Erythrocyte sedimentation rate

Keywords: ESR

Specimen:

2 mL blood added to 0.5 mL citrate, or special tube provided by laboratory.

Method:

Blood placed in vertical tube; length (in mm) of column of plasma above sedimented red cells at 1 hour is the ESR.

Reference Interval:

Refer to laboratory.

Application:

The ESR should not be used to screen asymptomatic patients for the presence of disease.

It is a non-specific indicator of inflammatory and neoplastic disease and has limited utility outside specific indications as outlined below; C-Reactive protein is a more sensitive early indicator of an acute phase response.

Diagnosis and monitoring of Temporal arteritis and Polymyalgia rheumatica.

Follow up of Osteomyelitis and prosthetic joint infection.

Interpretation:

A normal ESR does not exclude active disease.

The ESR increases with age, and is raised in pregnancy and in anaemia; mild to moderate elevations should be interpreted with caution in these situations.

It is increased in acute and chronic inflammatory disease and in neoplastic disease.

The ESR may be very high (> 100 mm in 1 hour) in Plasma cell myeloma and autoimmune disease, especially Temporal arteritis (giant cell arteritis), Polymyalgia rheumatica and Systemic lupus erythematosus.

A low ESR (< 1 mm in 1 hour) may be seen in Polycythaemia vera and Sickle cell disorders.

See also C-Reactive protein and Acute phase reactants.

Reference:

ICSH. Br J Haematol 1973; 24: 671-673.

ICSH. Am J Clin Pathol 1977; 68: 505-507.