Complete Hemogram Test - ESR

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CBC with ESR.

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Complete Hemogram Test - ESR (Erythrocyte Sedimentation Rate)

Why is it done?
- The ESR (Erythrocyte Sedimentation Rate) measures the rate at which red blood cells settle at the bottom of a test tube over one hour, indicating the presence of inflammation or infection in the body
- Diagnose inflammatory conditions such as rheumatoid arthritis, systemic lupus erythematosus, and vasculitis
- Detect infections including bacterial, viral, and fungal infections
- Monitor disease progression and response to treatment in chronic conditions
- Screen for malignancies and monitor cancer patients during treatment
- Evaluate patients presenting with fever, unexplained weight loss, or general malaise
- Part of routine complete hemogram workup for comprehensive blood assessment
Normal Range
- Males: 0-15 mm/hour
- Females: 0-20 mm/hour
- Children: 0-10 mm/hour
- Unit of measurement: millimeters per hour (mm/hour or mm/hr)
- Interpretation:
- Normal ESR: Red blood cells settle at a slow, steady rate. This typically indicates absence of significant inflammation or infection
- Elevated ESR (High): Red blood cells settle faster than normal, suggesting acute or chronic inflammation, infection, or systemic disease
- Low ESR (Rare): Red blood cells settle slower than normal, which can indicate polycythemia vera, sickle cell disease, or certain blood disorders
Interpretation
- Mildly Elevated (15-30 mm/hour):
- May indicate minor inflammation, recent infection, stress, or benign conditions
- Moderately Elevated (30-60 mm/hour):
- Suggests active inflammation or infection; warrants further investigation with additional tests
- Markedly Elevated (>60 mm/hour):
- Indicates severe inflammation, active infection, malignancy, or significant systemic disease requiring urgent evaluation
- Factors Affecting Results:
- Age: ESR naturally increases with age; normal ranges may be higher in elderly patients
- Pregnancy: ESR significantly increases during pregnancy and postpartum period
- Anemia: Lower hemoglobin increases ESR due to increased red cell settling
- Polycythemia: Higher hemoglobin decreases ESR
- Medications: Anti-inflammatory drugs, corticosteroids, and NSAIDs can lower ESR
- Temperature: Room temperature variations can affect test results
- Time of day: ESR may vary slightly depending on time of specimen collection
- Clinical Significance:
- ESR is non-specific and sensitive but not diagnostic for any particular condition
- Must be interpreted alongside clinical presentation and other laboratory findings
- Trend in values over time is more clinically meaningful than a single result
- Useful for monitoring disease activity and treatment response in chronic inflammatory conditions
Associated Organs
- Primary Organ Systems Involved:
- Hematopoietic system (bone marrow, blood vessels): Production and function of red blood cells
- Immune system: Inflammatory response and infection detection
- Conditions Associated with Elevated ESR:
- Rheumatoid arthritis: Chronic autoimmune joint inflammation
- Systemic lupus erythematosus (SLE): Multisystem autoimmune disease
- Temporal arteritis: Inflammation of medium and large arteries
- Polymyalgia rheumatica: Inflammation of multiple muscle groups
- Vasculitis: Inflammation of blood vessels
- Bacterial infections: Pneumonia, meningitis, endocarditis, tuberculosis
- Multiple myeloma: Malignant plasma cell tumor
- Lymphomas and leukemias: Blood and lymphatic cancers
- Myocardial infarction: Heart muscle inflammation following heart attack
- Pericarditis: Inflammation of heart membrane
- Inflammatory bowel disease: Crohn's disease and ulcerative colitis
- Kidney diseases: Glomerulonephritis, pyelonephritis
- Thyroid disorders: Thyroiditis
- Potential Complications of Elevated ESR:
- Untreated inflammation may lead to tissue damage and organ dysfunction
- Chronic infections may spread or develop complications if not properly diagnosed and treated
- Undetected malignancies may progress to advanced stages
Follow-up Tests
- Recommended Follow-up Tests for Elevated ESR:
- C-Reactive Protein (CRP): Another acute phase reactant to confirm inflammation
- Complete Blood Count (CBC): Assess all blood cell counts for anemia, infection, or malignancy
- Comprehensive Metabolic Panel (CMP): Evaluate liver and kidney function
- Rheumatoid Factor and Anti-CCP Antibodies: Diagnose rheumatoid arthritis
- Antinuclear Antibody (ANA) Panel: Screen for systemic autoimmune diseases like SLE
- Blood Culture: Identify bacterial infections if infection is suspected
- Imaging Studies (Chest X-ray, CT scan): Visualize affected organs and identify infection sites
- Thyroid Function Tests (TSH, T3, T4): Assess thyroid inflammation if thyroiditis suspected
- Tissue Biopsy: Confirm diagnosis if malignancy or specific inflammatory condition suspected
- Monitoring Frequency:
- Baseline testing followed by repeat ESR at regular intervals (2-4 weeks) depending on condition severity
- Monthly monitoring during active treatment phase
- Quarterly testing during maintenance therapy for chronic conditions
- Serial measurements more valuable than single result for assessing disease activity and treatment response
Fasting Required?
- Fasting Required: No
- ESR is independent of food or drink intake and does not require fasting
- Patient Preparation Requirements:
- No special preparation required
- Patient can eat and drink normally before the test
- Simple blood draw procedure via venipuncture from antecubital vein
- Collect sample in EDTA (ethylenediaminetetraacetic acid) tube or citrate tube depending on protocol
- Medications:
- No specific medications need to be avoided before ESR testing
- However, inform phlebotomist of all current medications as some may affect results
- Anti-inflammatory medications and corticosteroids may lower ESR values
- Additional Instructions:
- Maintain room temperature during specimen handling (avoid excessive heat or cold)
- Test must be performed within 2-4 hours of blood collection for accurate results
- Blood sample should not be agitated excessively as this affects sedimentation rate
- Avoid scheduling test immediately after strenuous exercise or emotional stress if possible
- Inform physician if patient is menstruating, as this may slightly elevate ESR

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