"The clinical significance of the erythrocyte sedimentation rate (ESR) as a marker of inflammatory processes was first recognised in 1894 by a Polish physician, Edmund F Biernacki (1866-1911) 1,4,6. Unfortunately for Dr Biernacki, the discovery of the clinical significance of ESR has been misattributed to a large number of other individuals, at least partially due to its first appearance in the non-English literature 4."
"Clinically C-reactive protein (CRP) is often preferred to erythrocyte sedimentation rate in that it is elevated for longer and is slower to rise. However, erythrocyte sedimentation rate is superior to CRP for detecting low severity chronic bone and joint infections and for monitoring SLE disease severity 3."
Expected headings
"Physiological basis"
"Elevation"
"Normal"
"Reduced"
"Erythrocyte sedimentation rate is the distance that erythrocytes in a sample of anticoagulated blood have fallen in one hour and is measured in millimetres per hour (mm/hr). It is the measure of the concentration of a number of acute phase reactant proteins, especially fibrinogen, relative to the number of red blood cells. In a healthy state red blood cells are roughly the same density as plasma and hence fall slowly. However, in the presence of inflammation or infection cytokines increase the production of acute phase reactant proteins. The higher the concentration of acute phase proteins, the more adherent red blood cells become to each other, resulting in the formation of "rouleax" (red cells clumping together and looking like stacks of coins); the heavier they are and the faster they fall results in a higher erythrocyte sedimentation rate 1,2."
"The normal erythrocyte sedimentation rate is calculated as age divided by two in men and in women as age plus 10 divided by two. Erythrocyte sedimentation rate is affected by a number of factors unrelated to the acute phase reaction including age, gender, pregnancy status, anaemia, red blood cell dysmorphia, obesity and fibrinogen deficiency 2."
"It is poorly sensitive for detecting infection, inflammation or neoplasia, but is very specific for all of these as a grouping, although is not specific for individual diseases 2. A list is provided below with states of elevated or normal erythrocyte sedimentation rate 2."
"inflammation (e.g. temporal arteritis)"
"infection (e.g. osteomyelitis)"
"neoplasia (e.g. gastric cancer)"
"red blood cell disorders (e.g. anaemia)"
"hypergammalobulinaemia (e.g. multiple myeloma)"
"red blood cell disorder/anaemias (e.g. sickle cell disease)"
"red blood cell disorder/haemoglobinopathies (e.g. sickle cell disease)"