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Erythrocyte Sedimentation Rate

Aka: Erythrocyte Sedimentation Rate, ESR

Hematology and Oncology


Pathology and Laboratory Medicine Chapter

Serum Ferritin

Serum Folate

Serum Iron

Erythrocyte Protoporphyrin

Reticulocyte Count

Sucrose Hemolysis Test

Total Iron Binding Capacity

Transferrin

Iron Saturation

Serum Tumor Marker

Serum Acid Phosphatase

Cancer Antigen 125

Complete Blood Count

Pancytopenia

Hematocrit

Anemia

Cancer

Complete Blood Count

Hemoglobin

Mean Corpuscular Hemoglobin Concentration

Mean Corpuscular Volume

Red Blood Cell

Erythrocyte Morphology on Peripheral Smear

Red Cell Distribution Width

White Blood Cell

Leukocytosis

Leukocyte Morphology on Peripheral Smear

Basophil Count

Eosinophil Count

Lymphocyte Count

Monocyte Count

Neutrophil Count

Neutropenia

Neutropenia Causes

Antithrombin III

Von Willebrand Factor

Bleeding Time

D-Dimer

Fibrin Degradation Products

Coagulopathy

Prothrombin Time

Partial Thromboplastin Time

Thrombin Time

Coombs

Direct Coombs

Indirect Coombs

G6PD Deficiency Detection

Ham Test

Hemolytic Disorders

Lymphatic Disorders

Reed-Sternberg Cell
Bone Marrow Disorders

Bone Marrow Exam

Peripheral

Peripheral Smear

Platelet Disorders

Platelet Count

Platelet Morphology on Peripheral Smear

Mean Platelet Volume

Platelet Function Closure Time

Complement C3

Acute Phase Reactant

C-Reactive Protein

C-Reactive Protein as Cardiac Risk Factor

Serum Cryoglobulin

Erythrocyte Sedimentation Rate

Fibrinogen

Haptoglobin

Procalcitonin
SPEP

Serum Protein Electrophoresis

Serum Protein Electrophoresis Abnormality

From Related Chapters

Pharmacology

Medication Causes of Neutropenia

I. Mechanism
A.

B.

Acute phase reactants in blood


1.

Nonspecifically bind to Red Blood Cells

2.

Increases sedimentation rate

Measures settling rate of anticoagulated erythrocytes


1.

C.

Height of RBCs that settle in tube within 1 hour

Marker of tissue inflammation


1.

High Sensitivity

2.

Low Specificity

D.

Factors affecting ESR


1.

Older age

2.

Female gender

3.

Pregnancy
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II. Dynamics of sedimentation rate


A.

Rises >24 hours after inflammation onset and symptoms

B.

Gradually returns to normal 4 weeks after resolution

III. Normal
A.

Newborn: 0-2 mm/hour

B.

Children: 3-13 mm/hour

C.

Women

D.

1.

Range for ages 18 to 50 years: 1-20 mm/hour

2.

Range for age over 50 years: 1-30 mm/hour

3.

Normal Maximum: (Age in years + 10) / 2

Men
1.

Range for ages 18 to 50 years: 1-15 mm/hour

2.

Range for age over 50 years: 1-20 mm/hour

3.

Normal Maximum: (Age in years) / 2

IV. Indications
A.

Grades acute illness severity in Emergency Setting


1.

299 Peds patients with Limp, Abdominal Pain, Fever

2.

3.

a.

ESR >50 (n=101): 56% had significant illness

b.

ESR 20-50 (n=109): 27% had significant illness

c.

ESR <20 (n=89): 8% had significant illness

Where significant illness


a.

Rheumatoid Arthritis

b.

Osteomyelitis

c.

Pneumonia

d.

Pyelonephritis

Reference
a.

B.

C.

Huttenlocher (1997) Clin Pediatr 339-44 [PubMed]

Diagnosis of Rheumatic Conditions


1.

Polymyalgia Rheumatica (sensitivity: 80%)

2.

Temporal Arteritis (sensitivity: 95%)

Staging of condition
1.

Rheumatic conditions with waxing and waning course

2.

Rheumatoid Arthritis

V. Falsely decreased ESR (interfere with rouleaux formation)


A.

Severe Leukocytosis

B.

Polycythemia

C.

Red Blood Cell abnormalities


1.

Acanthocytosis

2.

Poikilocytosis

D.

3.

Anisocytosis

4.

Spheocytosis

5.

Sickle cell disease

6.

Microcytosis (e.g. Iron Deficiency Anemia)

Protein abnormalities
1.

Hypofibrinogenemia

2.

Hypogammaglobulinemia

3.

Macroglobulinemia (e.g. Hyperviscosity Syndrome)

VI. Increased ESR in Infectious Disease


A.

Bacterial Infections

B.

Infectious hepatitis

C.

Cat Scratch Disease

D.

Post-perfusion syndrome

E.

Primary Atypical Pneumonia

F.

Tuberculosis

G.

Secondary Syphilis

H.

Leptospirosis

I.

Systemic Fungal Infection

VII. Increased ESR in Hematologic and Neoplastic Disease


A.

Severe Anemia or macrocytosis

B.

Leukemia

C.

Lymphoma

D.

Metastatic tumor

E.

Chronic granulomatous disease

VIII. Increased ESR in Gastrointestinal Disease


A.

Inflammatory Bowel Disease

B.

Acute Pancreatitis

C.

Lupoid hepatitis

D.

Cholecystitis

E.

Peritonitis

IX. Increased ESR in Collagen Vascular Disease


A.

Rheumatic Fever

B.

Rheumatoid Arthritis

C.

Systemic Lupus Erythematosus

D.

Dermatomyositis

E.

Scleroderma

F.

Systemic Vasculitis

G.

Henoch-Schonlein Purpura

H.

Mediterranean fever

X. Increased ESR in Renal disease


A.

Acute Glomerulonephritis

B.

Chronic Glomerulonephritis with Renal Failure

C.

Nephrosis

D.

Pyelonephritis

E.

Hemolytic Uremic Syndrome (HUS)

XI. Increased ESR in Miscellaneous disorders


A.

Hypothyroidism

B.

Thyroiditis

C.

Sarcoidosis

D.

Infantile cortical hyperostosis

E.

Trauma from surgery or Burn Injury

F.

Drug Hypersensitivity Reaction

XII. References
A.

Brigden (1999) Am Fam Physician 60:1443-50 [PubMed]

B.

Lascari (1972) Pediatr Clin North Am 19:1113-21 [PubMed]

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