II. Mechanism

  1. Acute phase reactants in blood
    1. Nonspecifically bind to Red Blood Cells
    2. Increases sedimentation rate
  2. Measures settling rate of anticoagulated erythrocytes
    1. Height of RBCs that settle in tube within 1 hour
  3. Marker of tissue inflammation
    1. High Test Sensitivity
    2. Low Test Specificity
  4. Dynamics of sedimentation rate
    1. Rises >24 hours after inflammation onset and symptoms
    2. Gradually returns to normal 4 weeks after resolution

III. Interpretation: Normal

  1. Newborn: 0-2 mm/hour
  2. Children: 3-13 mm/hour
  3. Women
    1. Range for ages 18 to 50 years: 1-20 mm/hour
    2. Range for age over 50 years: 1-30 mm/hour
    3. Normal Maximum: (Age in years + 10) / 2
  4. Men
    1. Range for ages 18 to 50 years: 1-15 mm/hour
    2. Range for age over 50 years: 1-20 mm/hour
    3. Normal Maximum: (Age in years) / 2

IV. Indications

  1. Grades acute illness severity in Emergency Setting
    1. 299 Peds patients with Limp, Abdominal Pain, Fever
      1. ESR >50 (n=101): 56% had significant illness
      2. ESR 20-50 (n=109): 27% had significant illness
      3. ESR <20 (n=89): 8% had significant illness
    2. Where significant illness
      1. Rheumatoid Arthritis
      2. Osteomyelitis
      3. Pneumonia
      4. Pyelonephritis
    3. Reference
      1. Huttenlocher (1997) Clin Pediatr 339-44 [PubMed]
  2. Diagnosis of Rheumatic Conditions
    1. Polymyalgia Rheumatica (Test Sensitivity: 80%)
    2. Temporal Arteritis (Test Sensitivity: 95%)
  3. Staging of condition
    1. Rheumatic conditions with waxing and waning course
    2. Rheumatoid Arthritis

V. Causes: Falsely decreased ESR (interfere with rouleaux formation)

  1. Severe Leukocytosis
  2. Red Blood Cell abnormalities
    1. Acanthocytosis (crenated RBCs that are shrunk and notched, such as when in hypertonic solution)
    2. Poikilocytosis
    3. Anisocytosis (unequal sized RBCs)
    4. Spherocytosis
    5. Sickle Cell Disease
    6. Microcytosis (e.g. Iron Deficiency Anemia)
    7. Polycythemia
  3. Protein abnormalities
    1. Hypofibrinogenemia
    2. Hypogammaglobulinemia
    3. Macroglobulinemia or other dysproteinemia (e.g. Hyperviscosity Syndrome)
  4. Lab error
    1. Clotted blood sample
    2. Tube vibration during measurement
    3. Short tube
    4. Inadequate mixing of sample
    5. Dilution problem

VI. Causes: Increased ESR due to miscellaneous factors

  1. Older age (increased Fibrinogen level)
  2. Female gender
  3. Pregnancy
  4. Lab error (e.g. dilution error, tube tilted during measurement, increased Temperature of specimen)

VII. Causes: Increased ESR in Infectious Disease

  1. Bacterial Infections
  2. Infectious hepatitis
  3. Cat Scratch Disease
  4. Post-perfusion syndrome
  5. Primary Atypical Pneumonia
  6. Tuberculosis
  7. Secondary Syphilis
  8. Leptospirosis
  9. Systemic Fungal Infection

VIII. Causes: Increased ESR in Hematologic and Neoplastic Disease

  1. Severe Anemia or macrocytosis
  2. Leukemia
  3. Lymphoma
  4. Metastatic tumor
  5. Chronic Granulomatous Disease
  6. Increased Fibrinogen level

IX. Causes: Increased ESR in Gastrointestinal Disease

X. Causes: Increased ESR in Collagen Vascular Disease

XI. Causes: Increased ESR in Renal disease

XII. Causes: Increased ESR in Miscellaneous disorders

  1. Hypothyroidism
  2. Thyroiditis
  3. Sarcoidosis
  4. Infantile cortical hyperostosis
  5. Trauma from surgery or Burn Injury
  6. Drug Hypersensitivity Reaction

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Related Studies

Ontology: Erythrocyte sedimentation rate measurement (C1176468)

Definition (NCI) A quantitative measurement of the distance that red blood cells travel in one hour in a sample of unclotted blood.
Definition (NCI_NCI-GLOSS) The distance red blood cells travel in one hour in a sample of blood as they settle to the bottom of a test tube. The sedimentation rate is increased in inflammation, infection, cancer, rheumatic diseases, and diseases of the blood and bone marrow.
Definition (NCI_CDISC) The distance (e.g. millimeters) that red blood cells settle in unclotted blood over a specified unit of time (e.g. one hour).
Concepts Laboratory Procedure (T059)
SnomedCT 103208001, 165464006, 142875000, 65920009, 416838001
CPT 85651, 1011860
LNC LP16409-2, MTHU007980
English Erythrocyte sedimentation rate, erythrocyte sedimentation rate (lab test), erythrocyte sedimentation rate, Erythrocyte Sedimentation Rate Measurement, esrs, rate sedimentation, erythrocyte sedimentation rates, sedimentation rate, erythrocyte rate sedimentation, erythrocyte sedimentation rate (ESR), erythrocytes rate sedimentation, rates sedimentation, Red blood cell sedimentation rate, Erythrocyte sedimentation rate (& level), Sedimentation rate, Sedimentation rate (procedure), Erythrocyte sedimentation rate (observable entity), Erythrocyte sedimentation rate (& level) (procedure), Sedimentation rate, erythrocyte, Biernacki Reaction, ESR, Erythrocyte Sedimentation Rate, Erythrocyte Sedimentation Rate Measurements, Sedimentation rate, NOS, ESR - Erythrocyte sedimentation rate, Erythrocyte sedimentation rate measurement (procedure), Erythrocyte sedimentation rate measurement
Italian Velocità di eritrosedimentazione, VES
Dutch erytrocytensedimentatiesnelheid, rode bloedcelsedimentatiesnelheid
French VS (vitesse de sédimentation), Taux de sédimentation érythrocytaire, Vitesse de sédimentation
German Blutkoerperchensenkungsrate, ESR, Blutkoerperchensenkung
Portuguese Velocidade de sedimentação, VS, Velocidade de sedimentação eritrocítica
Spanish Velocidad de sedimentación de glóbulos rojos, VSG, tasa de sedimentación, velocidad de sedimentación de glóbulos rojos, velocidad de eritrosedimentación, velocidad de sedimentación eritrocítica, tasa de sedimentación (procedimiento), velocidad de sedimentación eritrocítica (entidad observable), velocidad de sedimentación de eritrocitos, Velocidad de sedimentación eritrocitaria, determinación de la velocidad de eritrosedimentación (procedimiento), determinación de la velocidad de eritrosedimentación
Japanese 血沈検査, ESR, ケッチンケンサ, ESR
Czech Sedimentace červených krvinek, FW
Hungarian Vörösvértest süllyedés, Eritrocita süllyedés, ESR