Sed rate (erythrocyte sedimentation rate)

Overview:

Sed rate or the erythrocyte sedimentation rate (ESR) is a blood test done to the presence of inflammation in the body. It helps to diagnose and check the prognosis of the disease. It is not a specific test for a particular disease but is used in combination with other tests to detect the inflammatory activity of the disease. It is used as a sickness indicator for monitoring the disease. 

Technique: 

The ESR test is used to measure the rate at which the red blood cells (RBCs) sediment to the bottom of the tube. The sedimentation rate is the time it takes for the RBCs to fall to the bottom of the tube. Red blood cells, also called the erythrocytes, are negatively charged cells due to which they repel each other. While proteins are positively charged and can neutralize the negative charges present on the surfaces of the cells. 

When there is an inflammation there is an increase in the number of proteins in the blood. These proteins can effectively neutralize the RBCs and cause clumping of the RBCs. This clumping leads to RBCs sticking one over the other in the form of a stack. This stacking of the RBCs is called the rouleaux formation which is detected by the ESR test. 

The more the inflammation, the faster the rouleaux formation leading to an increase in the ESR. Hence ESR is not considered a specific test but is used in combination with other tests to detect the disease activity. 

Indications:

Though ESR cannot make a specific diagnosis, It is indicated in multiple conditions. It is indicated in

• Infections caused by bacteria, viruses, or toxins
• Autoimmune conditions
• Cancers
• Inflammatory joint diseases 
• Blood disorders 

Clinical symptomatic conditions when an ESR is done include

• Headaches
• Fevers of unexplained reasons 
• Severe weight loss 
• Stiffness in the joints 
• Immense pain in the shoulder and neck 
• Appetite loss 
• Anemia

Before the procedure:

Before undergoing an ESR test, an individual should understand the importance and necessity of the test by discussing it with the healthcare provider (HCP). All the medications taken by the individual should be informed to the HCP along with the history of previous diseases, infections, surgeries, and allergies. Multiple factors can influence the test results. 

Previous catheterizations and urinary tract infections can also affect the condition. Hence it is necessary to inform the HCP. Vigorous physical exercise can also alter the test results hence it is advisable to refrain from any exercises before undergoing the ESR test. 

During the procedure:

The skin at the site where the blood will be withdrawn is carefully swabbed with alcohol and an elastic band is wrapped around the arm. An individual has to fold the fist to allow the easy flow of blood. Blood will be drawn from a vein by using a small needle. The required amount of blood is collected in a vial and sent to the lab for evaluation. The area is bandaged. 

After the procedure:

One can continue daily activities after the test. The result values will depend on the laboratory standards. Based on the results further investigations will be done to confirm the diagnosis and medications will be prescribed. 

Interpretation:

ESR results are shown as millimetres of distance they have fallen in the test tube in an hour. Multiple factors influence the test results. They are: 

• Sex: women have higher ESR than men. 
• Age: Old age increases the ESR 
• Alcohol: Individuals with regular alcohol consumption had lower ESR levels than moderate or non-alcohol consumers. 
• Smoking: Smokers have high ESR values compared to non-smokers
• Exercise: Regular and intense physical exercise is associated with low ESR levels
• Weight: Overweight and obese are associated with high ESR levels. 

Clinical implications of ESR:

• Extremely high ESR levels(>100mm) indicate the presence of 
• Infections 
• A type of cancer called multiple myeloma, 
• Cancer affecting white blood cells called lymphoplasmacytic lymphoma.  
• A blood vessel condition called giant cell (temporal) arteritis. 
• Muscle disease called polymyalgia rheumatica.
• Small blood vessel disease called hypersensitivity vasculitis.
• Elevated ESR levels are important additional tests that detect coronary artery disease which is caused due to the inflammation of the blood vessels of the heart. 
• Elevated ESR levels are seen in brain conditions like brain injuries and stroke.
• ESR is also used to detect autoimmune diseases like rheumatoid arthritis, lupus, and osteoarthritis.  
• Elevated ESR levels are used to diagnose malignant cancers like multiple myeloma and also indicate the spread of the cancer. Increased levels of ESR are associated with poor prognosis in various cancers. 
• High ESR levels are also used to detect bacterial infections in children.
• Decreased ESR levels are seen in conditions of increased RBCs like polycythemia due to increased viscosity of the blood. 
• The discoid shape of RBCs is very important for the clumping or rouleaux formation. Disease conditions like Sickle cell disease alter the shape of the RBCs leading to impaired stacking. This can cause low ESR levels. 
• Medications like statins and valproic acid also cause decreased ESR levels. 
• Pregnancy also causes an increase in the ESR rate. 

Side effects:

Side effects associated with the procedure include fatigue, dizziness, nausea, vomiting, bleeding, and bruising at the site of withdrawal. 

Risks and complications: 

Some risks and complications associated with the test include the risk of inaccurate results due to factors like smoking, alcohol consumption, and exercise. 

Conclusion: 

Erythrocyte sedimentation rate (ESR) is a simple blood test used to identify the presence of inflammation in the body. It helps in identifying the inflammation and helps in prognosis. Though it is not a specific test it is used in combination with other tests to detect various diseases. 

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