Erythrocyte Sedimentation Rate (ESR) is a common laboratory test that is used to evaluate the presence of inflammation in the body. This non-specific test measures the rate at which red blood cells settle at the bottom of a tube over a certain period of time. Inflammation causes red blood cells to clump together and settle more quickly, resulting in an elevated ESR. The test is often used in combination with other diagnostic tests to help diagnose or monitor the progress of various conditions such as infections, autoimmune diseases, and certain cancers.
Although ESR is a simple and inexpensive test, it has some limitations and is not always reliable in detecting the underlying cause of inflammation. This article provides an overview of the ESR test, its indications, interpretation of results, limitations, and the potential applications in clinical practice.
How is the ESR test performed?
The ESR test is a simple blood test that can be performed in a laboratory or at a doctor’s office. Here is how the test is performed:
- A healthcare professional will clean the area on your arm where the blood will be drawn.
- A needle will be inserted into a vein in your arm, and a small amount of blood will be collected into a tube.
- The collected blood will be mixed with an anticoagulant solution to prevent the blood from clotting.
- The tube will be placed in a rack in an upright position, and the time will be noted.
- After a period of one hour, the height of the clear liquid (plasma) at the top of the tube will be measured.
- The result is reported as the millimeters of clear liquid that are present above the red blood cell layer at the bottom of the tube.
ESR normal values
The normal range of ESR values can vary depending on the age, gender, and health status of the individual being tested. In general, the reference range for ESR is:
- For men under 50 years of age: 0-15 millimeters per hour (mm/hr)
- For women under 50 years of age: 0-20 mm/hr
- For men over 50 years of age: 0-20 mm/hr
- For women over 50 years of age: 0-30 mm/hr
What does a high ESR indicate?
A high ESR indicates the presence of inflammation in the body, but it does not specify the location, cause or severity of the inflammation. The following conditions may cause a high ESR:
- Infections: Bacterial, viral, fungal or parasitic infections can cause an increase in ESR.
- Autoimmune diseases: ESR is commonly used in the diagnosis and monitoring of autoimmune diseases such as rheumatoid arthritis, lupus, and vasculitis.
- Cancer: Some cancers such as lymphoma, multiple myeloma, and leukemia can cause an increase in ESR.
- Inflammatory bowel disease: ESR may be elevated in people with Crohn’s disease or ulcerative colitis.
- Tissue damage: ESR may be elevated after a heart attack, surgery, or trauma.
- Pregnancy: ESR levels normally rise during pregnancy.
- Aging: ESR levels tend to increase with age.
What does a low ESR indicate?
A low ESR (erythrocyte sedimentation rate) is generally considered to be within the normal range and may indicate that there is no significant inflammation or infection in the body. However, a low ESR alone cannot be used to rule out all possible underlying medical conditions.
In some cases, a low ESR may be due to certain medical conditions or factors, such as sickle cell anemia, polycythemia, hypofibrinogenemia, and extreme leukocytosis. Additionally, certain medications, such as corticosteroids, can lower ESR levels.
Therefore, it is important to consider the clinical context in which the ESR test was ordered and interpret the results in conjunction with other clinical and laboratory findings.
Is ESR 40 high?
An ESR value of 40 mm/hour is slightly above the upper limit of the normal range for most laboratories, which is usually 20-30 mm/hour for men and 30-40 mm/hour for women. However, ESR is a non-specific test and the interpretation of the results should always be done in conjunction with other clinical and laboratory findings to determine the underlying condition causing the inflammation.
ESR over 100 causes
An ESR (erythrocyte sedimentation rate) value over 100 mm/hour is significantly elevated and indicates a high level of inflammation in the body. This elevation is not specific to any one particular condition and can be caused by a wide variety of underlying factors, including:
- Infections such as bacterial or viral infections, endocarditis, osteomyelitis, and tuberculosis.
- Autoimmune diseases such as lupus, rheumatoid arthritis, and vasculitis.
- Cancer or malignancy such as lymphoma, multiple myeloma, or leukemia.
- Tissue damage or injury such as burns, heart attack, or trauma.
- Certain medications such as oral contraceptives, methyldopa, and corticosteroids.
- Other inflammatory conditions such as inflammatory bowel disease, sarcoidosis, or Kawasaki disease.
What other tests are usually done along with ESR?
ESR is a non-specific marker of inflammation, and additional tests are often needed to help identify the underlying cause. The following tests may be done in conjunction with ESR:
- C-reactive protein (CRP): CRP is another blood test that can detect inflammation. It is often used in conjunction with ESR to help diagnose or monitor the progress of inflammatory conditions.
- Complete blood count (CBC): A CBC measures the levels of different types of blood cells, including white blood cells, red blood cells, and platelets. An abnormal CBC can indicate the presence of an infection or inflammation.
- Rheumatoid factor (RF): RF is an antibody that is often elevated in people with rheumatoid arthritis, an autoimmune disease that causes joint inflammation.
- Anti-nuclear antibody (ANA): ANA is an antibody that is commonly elevated in people with autoimmune diseases such as lupus.
- Imaging tests: Imaging tests such as X-rays, ultrasound, CT scans, and MRI may be used to visualize and assess the extent of inflammation or tissue damage.
How is the ESR test result interpreted?
The ESR test measures the rate at which red blood cells settle to the bottom of a tube, and the result is reported as millimeters of clear liquid that are present above the red blood cell layer after a period of one hour. The ESR test result is interpreted as follows:
- Normal range: The ESR value falls within the normal range for the individual’s age and gender.
- Mildly elevated: The ESR value is slightly higher than the upper limit of the normal range, and this may indicate a mild degree of inflammation.
- Moderately elevated: The ESR value is significantly higher than the upper limit of the normal range, and this may indicate a moderate degree of inflammation.
- Markedly elevated: The ESR value is extremely high, and this may indicate a severe degree of inflammation.
Can ESR be used to diagnose a specific condition?
ESR is a non-specific test that measures the presence of inflammation in the body, but it does not provide a specific diagnosis. A high ESR can indicate the presence of inflammation, but additional tests are often needed to determine the underlying cause of the inflammation.
For example, an elevated ESR may be seen in many conditions such as infections, autoimmune diseases, cancer, and tissue damage. Therefore, additional tests are needed to determine the specific condition causing the elevated ESR.
ESR is often used as a screening tool to detect the presence of inflammation, and it may be combined with other tests such as a complete blood count (CBC), C-reactive protein (CRP), and imaging studies to help diagnose the underlying condition. The interpretation of ESR results should always be done in conjunction with other clinical and laboratory findings to determine the specific condition causing the inflammation.
ESR and fever
Fever is a common symptom of inflammation and infection. When the body is fighting off an infection, it releases cytokines and other chemicals that trigger a rise in body temperature, which helps to stimulate the immune system and fight off the infection. ESR levels can be elevated in response to fever, particularly if the fever is due to an underlying infection or inflammation.
ESR and cancer
ESR is a non-specific test and is not considered a reliable test for diagnosing cancer. While a high ESR can be seen in some cases of cancer, it is also seen in a wide range of other conditions such as infections, autoimmune diseases, and tissue damage.
In the case of cancer, additional tests such as imaging studies, biopsies, and blood tests specific to certain types of cancer, such as prostate-specific antigen (PSA) for prostate cancer, are often needed to diagnose the disease. These tests are typically more specific and sensitive for cancer diagnosis than ESR.
However, a high ESR level may indicate the presence of inflammation in the body, which can sometimes be associated with cancer. If a healthcare provider suspects cancer based on the patient’s symptoms and medical history, they may order additional tests in addition to ESR to help diagnose the disease.
ESR and stress
Yes, ESR can increase in response to stress. Stress can cause an increase in inflammation in the body, which can lead to an elevation in ESR levels.
In addition to stress, there are many other factors that can affect ESR levels, such as infections, autoimmune diseases, tissue damage, and certain medications. Therefore, it is important to interpret ESR results in the context of other clinical and laboratory findings to determine the underlying cause of the inflammation.
How often should ESR be checked?
The frequency with which ESR should be checked depends on the individual’s medical history, symptoms, and the reason for the test. In some cases, ESR may be checked once as part of a routine medical evaluation, and in other cases, it may need to be checked regularly to monitor the progress of a condition.
For example, in the case of an acute infection, ESR may be checked at the time of diagnosis and then again after treatment to ensure that the inflammation has resolved. In the case of a chronic condition such as rheumatoid arthritis, ESR may be checked regularly to monitor disease activity and the response to treatment.
How can I lower my ESR if it is high?
ESR is a non-specific marker of inflammation, and a high ESR alone does not indicate a specific underlying condition. Therefore, the treatment to lower ESR will depend on the underlying condition causing the inflammation.
For example, if an infection is causing the inflammation, antibiotics or antiviral medications may be prescribed to treat the infection, and the ESR will decrease as the infection resolves. In the case of an autoimmune disease such as rheumatoid arthritis, medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), or biologic agents may be prescribed to help control inflammation and reduce ESR levels.
In addition to treating the underlying condition, there are several lifestyle changes that can help reduce inflammation and lower ESR levels, including:
- Maintaining a healthy weight: Excess body weight can contribute to inflammation in the body.
- Eating a healthy diet: A diet rich in fruits, vegetables, whole grains, and lean protein sources can help reduce inflammation.
- Exercising regularly: Regular exercise can help reduce inflammation and improve overall health.
- Managing stress: Chronic stress can contribute to inflammation in the body, so finding ways to manage stress such as meditation or yoga may help.
- Getting enough rest: Adequate sleep is important for overall health and can help reduce inflammation in the body.
High ESR and CRP
High levels of both ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) can be an indication of inflammation in the body.
ESR measures the rate at which red blood cells settle to the bottom of a test tube, which can be an indicator of inflammation in the body. CRP is a protein produced by the liver in response to inflammation.
An elevated ESR and CRP level can be caused by a wide range of conditions, such as infections, autoimmune diseases, cancer, and tissue damage. In some cases, the combination of elevated ESR and CRP levels can help to pinpoint the cause of inflammation in the body, particularly when the levels are significantly elevated.
However, neither test is specific for a particular disease or condition, and additional tests and evaluations may be needed to determine the underlying cause of the inflammation. Your healthcare provider can help to interpret your ESR and CRP levels in the context of your overall medical history, physical exam, and other laboratory findings to determine the most appropriate course of action.
How can I contact gastroenterologist Dr. Zavos for an appointment?
Dr. Chris Zavos is a board-certified gastroenterologist and hepatologist, located in Thessaloniki Greece, and specifically in Kalamaria suburb, about 7 kilometres (4 miles) southeast of downtown Thessaloniki. His private office is at: Fanariou 8 street (near Aigaiou and Adrianoupoleos avenues), Kalamaria (Thessaloniki), Greece.
Thessaloniki International Airport is only 10 km away from his private office in Kalamaria and can be reached by taxi within 13 minutes from the airport.
Dr. Chris Zavos performs endoscopies at Bioclinic private hospital in downtown Thessaloniki (Mitropoleos 86 street).
You can contact Dr. Zavos at phone numbers: (+30)-6976596988 and (+30)-2311283833, or you can email him at czavos@ymail.com. Dr. Zavos responds to Greek and English languages.