Erythrocytes Sedimentation test: A blood test as an indicator of inflammation
(Part I)
The erythrocyte sedimentation rate (ESR) is a blood test performed to measure the rate at which the red blood cells settle at the bottom of the test tube containing the blood sample. This test is generally done to diagnose any condition that might lead to inflammation. The rate at which red blood cells settle down gives your doctor an idea about any inflammation or acute infection in your body. Normally, red blood cells settle relatively slowly.
Significance of ESR test: 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 or other medical condition.
The higher ESR value is an indicator of inflammation in body that means a faster than normal rate may indicate inflammation in the body.
Now let us understand the meaning of medical term "Inflammation".
Inflammation is part of your immune response system. It can be a reaction to an infection or injury in body Inflammation may also be a sign of a chronic disease or an immune disorder.
Inflammation is a condition in which a part of the body becomes red, sore and swollen because of infection or injury.
Inflammation in the body:
Inflammation refers to your body's process of fighting against things that harm it, like infections, injuries, and toxins, in an attempt to heal itself. When something damages your cells, your body releases chemicals that trigger a response from your immune system.
When your body encounters an offending agent like viruses, bacteria or toxic chemicals or suffers an injury, it activates your immune system. Your immune system sends out its first responders: Cytokins and inflammatory cells.
Cytokins are chemical substances that stimulate more inflammatory cells.
Inflammation may be acute or Chronic.
Acute inflammation is the response to sudden body damage, such as cutting your finger. To heal the cut, your body sends inflammatory cells to the injury. These cells start the healing process.
Examples of conditions that involve acute inflammation include acute bronchitis, a sore throat from a cold or flu or an infected ingrown to nail.
The four signs of acute inflammation.
The four cardinal signs of inflammation—redness, heat, swelling , and pain were described in the 1st century AD by the Roman medical writer Aulus Cornelius Celsus. Redness is caused by the dilation of small blood vessels in the area of injury.
The causes of acute inflammation:Acute inflammation can result from exposure to a substance, such as a bee sting or dust, an injury or an infection.
Chronic inflammation: Your body continues sending inflammatory cells even when there is no outside danger.Chronic inflammation is also referred to as slow, long-term inflammation lasting for prolonged periods of several months to years. Generally, the extent and effects of chronic inflammation vary with the cause of the injury and the ability of the body to repair and overcome the damage.
The possible causes chronic inflammation in the body:
The most common reasons for chronic inflammation include:
Autoimmune disorders, such as lupus, where your body attacks healthy tissue,
exposure to toxins, like pollutants or industrial chemicals,
untreated acute inflammation, such as from an infection or injury.
An example of chronic inflammation:The longer you are overweight, the longer your body can remain in a state of inflammation. Research has shown that chronic inflammation is associated with heart disease, diabetes, cancer, arthritis, and bowel diseases like Crohn's disease and ulcerative colitis.
It is possible to cure acute chronic inflammation.You can control and even reverse inflammation through a healthy, anti-inflammatory diet and lifestyle. People with a family history of health problems, such as heart disease or colon cancer, should talk to their physicians about lifestyle changes that support preventing disease by reducing inflammation.
Covid can also cause high ESR value.It is reported ESR value is increased in a confirmed COVID patient. The high level of ESR sustained for a long time even after the patient recovered from COVID-19. High ESR value is also related to tumor, tuberculosis, rheumatic diseases and anemia.
The medical treatment when ESR is high: The high ESR is an indicator of Inflammation. If your doctor detects inflammation, they may recommend one or more of the following treatments: taking a non steroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) corticosteroid therapy to reduce inflammation.
Your health care provider or physician may recommend an ESR test, if you have symptoms of an inflammatory disorder. These include:Headaches,Fever,
Weight loss,Joint stiffness,
Neck or shoulder pain,Loss of appetite,Anemia etc.
ESR test is a part of Complete Blood Count (CBC).This test is performed by Westergren method.
Collection of blood sample (,Venipuncture technique): Patient don't need any special preparations for this test.A health care professional or pathology laboratory technician 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 site where the needle was put in, but most symptoms go away quickly.
Interpretation of result of test:If your results are not in the normal range, it doesn't necessarily mean you have a medical condition that requires treatment.
Certain medicines and supplements can also affect your results. These include oral contraceptives, aspirin, cortisone, and vitamin A. Be sure to tell your health care provider about any drugs or supplements you are taking.
Normal range of ESR:
The normal range is 0 to 20 mm/hr for men and 0 to 30 mm/hr for women.
If an ESR is abnormally high, it means that the red blood cells sediment faster than expected. This usually happens when the RBCs have more fibrinogen, a protein within them, which causes them to stick together and sediment faster. Many conditions can cause an ESR to become elevated.
In healthy subject ESR is higher in women than in men, and in both sexes, a rise occurs with age. It is well established that pathological elevation of the ESR may be due to elevation of the fibrinogen level.
The normal range of ESR is calculated using the Westergren method, which is considered a gold standard for measuring ESR. In this method, the blood sample is mixed with sodium citrate in a Westergren-Katz tube and is set vertically for one hour at room temperature. After an hour, how far the red blood cells have settled is measured in mm.
Author:Dr. Bhairavsinh Raol
