5th January 2021

Erythrocyte Sedimentation Rate

Dr. Shambhu Singh
PGT-1,Pathology
Moderator- Dr. Izhar Alam

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 INTRODUCTION
• The erythrocyte sedimentation rate (ESR) measures the rate of settling (sedimentation)
of erythrocytes in millimeters in an anticoagulated whole blood in a vertical pipette at
room temperature. Anticoagulated blood is allowed to stand in a glass pippette for 1
hour and the length of column of plasma above the red cells is measured in millimeters;
this corresponds to ESR. This is a simple and inexpensive test that is an indirect
measure of acute phase response.

• ESR is commonly used investigation to screen for inflammation and/or tissue

destruction They are not diagnostic of any disease but indicate need for further studies.
These tests are also used to follow the course of chronic inflammatory conditions
 STAGES OF ERYTHROCYTE SEDIMENTATION
RATE
1. Rouleaux formation : Red cells form rouleaux in first fifteen minutes phase during
when minimum sedimentation occurs.

2. Formation of fine threads by fibrinogen and globulin resulting in network formation

occurs during 2nd 15 minutes. The rouleaux of red cells get trapped in the mesh of
fibrin and globulin network and becomes heavier which starts settling rapidly.

3. Rapid fall of protein network: The protein network along with red cell mass is
maximum during the third 15 minute phase.

4. Phase of packing of red cells : The sedimented protein-red cell mass undergoes
rapid packing during fourth 15 minute phase
 AD
Factors increasing ESR Factors decreasing ESR

Old age Microcytosis

Pregnancy Low fibrinogen,afibrinogenemia

Anemia
Polycythemia
Elevated fibrinogen
Marked leukocytosis
Elevated gamma globulins
Sickle cell disease, anisopoikilocytosis,
Macrocytosis spherocytosis

Nephrotic syndrome (Hypoalbuminemia) Technical factors:

Vibration of tube during test, clotting of
Technical factors:
blood, short ESR tube
High temperature, tilting of ESR tube.
SIGNIFICANCE OF ERYTHROCYTE SEDIMENTATION
RATE
Acute rheumatic fever
Osteomyelitis
Bacterial endocarditis
Pyogenic arthritis
Infections Pelvic inflammatory disease
Tuberculosis
Acute hepatitis

Rheumatoid arthritis
Systemic lupus erythematosus
Inflammatory Diseases Temporal arteritis
Polymyalgia rheumatica

Acute myocardial infarction

Malignancy
Paraproteinemias
Technical problems
Multiple myeloma
Waldenström's macroglobulinemia
Cryoglobulinemia
Increased temperature
Tilted ESR tube

Ruptured ectopic pregnancy

Anemia
Others Renal disease with azotemia
 INDICATIONS FOR MEASUREMENT OF ESR
Erythrocyte sedimentation rate is sensitive markers of inflammation, but are not specific for any
particular disease. ESR should be interpreted in the context of clinical features. It is
recommended to measure ESR

(1) When infectious, inflammatory, or a neoplastic disease is suspected in symptomatic

individuals in whom a specific diagnosis has not been established;

(2) To monitor disease activity in tuberculosis, inflammatory arthritis, rheumatic fever, Hodgkin's
disease, giant cell arteritis, and polymyalgia rheumatica;

(3) As a diagnostic criterion for temporal arteritis and polymyalgia rheumatica. ESR can also be
helpful in distinguishing iron deficiency anemia from anemia of chronic disease in patients
known to have inflammatory disease.
 METHODS FOR ESTIMATION OF ERYTHROCYTE SEDIMENTATION
RATE
• Westergren method
• Wintrobe method
• Automated methods:
• SEDIMAT
• Ves-Matic
• ESR STAT-PLUS
• Zeta sedimentation ratio.
WESTERGREN’S METHOD

NORMAL RANGE/ BIOLOGICAL

REFERENCE RANGE

- Male. – 0 -20 mm after 1 hour

- Female – 0 - 30 mm after 1 hour
- Children – 0 -13 mm after 1 hour
THANK YOU