Background to the use of the ESR
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Usefulness of the ESR
The Erythrocyte Sedimentation Rate (ESR or Sed Rate) is one of the most widely
used laboratory tests throughout the world, the usefulness of which has been
reported by many workers as a screening test for general illness, 1 - 4
or as a
marker that can reflect the severity of acute inflammatory disease. 5
Monitoring Disease and Diagnosis
For many years the ESR has been used to monitor patients with temporal
arteritis and it is accepted to be of diagnostic importance in both this
condition and rheumatoid disease. 6 - 7 The test is also used to monitor
therapy in these conditions.
In chronic renal disease, changes in the ESR appear to be due to
alterations in fibrinogen concentrations and the constituents of uremic plasma,
independent of the degree of anaemia. 8
Prognosis Marker
The ESR can also be used as a prognosis marker, as shown by a study of ischemic
stroke, which indicated that a high ESR on admission was associated with
clinical deterioration during the first 24 hours of stroke onset. 9 Conversely
patients with congestive heart failure who had higher ESR values, had better haemodynamic and clinical benefits. They also had better one and two year
survival rates. 10
A high ESR in patients with non-metastasising renal cell carcinoma indicates a
poor prognosis. 11 Another study monitoring early stage Hodgkin's disease has
shown that the ESR could identify a group of patients at high risk for relapse
and subsequent death. 12
References
1. Hardison, C. The Sedimentation Rate. Erythrocyte sedimentation rate; blood
sedimentation rate. JAMA. 1968; 204: 257.
2. Pincherle G,
Shanks J. Value of the erythrocyte sedimentation rate as a screening test. Br J Prev Soc Med. 1967;
21:
133 - 136.
3. Zacharski LR, Kyle RA. Significance of extreme elevation of erythrocyte
sedimentation rate. JAMA. 1967; 202:
264 - 266.
4. Fincher RM, Page MI. Clinical significance of extreme elevation of the
erythrocyte sedimentation rate. Arch
Intern Med. 1986; 146: 1581-1583.
5. Miettinen AK, Heinonen PK, Laippala P, Paavonen J. Test performance of
ESR and C-reactive protein in assessing the severity of acute pelvic
inflammatory disease. Am J Obstet Gynaecol. 1993;
169:1143 - 1149.
6. Beevers DG, Harpur JE, Turk KA. Giant cell arteritis - the need for prolonged
treatment. J Chronic Dis. 1973; 26: 571-584.
7. Hamilton CR, Shelley WM, Tumulty PM. Giant cell arteritis: including temporal
arteritis and polymyalgia rheumatica. Medicine (Baltimore). 1971;
50:
1-27.
8. Shusterman N, Kimmel PL, Kiechle FL, Williams S, Morrison G, Singer I. Factors influencing
erythrocyte sedimentation in patients with chronic renal
failure. Arch Intern Med. 1985; 145: 1796 - 1799.
9. Chamorro A, Vila N, Ascaso C, Saiz A, Montalvo J, Alonso P, Tolosa E. Early
prediction of stroke severity. Role of the erythrocyte sedimentation rate. Stroke. 1995;
26: 573 - 576.
10. Haber HL, Leavey JA, Kessler PD et al. The erythrocyte sedimentation rate in congestive heart failure.
N Eng J Med. 1991; 324:
353 - 358.
11. Hannisdal E, Bostad L, Grottum KA, Langmark F. Erythrocyte sedimentation
rate as a prognostic factor in renal cell carcinoma. Eur J
Surg Oncol. 1989; 15: 333 -336.
12. Henry-Amar M, Friedman S, Hayat M et al. Erythrocyte sedimentation rate
predicts early relapse and survival in early-stage Hodgkin disease. The EORTC
Lymphoma Cooperative Group. Ann Intern Med. 1991; 114: 361 - 365.
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