Understanding the significance of an elevated ESR

Q: I was told that my ESR is high because it was 47, what could this mean?

ESR, when used in relation to a blood test, is an abbreviation for Erythrocyte (red-blood cell) Sedimentation (settling) Rate (speed). Blood is a suspension, with the red blood cells (RBCs) giving blood its colour. When the blood is placed in a test tube, the RBCs settle to the bottom leaving a straw coloured fluid (plasma) above the settled RBCs. In persons with certain conditions, especially persons who suffer with an illness which results in inflammation, the RBCs settle at a faster rate and such persons are noted to have an “elevated ESR”.

While the ESR is quite a useful measurement, however, an elevated ESR is not indicative of a specific diagnosis. In persons whose ESR is elevated the health care provider is obligated to identify the possible cause. The ESR is also a handy tool which can be used to monitor the level of activity of a range of inflammatory illnesses.

Normal ESR

To determine the ESR the blood is placed in a special tube set in an upright position, and after an hour the distance in millimetres the blood has fallen from the top of the column of blood is measured. The greater the distance the higher the ESR.

The normal rate of settling is linked to the gender and age of the patient. In children under 12 the range is 0-10 mm/hr. Females under the age of 50 the ESR is expected to be between 0-20 mm/hr; while females over 50 the normal ESR is between 0-30 mm/hr. While in men under 50 the normal ESR is between 0-15 mm/hr, and those older than 50 the normal ESR is 0-20 mm/hr.

Persons who should have an ESR test

Those reporting:

• Unexplained weight loss
• Joint pains, swelling and or stiffness
• Fever of unknown origin
• Headaches that may be inflammatory in nature
• Shoulder and neck pains
• Loss of appetite
• Unexplained facial and or jaw pain

Causes of an elevated ESR

•  Infections such as chest, UTIs, bone, rheumatic fever, heart (endocarditis), joint
• Cancers especially ovarian, lung, lymph glands, myeloma, sarcomas
• Autoimmune diseases – rheumatoid arthritis, SLE, Sjogrens, polyarteritis nodosa, etc.
• Gastrointestinal and liver conditions – inflammatory bowel disease, coeliac, fatty liver
• Sarcoidosis
• Certain kidney diseases

Conditions/ Situations which may result in an elevated ESR that are not necessarily serious

•  Pregnancy
• Being older than 70 years
• Certain medicines
• Recent consumption of a fatty meal
• Being overweight
• Having a menstrual period

Take home points

• While an ESR test is very sensitive when it comes to detecting inflammation, however, it is not specific for the type of inflammation
• The ESR can be useful in following persons who are being treated for an illness which causes inflammation
• An ESR is not always reliable and the results should always be correlated with the patient’s current clinical condition
• Follow up tests may be needed for an unexplained elevation in ESR

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale, www.familycaresvg.com, clinic@familycaresvg.com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)
Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.