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ESR (Erythrocyte Sedimentation Rate)
Blood
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No Fasting Required
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Erythrocyte sedimentation rate; elevated in chronic inflammation, autoimmune disease, or infection.
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ESR (Erythrocyte Sedimentation Rate) - Comprehensive Medical Test Guide
- Why is it done?
- Test Description: Measures the rate at which red blood cells settle in a test tube over one hour, indicating the presence of inflammation or infection in the body
- Primary Indications: Detect inflammatory conditions, autoimmune diseases, infections, and malignancies; screen for systemic disease
- Typical Ordering Circumstances: Patient presents with unexplained symptoms such as fever, fatigue, or joint pain; monitoring disease activity in known inflammatory conditions; evaluating response to treatment; assessing general health status
- Common Clinical Scenarios: Follow-up for rheumatoid arthritis, temporal arteritis, polymyalgia rheumatica, infection assessment, cancer screening, and general medical evaluation
- Normal Range
- Reference Ranges (mm/hour): Males: 0-15 mm/hour; Females: 0-20 mm/hour; Children: 0-10 mm/hour; Pregnant Women: up to 30-40 mm/hour
- Unit of Measurement: Millimeters per hour (mm/hour) or millimeters per 60 minutes
- Normal Result Interpretation: ESR within normal range suggests minimal inflammation or infection; generally associated with good health or well-controlled chronic disease
- Elevated ESR Interpretation: Indicates presence of inflammation, infection, or other systemic process; may suggest active disease requiring further investigation
- Result Classification: Mildly elevated: 20-40 mm/hour; Moderately elevated: 40-60 mm/hour; Markedly elevated: >60 mm/hour
- Interpretation
- Mildly Elevated Results (20-40 mm/hour): May indicate minor infection, inflammation, anemia, or normal variant; requires clinical correlation with patient symptoms and physical examination findings
- Moderately Elevated Results (40-60 mm/hour): Suggests active inflammation, infection, or systemic disease; warrants further diagnostic investigation and clinical assessment
- Markedly Elevated Results (>60 mm/hour): Indicates significant systemic disease or severe inflammation; may suggest malignancy, severe infection, temporal arteritis, or other serious conditions
- Factors Affecting ESR Results: Age (increases with age); Pregnancy (elevated); Menstrual cycle; Anemia (increases ESR); Polycythemia (decreases ESR); Medications (corticosteroids lower ESR); Fibrinogen and immunoglobulin levels; Red blood cell morphology; Temperature of test environment
- Non-Specific Nature: ESR is a non-specific marker; elevated results do not indicate specific diagnosis; must be interpreted alongside clinical symptoms, physical examination, and other laboratory tests
- Clinical Significance: Useful for monitoring disease progression and treatment response; can indicate need for additional diagnostic testing; helps clinicians assess disease activity in chronic inflammatory conditions
- Associated Organs and Conditions
- Primary Organ Systems: Hematologic system (blood); Immune system; Connective tissues; Multiple organ systems can be affected
- Autoimmune and Rheumatologic Conditions: Rheumatoid arthritis; Systemic lupus erythematosus (SLE); Polymyalgia rheumatica; Temporal arteritis; Vasculitis; Scleroderma; Sjögren's syndrome
- Infectious Conditions: Bacterial infections; Tuberculosis; Endocarditis; Pneumonia; Pyelonephritis; Osteomyelitis; Viral infections (variable elevation)
- Malignancy-Related Conditions: Lymphomas; Leukemias; Solid tumors; Multiple myeloma; Cancer-related inflammation and paraneoplastic syndromes
- Other Medical Conditions: Myocardial infarction; Inflammatory bowel disease; Chronic kidney disease; Anemia; Diabetes; Hypothyroidism; Hyperfibrinogenemia
- Potential Complications Associated with Abnormal Results: Progression of underlying inflammatory disease; Organ damage if untreated; Complications from undiagnosed infection; Delays in cancer diagnosis; Compromised immune function
- Follow-up Tests and Monitoring
- Common Follow-up Laboratory Tests: Complete blood count (CBC); C-reactive protein (CRP); Blood cultures; Comprehensive metabolic panel; Thyroid function tests; Autoimmune antibody panels (ANA, RF, anti-CCP); Immunoglobulin levels
- Imaging Studies: Chest X-ray; Ultrasound; CT scan; MRI; Positron emission tomography (PET) scan for suspected malignancy
- Specialized Testing: Biopsy procedures; Tissue analysis; Pathology review; Genetic testing when indicated; Microbiologic cultures
- Monitoring Frequency for Known Conditions: Rheumatoid arthritis: Every 3-6 months; Temporal arteritis: Every 1-2 months initially; Polymyalgia rheumatica: Every 2-4 weeks during treatment; Infection monitoring: Weekly to monthly depending on condition; Post-treatment: 4-6 weeks after treatment completion to assess response
- Complementary Tests: CRP (more specific for acute inflammation); Plasma viscosity (alternative to ESR); Fibrinogen levels; Prothrombin time (PT); Liver function tests; Kidney function tests
- Assessment of Treatment Response: Repeat ESR testing after initiating treatment; Should show gradual decline with effective therapy; Persistent elevation may indicate inadequate treatment or progression
- Fasting Required?
- Fasting Requirement: No - Fasting is NOT required for ESR testing
- Dietary Restrictions: None - Patient may eat and drink normally before test; No special dietary modifications needed
- Medication Instructions: Continue all routine medications unless specifically instructed otherwise by physician; NSAIDs and corticosteroids may lower ESR (inform physician of current medications)
- Patient Preparation: Wear comfortable, loose-fitting clothing for blood draw; Ensure adequate hydration; Arrive a few minutes early to relax; Notify phlebotomist of any needle anxiety
- Specimen Collection Details: Small amount of blood drawn via venipuncture; Specimen placed in tube with anticoagulant (usually EDTA or citrate); Test performed immediately or within specific timeframe; Sample stability important for accurate results
- Timing Considerations: Test can be performed at any time of day; No special timing requirements; Early morning testing generally preferred for consistency
- Additional Notes: Blood test typically takes less than 5 minutes; Results usually available within 24-48 hours; Some labs may provide same-day results; Actual ESR measurement takes approximately 1 hour to complete
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