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BLOOD >> Test >> Erythrocyte Sedimentation Rate (ESR)

To determine the presence of one or more types of conditions, including infections, tumors, inflammation, and those leading to the breakdown or decreased function of tissue or organs (degenerative), and/or to monitor the progress of disease or effect of therapy.

The erythrocyte sedimentation rate (ESR) is an easy, inexpensive, nonspecific test that has been used for many years to help detect conditions associated with acute and chronic inflammation, including infections, cancers, and autoimmune diseases. ESR is said to be nonspecific because increased results do not tell the doctor exactly where the inflammation is in the body or what is causing it, and also because it can be affected by other conditions besides inflammation. For this reason, the ESR is typically used in conjunction with other tests.

ESR is helpful in diagnosing two specific inflammatory diseases, temporal arteritis and polymyalgia rheumatica. A high ESR is one of the main test results used to support the diagnosis. It is also used to monitor disease activity and response to therapy in both of these diseases.

An ESR may be ordered when a condition or disease is suspected of causing inflammation somewhere in the body. A physician may order an ESR test (along with other tests) to evaluate a patient who has symptoms that suggest polymyalgia rheumatica or temporal arteritis, such as headaches, neck or shoulder pain, pelvic pain, anemia, unexplained weight loss, and joint stiffness. There are many other conditions that can result in a temporary or sustained elevation in the ESR.

Since ESR is a nonspecific marker of inflammation and is affected by other factors, the results must be used along with the doctor’s other clinical findings, the patient’s health history, and results from other appropriate laboratory tests.

Moderately elevated ESR occurs with inflammation, but also with anemia, infection, pregnancy, and old age. A very high ESR usually has an obvious cause, such as a marked increase in globulins that can be due to a severe infection. The doctor will use other follow-up tests, such as blood cultures, depending on the patient’s symptoms. People with multiple myeloma or Waldenstrom’s macroglobulinemia (tumors that make large amounts of immunoglobulins) typically have very high ESRs even if they don’t have inflammation. As noted before, those with polymyalgia rheumatica or temporal arteritis may also have very high ESRs. A rising ESR can mean an increase in inflammation or a poor response to a therapy; a decreasing ESR can mean a good response.

Although a low ESR is not usually a cause for concern, it can be seen with conditions that inhibit the normal sedimentation of RBCs, such as polycythemia, extreme leukocytosis, and some protein abnormalities. Some changes in red cell shape (such as sickle cells in sickle cell anemia) also lower the ESR.

ESR and C-reactive protein (CRP) are both markers of inflammation. Generally, ESR does not change as rapidly as does CRP, either at the start of inflammation or as it goes away. CRP is not affected by as many other factors as is ESR, making it a better marker of inflammation.

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