Erythrocyte Sedimentation Rate (ESR)


  • The erythrocyte sedimentation rate (ESR), also called a sedimentation rate or Biernacki Reaction, is the rate at which red blood cells sediment in a period of 1 hour.
    It is a common hematology test that is a non-specific measure of inflammation.
  • To perform the test, anticoagulated blood is placed in an upright tube, known as a Westergren tube, and the rate at which the red blood cells fall is measured and reported in mm/h. Since the introduction of automated analyzers into the clinical laboratory, the ESR test has been automatically performed.
  • The ESR is governed by the balance between pro-sedimentation factors, mainly fibrinogen, and those factors resisting sedimentation, namely the negative charge of the erythrocytes (zeta potential).
  • When an inflammatory process is present, the high proportion of fibrinogen in the blood causes red blood cells to stick to each other.
    The red cells form stacks called ‘rouleaux,’ which settle faster. Rouleaux formation can also occur in association with some lymphoproliferative disorders in which one or more immunoglobulin are secreted in high amounts.
  • The ESR is increased by any cause or focus of inflammation, pregnancy , rheumatoid arthritis, and decreased in polycythemia, sickle cell anemia, hereditary spherocytosis, and congestive heart failure. The basal ESR is slightly higher in females.
Erythrocyte sedimentation rate

Erythrocyte sedimentation rate


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