see also:

• pathology
• C reactive protein (CRP)

• ESR is generally used as a marker of acute phase reaction and inflammation, although there are now better, more specific markers of acute phase reactions including:
  • C reactive protein (CRP)
  • serum amyloid A protein
  • procalcitonin
• the ESR is raised by:
  • higher concentrations of fibrinogen and alpha-globulins
  • higher plasma albumin concentration
  • size, shape and number of RBCs (eg. anaemia may cause raised ESR)
  • renal failure
  • obesity
  • old age
  • female gender
  • malignancy
  • non-acute phase reaction proteins such as immunoglobulins
    • these proteins all have half-lives of days to weeks, and there is a significant lag time between changes at the clinical level and variations in the ESR.
• these non-acute phase influences, plus the influence of various other factors on the ESR such as diurnal variation, and food intake, makes it an imprecise guide to disease activity in most cases
• furthermore, the ESR response to acute phase reaction is slow resulting in early false negative results, and may take weeks or months to resolve
• however, ESR remains helpful in certain clinical situations such as:
  • the detection of heavy chain multiple myeloma although plasma and urine protein electrophoresis are far more specific tests
  • systemic lupus erythematosus (SLE)
  • some low grade bone/joint infections
• as an acute inflammatory marker, and marker for most auto-immune conditions (including polymyalgia rheumatica, temporal arteritis, subacute thyroiditis), C reactive protein (CRP) is generally a better test.

• sepsis / septicaemia
• low grade bone/joint infections
• neoplasia / cancer / tumours including multiple myeloma
• auto-immune conditions
  • systemic lupus erythematosus (SLE)
  • polymyalgia rheumatica / temporal arteritis
  • subacute thyroiditis)
  • etc
• immunoglobulin therapy ¹⁾