres per hour (mm/h). The ESR is considered a non-specific marker of inflammation and is widely used in routine medical diagnostics.
How Does the Test Work?
A blood sample is collected and mixed with an anticoagulant to prevent clotting. The sample is then placed in a narrow, upright tube. Because red blood cells are denser than the surrounding plasma, they gradually sink. The distance the red blood cell column has fallen after one hour is recorded in millimetres. A second reading is often taken after two hours for additional information.
Reference Values
Normal ESR values differ by age and sex:
- Men under 50 years: up to 15 mm/h
- Men over 50 years: up to 20 mm/h
- Women under 50 years: up to 20 mm/h
- Women over 50 years: up to 30 mm/h
Elevated ESR values during pregnancy are considered physiologically normal and do not necessarily indicate disease.
Causes of Elevated ESR
An accelerated sedimentation rate may indicate a variety of conditions, including:
- Infections: bacterial or viral, such as pneumonia or tuberculosis
- Inflammatory diseases: rheumatoid arthritis, Crohn's disease, ulcerative colitis
- Autoimmune conditions: lupus erythematosus, polymyalgia rheumatica
- Malignancies: various cancers, particularly multiple myeloma
- Anaemia: low red blood cell count from various causes
- Pregnancy and post-surgical states
Causes of Decreased ESR
A lower-than-normal ESR is less commonly clinically significant but may be observed in:
- Polycythaemia (excess production of red blood cells)
- Sickle cell anaemia
- Heart failure
- Liver disease with reduced fibrinogen production
Clinical Relevance and Limitations
The ESR is a non-specific test: an elevated value signals that inflammation or tissue damage is present somewhere in the body, but it does not identify the underlying cause. It is therefore always interpreted alongside other laboratory values, particularly C-reactive protein (CRP), a full blood count, and other relevant markers. While the ESR is inexpensive and widely available, it responds more slowly to acute inflammation compared to CRP.
When is the ESR Used?
The ESR is typically ordered in the following clinical situations:
- Suspected inflammatory or infectious disease
- Monitoring of chronic inflammatory conditions such as rheumatoid arthritis
- Routine health screening
- Investigation of unexplained symptoms such as persistent fatigue, fever, or unintentional weight loss
References
- Gabay, C. & Kushner, I.: Acute-phase proteins and other systemic responses to inflammation. New England Journal of Medicine, 340(6), 448-454, 1999.
- World Health Organization (WHO): Use of Anticoagulants in Diagnostic Laboratory Investigations. WHO/DIL/LAB/99.1. Geneva, 2002.
- Tishkowski, K. & Gupta, V.: Erythrocyte Sedimentation Rate. In: StatPearls. StatPearls Publishing, Treasure Island (FL), 2023.
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