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Erythrocyte sedimentation rate (ESR)

Clinical significance

Although ESR is neither specific nor absolutely accurate test, it is very useful in inflammatory process monitoring.
The cause of ESR increase remains unexplained in 5% of cases. Young individuals (aged 18-33 years) with a constant slight increase in ESR values are at a 5-fold risk of disease.

Pathologic changes

Increased ESRDecreased values
• abscess of lung,
• acute and chronic infections,
• acute appendicitis,
• acute cholecystitis,
• acute poststreptococcal glomerulonephritis,
• agranulocytosis,
• allergic purpura,
• amebiasis,
• amyloidosis,
• analbuminemia,
• anemia,
• arteritis temporalis, temporal arteritis;
• asbestosis,
• bacterial endocarditis,
• Behcet’s syndrome,
• carcinoma of the kidney,
• chronic bronchitis,
• chronic renal failure,
• cranial arteritis and related conditions,
• Crohn’s disease,
• cystinosis,
• dermatomyositis/polymyositis,
• dextran therapy (ESR may rise up to 75 mm/h; the values normalize in 11-15 days of therapy completion),
• dysproteinemia (ESR >100 mm at 1 hour; in blood smear, erythrocytes are found in the for of rouleaux),
• elderly individuals (in men and women aged >60, 1-hour ESR values may frequently reach 20 and 30 mm, respectively);
• gout,
• Guillain-Barre syndrome,
• Henoch-Schönlein’s purpura,
• Hodgkin’s disease,
• hormonal contraception (for fibrinogen concentration increase);
• hydronephrosis,
• hyperlipoproteinemia, especially in the presence of chylomicrons;
• hyperparathyroidism,
• increase in concentration of immunocomplex,
• increase in concentration of immunoglobulin,
• intracranial abscess,
• juvenile rheumatoid arthritis,
• Laennec’s or alcoholic cirrhosis,
• leptospirosis,
• liver cirrhosis,
• macrocytosis,
• menses (highest value in the immediate premenstrual period);
• metastatic tumor,
• multiple myeloma,
• neoplastic syndromes and degenerative diseases;
• nephrotic syndrome,
• non-Hodgkin’s lymphoma,
• peptic ulcer,
• polyarteritis nodose,
• polymyalgia rheumatica,
• pregnancy (ESR continuously rises to the fourth month of gestation, with a maximal value of 45 mm/h, and normalizes in 3-4 weeks postpartally),
• process of tuberculosis,
• pulmonary embolism and infarction,
• pulmonary tuberculosis, pulmonary tuberculosis.
• pyelonephritis,
• rheumatic disease,
• rheumatic fever,
• rheumatoid arthritis,
• rheumatoid spondylitis,
• septicemia,
• silicosis,
• Sjögren’s syndrome,
• SLE,
• subacute thyroiditis, subacute thyroiditis;
• syphilis,
• tularemia,
• Waldenström’s macroglobulinemia.
• a-β-lipoproteinemia,
• factor v deficiency,
• hereditary spherocytosis,
• infectious mononucleosis,
• cryoglobulinemia,
• newborns (ESR is very low because of high hematocrit and low fibrinogen concentration),
• polycythemia rubra vera (ESR may be 0 mm/h),
• polyglobulia (ESR is decreased because of slow erythrocyte sedimentation),
• progressive systemic sclerosis.