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Subject: Erythrocyte Sedimentation Rate (ESR)
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ESR is the distance in millimeters that erythrocytes fall during 1 hour in a sample of venous blood (Westergren principle). Newer techniques allow the test to be performed in 30 minutes, resulting in improved turnaround time.
Normal range: 0–15 mm/hour in men and 0–20 mm/hour in women.
ESR is not a good screening test because of its low sensitivity. CRP is superior to ESR because it is more sensitive and reflects a more rapid change in the patient's condition. ESR may be used as a screening test to detect the presence of a systemic disease; however, a normal test does not exclude malignancy or other serious disease, although it does rule out temporal arteritis or polymyalgia rheumatica.
Finding a much accelerated ESR (>100 mm/hour) in patients with ill-defined symptoms directs the physician to search for a severe systemic disease, especially paraproteinemias, disseminated malignancies, connective tissue diseases, and severe infections such as bacterial endocarditis.
Finding a normal ESR in patients with paraproteinemia suggests the development of hyperviscosity syndrome.
ESR is also used to monitor the course or response to therapy of diseases if greatly accelerated initially.
Vasculitis, including temporal arteritis
Malignancies and plasma cell dyscrasias
Tissue injury, including myocardial infarction
Pregnancy (but not first trimester)
Sickle cell anemia
Typhoid and undulant fever, malarial paroxysm, trichinosis, pertussis, infectious mononucleosis, uncomplicated viral diseases
Increased fibrinogen; increased gamma- and betaglobulins
Drugs (dextran, penicillamine, theophylline, vitamin A, methyldopa, methysergide)
Technical factors (e.g., hemolyzed sample, high temperature in the laboratory)
Abnormally shaped RBCs (sickle cells, spherocytes, acanthocytes)
Technical factors (low temperature in the laboratory, clotted blood)
Drugs (quinine, salicylates, high steroid levels, drugs that cause high glucose levels)