What is sed rate?
Sed rate is a short form for Erythrocyte sedimentation rate and abbreviated to ESR Test too. Erythrocyte is the scientific name for the red blood cell, sedimentation (sed.) means the process of depositing sediment, rate means the speed at which the test proceeds which is often expressed in terms of the millimeters of blood that is sedimented in an hour of time.
Sedimentation rate blood test is measured in the medical laboratory by letting an amount of blood to separated and settled to the bottom of a tube in a certain amount of time so that the RBC sed rate is the volume of Red blood Cells precipitated in an hour time.
Sed rate test is the most used marker for chronic inflammations by doctors.
What is sed rate used for?
Why does my doctor want me to take ESR blood test?
The main purpose to measure the rate of RBC sedimentation is to monitor the inflammation progress, inflammation means normally increased body defense due to the existence of an injury or casual agents such as trauma, post-surgery, infection by bacteria or worms, and allergic reaction in response to immunological reasons as in Systemic Lupus Erythematosus and Rheumatoid Fever or Non-immunological causes such as the acquired allergies by drugs.
The Inflammatory response triggers the body's proteins and cells in the so-called "Exudate", RBC becomes heavy and ill due to high weight blood content.
ESR is usually an important component of general medical checkup
ESR and C-Reactive Protein are tests used both as biomarkers of inflammation to improve diagnostic sensitivity and specificity.
We can conclude, why do doctors choose the ESR rate to diagnose diseases?
- To clarify what causes the symptoms such as whooping cough or pertussis.
- To confirm or verify previous diagnosis of a disease such as TB.
- To screen people of a high risk for a specific disease like aged people
- To preliminary diagnosis such Arthritis, temporal arthritis, systemic vasculitis, and polymyalgia rheumatica.
- To indicate the severity of a disease such in Sore throat and tonsillitis
- To state the progression of a disease
- To decide the effectiveness of a treatment especially with antibiotics therapy.
Sedimentation normal rates are:
Sed rate values are higher in women than men and higher in older people than younger.
When Eryth. Sed. Rate exceeds predefined normal value we report that ESR is High and you may show it flagged with the letter "H".
Sedimentation Rate Normal Levels in General,
- Men, Youngers, Youth: 0–15 millimeters per hour (mm/hr)
- Men older than 50: 0–20 mm/hour
- Women, younger girls.: 0–20 mm/hr
- Women older than 50: 0–30 mm/hr
- Children: 0–10 mm/hour
- Neonatal to puberty: 3 to 13 mm/h, but other laboratories place an upper limit of 20
- Newborns: 0–2 mm/first hour
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What is sed rate Westergren blood test or Westerngren ESR?
A diagnostic technique used in blood measurement of Blood Sed rate.
Sed rate by modified westergren method is a certain long tube called Westergren tube. An amount of anticoagulant usually Citrate is placed into a tube. An equivalent amount of fresh blood is mixed with an anticoagulant and covered. The tube is hung vertically perpendicular to the ground. The Lab Technician record Precipitated volume every hour.
Stages in erythrocyte sedimentation:
There are 3 stages in erythrocyte sedimentation
- Stage 1 : Rouleaux formation - First 10 minutes
- Stage 2 : Stage of sedimentation or settling - 40 mins
- Stage 3 : Stage of packing - 10 minutes, sedimentation slows and cells start to pack at the bottom of the tube
The Westergren method is the most sensitive of the sedimentation rate methods because of the longer tube, but it requires more blood.
The Wintrobe method
It requires a smaller amount of blood and involves no dilution. In addition, once the ESR has been read, the Wintrobe tube can be centrifuged to obtain a macrohematocrit, and blood films can be made from the buffy coat. However, because of the shorter column of blood, the Wintrobe method is not as sensitive as the Westergren.
WINTROBE ESR Method Normal Values
- First-hour Sed. rate: 0 – 7 mm/hr
- Second-hour Sed. rate: 0 – 15 mm/hr
WESTERGREN ESR Method Normal Levels
Less than age 50 yrs
- Male 0 – 10 mm/hr
- Female 0 – 20 mm/hr
- Children 4 – 14 yrs, 0 – 20 mm/hr
Greater than 50 yrs age
- Male 0 – 20 mm/hr
- Female 0 – 30 mm/hr
Erythrocyte Sedimentation rate blood test results Explained, What does ESR test results mean?
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Causes of ESR greater than 100 mm/1st Hour
Autoimmune diseases and cancers are the usual reasons for extremely high sed rate level and below are some details to understand why is that:
- Autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, or inflammation of the thyroid gland (Graves' disease). Diseases caused by an attack of autoantibodies to the body's cells are called immunological automimmuonolgical disorders, in such diseases, the body antibodies attack the body cells and proteins instead of attacking foreign substances, many organs are affected and the body becomes very ill which impact the health of Red blood cells, thus sed rate of Red cells become very high, usually, ESR is over 100 mm after the first hour.
Other test results that may be affected:
- WBC less than 4.0 *10^9 cells
- RF is Positive in RA patients
- LE cells test is Positive in SLE Patients.
- Positive Autoantibodies Anti-dsDNA and antinuclear-antibody test (ANA), over 1.0 in cut-off reports
- Ani-TSH Positive test in grave's disease.
- Arthritis due to gout show Uric Acid test over 7.0 mg/dl
- Hb% may be lower than 8.0 mg/dl due to chronic inflammation Anemia.
- Cancers, such as lymphoma or multiple myeloma.
Lymphoma is a kind of cancer that affects lymphatic tissue and is caused by viruses as the Epstein-bar virus or HIV and causes signs like painless enlargement of lymph nodes, in addition to feeling tired with fevers, night sweats, itchiness, and weight loss.
Multiple Myeloma or Kahler's disease is a sub-kind of lymphomas in which some kind of defensive blood cells called plasma cells become cancerous and abnormally proliferate and accumulate in the bone marrow and other marrows. Plasma cells contain and produce Bence Jones proteins in excessive amounts causing inflammation of the kidneys, however, those cells are helpful at normal levels.
Elevated ESR levels in malignancies are a result of excessive protein content in the patient's blood fluid. ESR blood test levels are usually over 100 mm after the first hour however High ESR extends as cancer persists.
Other testing results that may be affected include:
- FBC test shows WBC over 50.000 cells or over 500.000 cells mostly lymphocytes (normal 4 - 11 *10^9 cell/mL)
- Urine Bence Jones protein test is Positive in multiple myeloma disease exclusively.
- Low Hb% due to Anemia.
Causes of moderate-high ESR results (usually around 50 mm/hr)
At the beginning of the inflammation episode, the sed rate become mildly elevated usually around 30 mm/hr then when the inflammation process is prolonged the sed rate raised to become around 50 mm/hr, but, sed rate become extremely high when the underlying reason of inflammation left untreated for a very long period of time, below are some examples of reasons that cause mild to moderate increased sed-rate levels.
- Chronic kidney disease.
Why does the sed-rate level increase in kidney diseases?
The reasons may be due to inflammation of kidney units called Nephrons which are the responsible organs in kidney functioning. Loss of Nephron's function leads to kidney failure to filtrating the blood of toxins and thus accumulate in the blood and cause blood cells to overburden, and this is enough to become very high blood sedimentation speed.
CKD ESR level usually is 50 - 75 mm/1st hour in adults, over 100 in late stages.
Other testing results that may be affected:
- Urea over 50 mg/dl
- Creatinine is 1.5 - 10.0 mg/dl
- Chronic Inflammatory diseases
The list of illnesses that cause a persistent moderate increase in sed rate levels include:
- Bacterial infection of the Kidneys, in medical books they call it pyelonephritis.
- Bone inflammation, medical term is Osteomyelitis.
- Joint inflammation, generaly named Arthritis in the medicine science.
- Skin inflammatory diseases, also named Dermatitisby the doctors, autoimmune skin disorders such as psoriasis and Eczema may not elevate ESR levels unless reaches the final complicated stages.
- or heart valves infections, such as pneumonia, pelvic inflammatory disease, or appendicitis.
As explained, the inflammation products cause high-weight blood flow, thus the sed rate value is elevated.
CID ESR level usually is moderately elevated (15 - 40 mm/ first hour, 25 - 80 after the second hour).
Other test results that may be affected include;
- CRP titers may be normal or be positive (more than 12.0 mg/dl and up to 48.0 mg/dl) in 24 hours
- CBC test shows abnormal white blood cells morphology and count as well as mild anemia.
- Pregnancy and preeclampsia (toxemia of pregnancy).
Pregnancy is a normal increase in the body processes due to gestation, the matter which causes high-loaded blood flow with nutrients for the fetus, causing temporarily-increased sed-rate,
Toxemia of pregnancy is caused by infiltration of fetus proteins into the mother's bloodstream, which doing the same role in overloading blood fluid with inflammation agents, thus the sed rate is raised.
- ESR blood test is mild/moderate-high, first-hour sed rate between 20 - 40 mm.
- Anemia, Hb% may be lower than 9.0 in such cases due to iron deficiency during pregnancy.
- Viral infections
Hepatitis B and Hepatitis C viruses can cause chronic inflammation to the liver, and therefore, the blood-red-cells become overloaded with the inflammatory agents, thus the sed rate of RBC read moderately high.
- Inflammation of joints
Such as polymyalgia rheumatica and blood vessels diseases (such as giant cell arteritis), however, joint inflammations don't cause extremely high sed rates.
Causes of low ESR values
Values of ESR are usually seen between 0 - 10 and 20 mm, also Sed rates may be seen in normal ranges during certain diseases such as:
- High blood sugar levels, the Hyperglycemia, unless the diabetes becomes a chronic disease it wouldn;t elevate the sed rate.
- Polycythemia, a disease of increased redblood cells production, although the RBC form similar stages of ESR test measuring process, the sed rate does not show elevated or just increased slowly because the red cells that is under study by ESR test is defected.
- Sickle cell disease, a defective disease of redblood cells that causing the RBC can't do its normal function, thus can't carry too much agents, and therfore the sed rates does not increase even the body is ill.
- Severe liver disease, it doesn't elevate the sed rate unless it turns chronic.
- Congestive Heart failure, doesn't affect sed rate levels becuase doesn't cause too much inflammation at the beginning.
- Neuritis, the inflammation of a nerve or the general inflammation of the peripheral nervous system, the interesting is that neuritis doesn't elevate sed rate levels, in the laboratory we can't find high sed rate for patients with nerves inflammations although it's a chronic persistent illness.
- Any Acute illness, the diseases that occur during short period of time doesn't elevate the ESR reading, because ESR results from long overloading of erythrocytes (red blood cells) with inflammatory agents which called a chronic condition in the medical terms.
Sed rate False Positive Negative Results
To understand, why do some sed rate test results may not be correct? please read carefully the factors that produce irrelevant and erroneous ESR reading and know the best requirements needed to produce correct ESR reading.
- The best time to take the ESR test is during the day, Fasting before ESR test is preferred after about 4 - 6 hours for those not suffering from a clear complain. taking into account that some meals may contain foods that falsly increase the ESR reading. Especially for those follow-up a disease progression by the sed rate test.
- The sed rate test must be set 1 hour after collection or up to 6 hours if the sample is refrigerated. Also the lab technician must read the levels every 60 minutes, any delay will alter the results.
- The ESR reading is affected by a number of mechanical and technical factors that include: Anticoagulant is EDTA or Sodium Citrate (blue-top tube), other anticoagulants cause shrinkage to RBC. Tube perpendicular to surface, any Horizontal degrees will accelerate Sedimentation and end up to false high esr. Some Newer Westergren tubes have a cotton plug in the "zero" end which prevent leakage of blood from the open end of the tube.
- Because the red blood cell shape affects the rate of fall of the cells, it should be apparent that those diagnosed with Sickle cell anemia and their blood contain the sickle cells and spherocytes which will result in a potential falsely decreased ESR. Also, other conditions that result in poikilocytosis (variation in the shape of the red cells) will produce similar decreased sed rate results by false.
- There is considerable dispute about the effect of severe anemia on the ESR. Some laboratories correct the ESR in cases of severe anemia. Because ESR is the best measurement of long underlying illnesses, the severity which occur in shorter period of time can't be assessed by sed rate values.
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