Erythrocyte Sedimentation Rate (ESR): Testing for Inflammation

To Summarize:

  • Inflammation can affect and drive many diseases, including certain autoimmune disease
  • ESR stands for Erythrocyte Sedimentation Rate
  • ESR is a marker of systemic inflammation
  • It represents how sticky our Red blood cells are
  • ESR will identify the presence of inflammation, but will not tell what specifically is causing the inflammation

Erythrocyte Sedimentation Rate (ESR) is a cheap, helpful way we can measure for inflammation in the body. Although it won’t tell us where inflammation is coming from specifically, it does confirm its presence. I often run this test to track disease progression as well as treatment effectiveness.

Testing for Inflammation

Testing provides many important insights into disease: We can use testing to make a diagnosis, track how severe a disease is or how well it’s responding to treatment [1].

Inflammation is an immunological response. We can measure inflammation in a person’s body through various tests. One test for inflammation is Erythrocyte Sedimentation Rate (ESR). Click here to learn about some of the others.

What is ESR

Erythrocyte Sedimentation Rate, or ESR is a measurement with which red blood cells (RBC) settle in saline or plasma [2]. ESR increases with inflammation, to testing it in the blood gives us a quantitative measurement of inflammation throughout the body.

Figure 1: ESR measures how quickly red blood cells with settle down and clump together. These test tubes are showing various amounts of red blood cell sedimentation rates: notice how the amount of dark red (red blood cells) are all at various heights in each tube. ESR also incorporates time into this measurement.
Figure 1: ESR measures how quickly red blood cells with settle down and clump together. These test tubes are showing various amounts of red blood cell sedimentation rates: notice how the amount of dark red (red blood cells) are all at various heights in each tube. ESR also incorporates time into this measurement.

ESR is Non-Specific

ESR is not specific, and therefore not diagnostic for any organ disease or injury [2]. ESR is known to increase in both acute and chronic infection as well as inflammatory disease [2]. ESR is often used to evaluate vague symptoms.

Testing ESR

Erythrocyte sedimentation rates (ESR) are useful when evaluating unexplained joint and muscle aches, also unexplained fever. We run this test to help determine severity of inflammatory rate and monitor the effect of treatment.

One downfall of ESR is it is time sensitive; meaning, results have to be collected and interpreted within a few hours. In fact, artificially low results occur when the collected specimen is allowed to stand longer than 3 hours before testing [2].

Results will be reported in the distance (in mm) that red blood cells have descended in one hour.

A normal value for men is considered anything between 0 and 22 mm/hr. A normal value for women is considered anything between 0 and 29 mm/hr.

One downfall with ESR (versus, say CRP) is it’s relatively slow response time. In fact, with Rheumatoid arthritis, ESR correlates well with disease activity, but when we normalize ESR, this often lags behind successful treatment that causes resolution of the inflammatory state [3].

In general: as disease worsens, ESR increases as disease improves, ESR decreases. When ESR doesn’t tell us much, CRP will be tested [2].

Interfering Factors

When we interpret ESR, it’s important to consider all the external factors which may affect the levels. Not to say testing ESR is useless in these conditions, but we need to consider all contributing factors.

  • Elevated ESR seen with [3] [2]:
    • Advanced age
    • Female sex
    • Pregnancy (second and third trimester)
    • During Menstruation
    • RBC morphology, increased hemoglobin concentration and serum levels of immunoglobulin
  • Decreased ESR seen with [2]:
    • Polycythemia
  • Drugs that may cause increased ESR [2]:
    • Dextran
    • Methyldopa
    • Oral contraceptives
    • Penicillinamine
    • Procainamide
    • Theophylline
    • Vitamin A
  • Drugs that may cause deceased ESR [2]
    • Aspirin
    • Cortisone
    • Quinine [2]
  • Certain kidney problems, thyroid disease and some cancers can interfere with ESR (either increase or decrease ESR)

Diseases Associated with High ESR [3] [2]

The following are conditions and diseases known to see elevated ESR. Bolded items are autoimmune in nature.

  • Rheumatoid Arthritis
  • Systemic Lupus Erythematous [4]
  • Inflammatory diseases
  • Chronic renal failure
  • Malignant diseases
  • bacterial infection
  • necrotic tissue diseases
  • Hyperfibrinogenemia
  • Macroglobulinemia
  • Severe anemias (such as iron deficiency or B12 deficiency)

Diseases Associated with Low ESR [3] [2]

The following are conditions and diseases known to see elevated ESR.

  • Sickle cell anemia
  • Spherocytosis
  • Hypofibrinogenemia
  • Polycythemia vera

Summary

ESR is one of many inflammatory markers we can test. It has clinical use in detecting inflammation as well as monitoring severity and success of treatment. Although it wont specifically diagnose a disease or origin of inflammation, this test is important in many ways.

References

About the Author

picture of me, johann de chickera, naturopathic doctor
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Dr. Johann de Chickera works in the cities of Hamilton and Toronto, in Ontario Canada.

His clinical focus lies in Autoimmune Disease. Click here to learn more about Autoimmune Pages.

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