5. Factors that
accelerate ESR
• Rouleaux formation
• Specific gravity
• Temperature
• Fibrinogen & globulin
• Cholesterol
• RBC count
• Albumin conc.
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Factors that
retard ESR
• Rouleaux form.
• Specific gravity
• Temperature
• Fibrinogen &
globulin
• RBC count
• Deformed RBCs
like spherocytes
6. Significance of ESR
PROGNOSIS
• ESR is not for a diagnosis
• Presence of a disease
• To exclude organic disease
• Functional disorders
• Feigned illness
• Tuberculosis (PTB)
• Rheumatoid
arthritis
• Polymyalgia
rheumatica
• Temporal arteritis
• ESR can evaluate the degree of activity of
disease and effectiveness of the treatment
7. Uses of ESR values
1) DIAGNOSIS
• It can sometimes be useful in diagnosing some diseases,
such as multiple myeloma, temporal arteritis, polymyalgia
rheumatica, various auto-immune diseases, systemic lupus
erythematosus, rheumatoid arthritis, and chronic kidney
diseases.
• In many of these cases, the ESR may exceed 100 mm/hour.
• It is commonly used for a differential diagnosis for
Kawasaki's disease and it may be increased in some chronic
infective conditions like tuberculosis and infective
endocarditis.
7
8. Uses of ESR values
8
2) Disease severity
• It is a component of the PCDAI (Pediatric Crohn's Disease
Activity Index), an index for assessment of severity of
inflammatory bowel disease in children.
3) Monitoring response to therapy
• Certain inflammatory d such as temporal arteritis,
polymyalgia rheumatica and rheumatoid arthritis.
• Used as a crude measure of response in Hodgkin's
lymphoma.
• Additionally, ESR levels are used to define one of the
several possible adverse prognostic factors in the staging of
Hodgkin's lymphoma.
9. ESR helping in Diagnosis
• Distinguishes functional from organic disorders
• Rise in active RA, acute gout, infective arthritis
but normal OA
• High in AMI but normal in angina
• Differentiates Ca stomach from peptic ulcer
• Increased in pelvic inflammation but normal in
unruptured ectopic gestation
10. ESR helping in Prognosis and T/t
• Fever
– Rising ESR Worsening
– Falling ESR Recovery
• Rheumatic fever
– Rising ESR persistent rheumatic infection
• Coronary thrombosis
– Successive falling ESR Healing
• Acute nephritis
– ESR remains high if passing into chronic stage
12. Low ESR is seen in
• Dehydration
• Polycythemia vera
• Congestive heart failure
• Whooping cough
Editor's Notes
Age: ESR is less in children and infants because of more number of RBCs.
Sex: It is more in females than in males because of less number of RBCs.
Menstruation: The ESR increases during menstruation because of loss of blood and RBCs
Pregnancy: From 3rd month to parturition, ESR increases up to 35 mm in 1 hour because of hemodilution
ESR is easy, inexpensive and non-specific test, which helps in diagnosis as well as prognosis.
It is non-specific because it cannot indicate the exact location or cause of disease. But, it helps to confirm the diagnosis. Prognosis means monitoring the course of disease and response of the patient to therapy.
Determination of ESR is especially helpful in assessing the progress of patients treated for certain chronic inflammatory disorders such as:
1. Pulmonary tuberculosis
2. Rheumatoid arthritis
3. Polymyalgia rheumatica (inflammatory disease characterized by pain in shoulder and hip)
4. Temporal arteritis (inflammation of arteries of head).
