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to account for 70% of the sedimentation phenomenon), and immunoglobulins
(which increase in the case of oncological/hematological diseases and acute
infections). ESR is therefore a non-specific measurement of an inflammatory
state; the rate is high in various pathological conditions such as inflammatory
diseases (infections, rheumatic diseases), a relative/absolute increase in
globulins (nephrotic syndrome, myeloma), tissue necrosis (myocardial
infarction, tumours). ESR is useful for predicting a diagnosis of some diseases,
such as polymyalgia rheumatica, temporal arteritis, rheumatoid arthritis and
Hodgkin’s disease, and is useful as an effective marker for pharmacological
treatment in many diseases such as rheumatoid arthritis, vasculitis,
collagenosis and septic arthritis. The erythrocyte sedimentation rate is usually
higher in women compared to men, increases in pregnancy, and tends to rise
with age in both genders.
Normal ESR values (Westergren citrated)
With the Westergren reference method, the test is performed on blood diluted
in citrate, with 4 parts blood to one part anti-coagulant. The diluted blood is then
aspirated inside a special, graduated, 2.5-mm diameter pipette and kept
upright. The erythrocyte sedimentation level is recorded after exactly one hour,
measuring the distance between the lower side of the plasma meniscus and
the meniscus of the sedimented red blood cells.
Guidelines for ESR Reference Values for the Westergren ESR Method* are
as follows:
Normal 0-20mm/hr
* Follow CLSI
Procedures for the Erythrocyte Sedimentation
Rate Test; Approved Standard. CLSI document H02.
Reference values should be established locally in accordance with the
individual laboratory’s accrediting agencies. Refer to CLSI document H02
for age and gender-specific reference values.
