What is sed rate?
Sed rate is a short form for Erythrocyte sedimentation rate and abbreviated to ESR Test too.
Sedimentation rate blood test is measured by letting an amount of blood to separated and settled to the bottom of a tube in a certain amount of time, so that the RBC sed rate is the volume of Red blood Cells precipitated in an hour time.
What is sed rate used for?
Why my doctor want me to take ESR blood test?
The main purpose to measure the rate of RBC sedimentation is to monitor the inflammation progress, Inflammation means normally increased body defense due to existence of injury or casual agent such as the trauma, post surgery, infection by bacteria or worms, and allergic reaction in response to immunological reasons as in Systemic Lupus Erythromatosus and Rheumatoid Fever or Non immunological causes as acquired allergies by drugs.
Such Inflammatory response triggers the body proteins and cells in so called “Exudate”, RBC become heavy and ill due to high weight blood content.
ESR usually important component of general medical checkup
ESR and C-Reactive Protein are tests used both as bio-markers of inflammation to improve diagnostic sensitivity and specificity
We can conclude why doctor choose ESR to diagnose diseases?
To clarify what causes the symptoms such as in whooping cough or pertussis.
To confirm or verify previous diagnosis of a disease such as TB.
To screen people of a high risk for a specific disease like aged people
To preliminary diagnosis such Arthritis, temporal arthritis, systemic vasculitis, and polymyalgia rheumatica.
To indicate the severity of a disease such in Sore throat and tonsillitis
To state the progression of a disease
To decide the effectiveness of a treatment especially with antibiotics
Sedimentation normal rates are:
Sed rate values is higher in women than men and more higher in older people than younger.
When Eryth. Sed. Rate exceeds predefined normal value we report that ESR is High.
Sedimentation rate Normal levels in general,
Men 0–15 millimeters per hour (mm/hr), or 0–20 mm/hourr for men older than 50
Women 0–20 mm/hr, or 0–30 mm/hr for women older than 50
Children 0–10 mm/hour
Neonatal to puberty: 3 to 13 mm/h, but other laboratories place an upper limit of 20
Newborns 0–2 mm/first hour
You can comment with your results to explain it for you.
What is sed rate westergren blood test or westerngren ESR?
A diagnostic technique used in blood measurement of Blood Sed rate.
Sed rate by modified westergren method is:
Certain long tube called westergren tube
An amount of anticoagulant usually Citrate is placed into tube.
Equivalent amount of fresh blood is mixed with anticoagulant and covered.
The tube is hanged vertically perpendicular to the ground
Record Precipitated volume every hour.Stages in erythrocyte sedimentation:
There are 3 stages in erythrocyte sedimentation 1) Stage 1 : Rouleaux formation – First 10 minutes 2) Stage 2 : Stage of sedimentation or settling – 40 mins 3) Stage 3 : Stage of packing – 10 minutes, sedimentation slows and cells start to pack at the bottom of the tube
The Westergren method is the most sensitive of the sedimentation rate methods because of the longer tube, but it requires more blood.
The Wintrobe method requires a smaller amount of blood and involves no dilution. In addition, once the ESR has been read, the Wintrobe tube can be centrifuged to obtain a macrohematocrit, and blood films can be made from the buffy coat. However, because of the shorter column of blood, the Wintrobe methods is not as sensitive as the Westergren.
WINTROBE ESR Method Normal Values
0 – 7 mm/hr
0 – 15 mm/hr
WESTERGREN ESR Method Normal Levels
Less than age 50 yrs
Male 0 – 10 mm/hr
Female 0 – 20 mm/hr
Children 4 – 14 yrs 0 – 20 mm/hr
Greater than 50 yrs age
Male 0 – 20 mm/hr
Female 0 – 30 mm/hr
Erythrocyte Sedimentation rate blood test results Explained
1- Causes of ESR greater than 100 mm/1st Hour
Autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, or inflammation of the thyroid gland (Graves’ disease).
Diseases caused by attack of autoantibodies to the body’s cells are called immunological auomimmuonolgical disorders, in such diseases the body antibodies attack the body cells and proteins instead of attacking foreign substances, many organs affected and the body become very ill which impact on health of Red blood cells, thus sed rate of Red cells become very high, usually ESR is over 100 mm after the first hour.
Other tests: WBC less than 4.0 *10^9 cells
RF is Positive in RA patients
LE cells test is Positive in SLE Patients.
Positive Autoantibodies Anti-dsDNA and antinuclear antibody test (ANA), over 1.0 in cut-off reports
Ani-TSH Positive test in grave’s disease.
Arthritis due to gout show Uric Acid test over than 6.0 mg/dl
Hb% may be lower than 8.0 mg/dl due to chronic inflammation Anemia.
Cancer, such as lymphoma or multiple myeloma.
Lymphoma are kind of cancers affect lymphatic tissue and caused by viruses as Epstein-bar virus or HIV and cause signs like painless enlargement of lymph nodes, in addition to feeling tired with fevers, night sweats, itchiness, and weight loss.
Multiple Myeloma or Kahler’s disease is sub-kind of lymphomas in which some kind of defensive blood cells called plasma cells become cancerous and abnormally proliferate and accumulate in bone marrow and other marrows. Plasma cells contain and produce Bence Jones proteins in excessive amounts causing inflammation of kidney, however those cells are helpful in normal levels.
Elevated ESR in malignancies is a result of excessive protein content in patient’s blood fluid.
ESR blood test usually over 100 mm after first hour however High ESR extends as the cancer persists.
Other testing results: FBC show WBC over 50.000 cells or over 500.000 cells mostly lymphocytes (normal 4 – 11 *10^9 cell/mL)
Urine Bence Jones protein test is Positive in multiple myeloma disease exclusively.
Low Hb% due to Anemia.
2-Causes of moderate high ESR results
Chronic kidney disease.
Why Sed rate increases in kidney diseases? the reasons may be due to inflammation of kidney units called Nephrons which is the the responsible organs in kidney functioning, Loss of Nephrons function leads to kidney failure to filtrating the blood of toxins and thus accumulate in the blood and cause blood cells to overburden, and this is enough to become very high blood sedimentation speed.
ESR is 50 – 75 mm/1st hour in adults, over 100 in late stages.
Other testing results:
Creatinine is 1.5 – 10.0 mg/dlInflammatory diseases due to Bacterial infection of Kidney, bone, joint, skin, or heart valve infections, such as pneumonia, pelvic inflammatory disease, or appendicitis.
ESR is moderately elevated usually 15 – 40 mm/ first hour, 25 – 80 after second hour.
Other test results:CRP titres more than 12.0 mg/dl and up to 48.0 mg/dl in 24 hours
FBC show abnormal white blood cells morphology and count as well as mild anemia.Pregnancy and preeclampsia (toxemia of pregnancy).
Pregnancy is normal increase in body processes due to gestation, the matter which cause high loaded blood flow with nutrients for he fetus, causing temporarily increased sed rate, However toxemia of pregnancy caused by infiltration of fetus proteins into mother’s blood stream, which do the same role in overloading blood fluid.
ESR blood test is mild/moderate high, first hour sed rate between 20 – 40 mm.
Anemia, Hb% lower than 9.0 in such cases due to iron deficiency during pregnancy.
Other causes of high esr count
Inflammation of joints (such as polymyalgia rheumatica) and blood vessels (such as giant cell arteritis).
3- Causes of low ESR values
Values of ESR between 0 – 10 and 20 mm
Sed rate are in normal ranges in certain diseases such as:
High blood sugar levels.
Sickle cell disease.
Severe liver disease.
Congestive Heart failure
Sed rate False Positive Negative Results
Please read carefully the factors and requirements to understand why ESR results may be not correct.
Best time to take ESR test is during he day, Fasting before esr test is preferred about 4 – 6 hours for those not suffering from clear complains.
Test must be set 1 hour after collection or up to 6 hours if sample refrigerated.
Read Results every 60 minutes, any delay will alter the results.
The ESR is affected by a number of mechanical and technical factors.
Anticoagulant is EDTA or Sodium Citrate (blue-top tube), other anticoagulants cause shrinkage to RBC
Tube perpendicular to surface, any Horizontal degrees will accelerate Sedimentation and end up to false high esr.
Some Newer Westergren tubes have a cotton plug in the “zero” end which prevent leakage of blood from the open end of the tube.
Because the red cell shape affects the rate of fall of the cells, it should be apparent that sickle cells and spherocytes will result in a potential falsely decreased ESR. Other conditions that result in poikilocytosis (variation in the shape of the red cells) will produce similar results.
There is considerable dispute about the effect of severe anemia on the ESR. Some laboratories correct the ESR in cases of severe anemia.