ESR doesn't tell your healthcare provider whether you have a specific disease. It only suggests that you may have an active disease process in your body. You may have other tests if your healthcare provider is doing this test to diagnose a disease.
One of these tests is call C-reactive protein, or CRP. This test also measures active inflammation in the body. Your provider may do an ESR alone if he or she is monitoring a disease you already have.
Because ESR tells your provider only what is happening right now, you may need to have the test repeated over time. Test results may vary depending on your age, gender, health history, the method used for the test, and other things. Your test results may not mean you have a problem. Ask your healthcare provider what your test results mean for you. For instance, you may have:.
The test is done with a blood sample. A needle is used to draw blood from a vein in your arm or hand. Having a blood test with a needle carries some risks. These include bleeding, infection, bruising, and feeling lightheaded. When the needle pricks your arm or hand, you may feel a slight sting or pain. It can be a reaction to an infection or injury. Inflammation may also be a sign of a chronic disease, an immune disorder , or other medical condition.
An ESR test can help determine if you have a condition that causes inflammation. These include arthritis , vasculitis , or inflammatory bowel disease. An ESR may also be used to monitor an existing condition. Your health care provider may order an ESR if you have symptoms of an inflammatory disorder. These include:. A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial.
You may feel a little sting when the needle goes in or out. This usually takes less than five minutes. There is very little risk to having an ESR. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly. The converse is also true, because clinical relapse can occur in the face of a normal ESR finding. In rheumatoid arthritis, the ESR tends to reflect clinical disease activity but usually mirrors other symptoms such as morning stiffness or fatigue.
In one study, the ESR level that best distinguished patients with rheumatoid arthritis in remission from those with active disease was less than 20 mm per hour for men and less than 30 mm per hour for women.
In oncology, a high ESR has been found to correlate with overall poor prognosis for various types of cancer, including Hodgkin's disease, gastric carcinoma, renal cell carcinoma, chronic lymphocytic leukemia, breast cancer, colorectal cancer and prostate cancer.
However, European studies of patients with Hodgkin's disease have suggested that an elevated ESR may still be an excellent predictor of early relapse, especially if the value remains elevated after chemotherapy or fails to drop to a normal level within six months after therapy.
The ESR may be useful in differentiating iron deficiency from anemia of chronic disease in patients with a background chronic inflammatory condition such as rheumatoid arthritis. Unfortunately, neither iron studies nor serum ferritin levels are definitive in distinguishing between these two types of anemia. Because both may have a transferrin saturation of around 15 percent, simply evaluating the serum iron level and percent saturation will not differentiate between the two conditions.
Similarly, an individual serum ferritin level may not be helpful when inflammation is present because ferritin is an acute phase reactant and may be artifactually elevated. The probability of iron deficiency can usually be established by correcting an individual ferritin value for the degree of coexistent inflammation as indicated by the ESR, possibly avoiding a bone marrow examination.
A nomogram to verify the presence or absence of iron deficiency coexistent with an underlying inflammatory condition by correlating serum ferritin level with degree of inflammation as evidenced by the erythrocyte sedimentation rate. Predicting bone marrow iron stores in anemic patients in a community hospital using ferritin and erythrocyte sedimentation rate.
Am J Clin Pathol ; Unfortunately, the ESR is neither sensitive nor specific when used as a general screening test. Because an elevated ESR may occur in so many different clinical settings, this finding is meaningless as an isolated laboratory value. In addition, some patients who have malignant tumors, infections or other inflammatory disorders will have normal ESR values.
Most unexplained ESR elevations are short-lived and not associated with any specific underlying process. In those instances where disease is present, it will usually be obvious after completion of history taking, physical examination and collection of routine laboratory data. Although an elevated ESR may occur with many types of cancer, it rarely indicates an occult tumor because most of these patients have widely metastatic disease. Recent studies have evaluated the ESR as a screening test for infection in specific clinical instances such as infection associated with orthopedic prostheses, pediatric bacterial infection and gynecologic inflammatory disease.
The appropriateness of the ESR as a screening test for infection, even in these well-defined clinical settings, requires further evaluation. However, this investigation specifically excluded patients known to have an ESR-elevating disease and those in whom no disease was suspected. The authors concluded that combining clinical evaluation with an individual ESR value allowed the identification of groups of patients in whom the likelihood of disease was quite low or reasonably high, possibly limiting unnecessary investigations.
An extreme elevation of the ESR defined as greater than mm per hour is associated with a low false-positive rate for a serious underlying disease. In most series, infection has been the leading cause of an extremely elevated value, followed by collagen vascular disease and metastatic malignant tumors. Because most of these conditions are clinically apparent, any tests performed should be clinically driven.
For instance, if symptoms of infection are present, the appropriate cultures, including urine and blood, and skin testing for tuberculosis should be obtained.
No obvious cause is apparent in fewer than 2 percent of patients with a markedly elevated ESR. In such patients, the history and physical examination coupled with readily available tests Table 5 will usually establish the etiology. Because a notable number of patients with an ESR greater than mm per hour have myeloma or some other type of dysproteinemia, urine and serum protein electrophoretic studies should be included in the testing.
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Address correspondence to Malcolm L. Brigden, M. Reprints are not available from the author. Saadeh C. The erythrocyte sedimentation rate: old and new clinical applications. South Med J. Brigden M. The erythrocyte sedimentation rate: still a helpful test when used judiciously. Postgrad Med. The erythrocyte sedimentation rate: guidelines for rational use.
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Tests for detecting and monitoring the acute phase response. Arch Dis Child. Test performance of erythrocyte sedimentation rate and C-reactive protein in assessing the severity of acute pelvic inflammatory disease. Am J Obstet Gynecol. A comparison between erythrocyte sedimentation rate ESR and selected acute-phase proteins in the elderly.
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