Erythrocyte Sedimentation Rate: ESR

Erythrocyte Sedimentation Rate: ESR

ESR stands for erythrocyte sedimentation rate. It is commonly called a "sed rate."

It is a non-specific test for internal inflammation.


Below is one of the best sites explaining briefly what causes a high ESR.




http://www.nlm.nih.gov/medlineplus/ency/article/003638.htm

ESR

    

ESR stands for erythrocyte sedimentation rate. It is commonly called a "sed rate."

It is a test that indirectly measures how much inflammation is in the body.

How the Test is Performed
How to Prepare for the Test
How the Test will Feel
Why the Test is Performed

• Unexplained fevers

• Certain types of arthritis

• Muscle symptoms

• Other vague symptoms that cannot be explained

• Autoimmune disorders

• Bone infections

• Certain forms of arthritis

• Inflammatory diseases that cause vague symptoms

• Tissue death

Normal Results

• Men under 50 years old: less than 15 mm/hr

• Men over 50 years old: less than 20 mm/hr

• Women under 50 years old: less than 20 mm/hr

• Women over 50 years old: less than 30 mm/hr

• Newborn: 0 to 2 mm/hr

• Newborn to puberty: 3 to 13 mm/hr

What Abnormal Results Mean

• Anemia

• Cancers such as lymphoma or multiple myeloma

• Kidney disease

• Pregnancy

• Thyroid disease

• Lupus

• Rheumatoid arthritis in adults or children

• Allergic vasculitis

• Giant cell arteritis

• Hyperfibrinogenemia (increased fibrinogen levels in the blood)  

• Macroglobulinemia - primary

• Necrotizing vasculitis

• Polymyalgia rheumatica

• Body-wide (systemic) infection

• Bone infections

• Infection of the heart or heart valves

• Rheumatic fever

• Severe skin infections, such as erysipelas

• Tuberculosis

• Congestive heart failure

• Hyperviscosity

• Hypofibrinogenemia (decreased fibrinogen levels)

• Leukemia 

• Low plasma protein (due to liver or kidney disease)

• Polycythemia

• Sickle cell anemia

Alternative Names
References
Update Date 5/11/2013

A blood sample is needed. Most of the time blood is drawn from a vein located on the inside of the elbow or the back of the hand. The blood sample is sent to a lab.

The test measures how fast red blood cells (called erythrocytes) fall to the bottom of a tall, thin tube.

There are no special steps needed to prepare.

You may feel slight pain or a sting when the needle is inserted. You may also feel some throbbing at the site after the blood is drawn.

Reasons why a "sed rate" may be done include:

This test may also be used to monitor whether an illness is responding to treatment.

This test can be used to monitor inflammatory diseases or cancer. It is a screening test. This means it cannot be used to diagnose a specific disorder.

However, the test is useful for detecting and monitoring:

For adults (Westergren method):

For children (Westergren method):

Note: mm/hr = millimeters per hour

Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

An abnormal ESR may help with a diagnosis, but it does not prove that you have a certain condition. Other tests are almost always needed.

An increased ESR rate may be due to:

The immune system helps protect the body against harmful substances. An autoimmune disorder is when the immune system mistakenly attacks and destroys healthy body tissue. ESR is often higher than normal in people with an autoimmune disorder.

Common autoimmune disorders include:

Very high ESR levels occur with less common autoimmune disorders, including:

An increased ESR rate may be due to some infections, including:

Lower-than-normal levels occur with:

Erythrocyte sedimentation rate; Sed rate; Sedimentation rate

Pisetsky DS. Laboratory testing in the rheumatic diseases. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

Should I Be Checked For Nutritional or Micronutrient Deficiency?

Should I Be Checked For Micronutrient Deficiency

Checking for nutrient deficiency is a very controversial subject in medicine partly because there are no published (in well-respected journals),  double blinded, randomized controlled studies to prove that such deficiencies directly impact a particular patient's symptoms or disease processes (with some exceptions such as an iron deficiency anemia, low magnesium, low calcium, low Vit D).

However, checking for a deficiency is not a bad idea for patients who have unexplained symptoms.

Below is an example of a posting for Spectra Cell test.

Results of such tests should be discussed with your physician and nutritionist to determine its importance in your health.

http://wholehealthchicago.com/2012/04/02/can-i-be-tested-for-nutritional-deficiencies-2/

Can I Be Tested for Nutritional Deficiencies?

Posted on April 2, 2012 by — 15 Comments ↓

This is a fairly common question in our office and the short answer is yes. It’s easy to understand the curiosity. You’ve cleaned up your eating habits, buying all those fruits and veggies. Whole grains, even. And more fish (oh, those omegas!) than you ever dreamed of eating when you were a kid.

On your kitchen counter sits a row of supplements you dutifully swallow each morning, maybe twice a day if the bottle tells you to. Is all that nutrition’s really getting into you? Are your efforts worthwhile?

With these investments, your nutritional status is likely solid, all the effort paying off. But keeping in mind that each of us is metabolically unique, know that some of us absorb nutrients better than others, have individual nutritional needs, or burn through certain vitamins more quickly.

If you’d like to see some hard data, a comprehensive test is available that measures your levels of an impressive array of micronutrients. The bad news is that you’ll have to pay for this test out-of-pocket, though you can always submit an insurance claim yourself and try your luck at reimbursement. The same holds true if you have a Health Savings Account where you work. You should be paid back…but nothing is predictable in health care these days.

It’s worth noting that the price of this test has dropped dramatically since it was first developed. And while you personally may prefer to spend its $373 test price tag on a meal at Charlie Trotter’s, this is one case in which you’re getting a lot of test for your health care dollar.

Spectra Cell Laboratories has been performing micronutrient testing for years using a patented technique called Functional Intracellular Analysis, which measures how an individual nutrient is being processed inside a cell. The test is performed on your lymphocytes, one type of white blood cell. Some researchers believe cellular analysis is superior to measuring levels of nutrients inserum or plasma because testing these latter two doesn’t determine if the nutrient accomplishing anything.

Here’s a list of what’s measured in the Spectra Cell test (pour yourself another coffee–it’s lengthy):

Vitamin A

B complex vitamins
B-1 (thiamine)
B-2 (riboflavin)
B-3 (niacinamide)
B-6 (pyridoxine)
B-12 (cobalamin)
Folic acid
Pantothenate
Biotin

Vitamin C

Vitamin D

Vitamin E

Vitamin K

Amino acids and metabolites
Serine
Glutamine
Asparagine
Choline
Inositol
Carnitine

Fatty acids
Oleic acid

Minerals
Calcium
Magnesium
Zinc
Copper
Manganese

Antioxidants
Glutathione
Cysteine
Coenzyme Q-10
Selenium
Alpha lipoic acid

The test also measures these specific cellular functions:

Carbohydrate metabolism (abnormalities point to increased diabetes risks)
Glucose-insulin interaction
Fructose sensitivity
Chromium

Total antioxidant function  

Low levels of antioxidants are linked to increased susceptibility to chronic degenerative diseases.

Cellular immunity function 
This measures your cell-mediated immune system performance (T-cell proliferation), a systemic measure of your general health (higher = better).

When the results are returned (we send them by email with the test attached, followed by a hard copy), SpectraCell also provides a list of recommended supplements and dosing levels. If you have a lot of deficiencies, I generally encourage you to schedule a visit with one of our nutritionists,Marla Feingold or Seanna Tully. If you have just one or two low results, you can purchase the supplements in our apothecary or at your local health food store.

Anticipating your next question: why doesn’t health insurance cover this? The quick answer is that everyone with health insurance would want to have this test and health insurance companies want to keep your money for themselves. The longer answer is that your health insurance has very specific guidelines on what they’ll allow for screening tests (generally covered are those that everyone should have, like cholesterol levels) and diagnostic tests, those needed in the diagnosis of a specific illness.

Your insurance would cover one or two of these nutrient tests if I were using them to diagnose a specific illness, but they draw the line at my ordering them all. They also add some interesting roadblocks. If, for example, I were to order the five antioxidant tests (separately, about $450), they’d likely request a letter from me with an explanation—what exactly was I trying to diagnose?

If you’re interested in having the micronutrient test, call WholeHealth Chicago and schedule a “lab only.” One of our assistants will call you to verify that we have a SpectraCell test kit in stock. Overnight fasting (no food after midnight) is recommended to improve accuracy. You’ll come in, we’ll draw some blood, and you’ll receive documentation for submission to your insurance carrier or Health Savings Account.

Be well,

David Edelberg, MD

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Tagged with: functional intracellular analysis, lab test, nutritional deficiencies, Spectra Cell Laboratories
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1. Michele Salustro-Doll says:

   April 3, 2012 at 6:25 am

   I paid for this test, my cardiologist read the results they sent me and said it was a hoax, that if my B12 were as low as this test claimed that I would be dead. I paid $400. for the test, bought all the supplements and none of it made any difference in how I feel.
2. Patricia Schulze says:

   April 3, 2012 at 7:24 am

   David,
   Thank you so much! Plain talk with specific information. That is so rare.
   I live in Connecticut but heard about your practice from my younger sister, so I signed up for your newsletter.

   Best Regards,
   Patricia
3. Mark Evans says:

   April 3, 2012 at 8:07 am

   So how often do you encounter a patient with a pathologically low level of something that you didn’t already suspect?
4. Dr E says:

   April 3, 2012 at 9:16 am

   Hi Michele
   I frequently encounter comments like your cardiologist’s when something is introduced that is beyond a doctors area of expertise. Similar comments occur when it comes to food sensitivity testing, salivary hormone testing, and urinary measurements of neurotransmitters. The attitude “if I didn’t learn it in medical school, it can’t be real” is really not a helpful stance for any physician to take. SpectraCell is a CLIA certified lab, meaning it meets very strict govenment standards about how a lab should operate and tests run. I strongly doubt if your cardiologist has actually sat down and read how the technique was developed, the standards they follow, etc., etc. Being an authority figure, you’re accepting his opinions as “facts” (as he does himself)
5. Judy Kayser says:

   April 3, 2012 at 4:38 pm

   This sounds like a very good test, especially for those like me who have serveral serious health conditions. I have seen so many doctors, before I became Doctor E’s patient, who simply dismiss that which is not evident through a test or taught in med school. Specialist are so focused on their specialty they never stop to realize thier area of expertise makes up only one part of a very complicated system. It is seldom that any of my different specialist, although very good in their areas, stop to consider my overall health and how everything in my body plays off each other. I am lucky to have Dr. E who understands this. This is a test I will gladly pay for and thanks for letting us know it’s out there.
6. Anne says:

   April 4, 2012 at 1:36 pm

   Hi Dr. E,

   This topic leads me to ask another question about testing for metabolic efficiency. Is this something that can be tested (either by blood, breath, etc.)? I think nutrient testing is probably very useful but I personally am also interested in getting a baseline to understand my metabolism and become more effective in weight loss (assuming good diet and exercise). I noticed that this nutrient testing looks at carb metabolism but is that the only piece of it?

   Thanks — Anne
7. Kathleen says:

   May 19, 2012 at 6:52 pm

   Is there a way to get this test done when you don’t live in the Chicago area?
   I would be willing to get the test done and then go to Chicago for nutritional evaluation once the results are complete. I’m located 80 minutes from New York City.
8. Dr. R says:

   May 20, 2012 at 8:04 pm

   You might check with SpectraCell laboratory for a referral of a doctor in your area that runs this test. http://www.spectracell.com/
9. Teddy bear says:

   February 22, 2015 at 8:51 pm

   I have MS. I have dramatically improved my eating habits, and have started a vitamin regimen( on my own). Still feel tired and wore out 3/4 of the time. Would this be a helpful test? Or do I chalk the tiredness to the disease?
10. Dr E says:

    February 24, 2015 at 11:06 am

    Hi
    I think either this or the Individual Optimal Nutritional test (by Genova) would be worthwhile. You should also be tested for borderline hypothyroidism and adrenal fatigue, two frequently overlooked causes of tiredness in MS patients
11. Sarah says:

    March 10, 2015 at 4:43 pm

    I came across this website when I decided to research how to get tested for nutritional deficiency and that’s how I found you – praise GOD!

    I live in Scotland and wondered if there is similar tests I could do here? I suffer from lack of motivation which is mainly due to a diagnosed BPD (borderline Personality Disorder, not because I’m lazy), anxiety which is brought on by stress and lower back pain which has a knock on effect on my whole body by causing my nervous muscles to contract which makes my entire body tense. It’s a never-ending battle and trying to get my psychiatrists to understand that I’d prefer supplements rather than what they are prescribing which is ‘Sertraline’, and instead treat my condition naturally through an organic supplement yet can’t find anyone that would support nutritional supplements to aid the deficiency instead of treating the deficiency with chemicals which could infect and make things worse especially with it not being monitired given that I attend an outpatient clinic. Can you point me in the right direction? I’m willing to travel?

    Thank you for reading!
    Sarah
12. Dr E says:

    March 11, 2015 at 8:30 am

    Hi Sarah
    When patients tell me of back pain and ‘entire body is tense’ sort of phrasing, I think of fibromyalgia with chronic fatigue. Psychiatrists virtually never check for this and treat patients for years with antidepressants. Ask your GP about fibromyalgia (which may go by a different name in Scotland, myalgic encepahlomyelitis
    Dr E
13. Nikki says:

    June 21, 2015 at 10:33 am

    Hi Dr E,

    I have been really physically sick for 9 weeks because of what seems to be Thyroid related.

    The diagnosis is likely to be Hyperthyroidism or Hashimoto’s Thyroiditis.

    I’m on a Vegan diet, however, I’m very malnourished and I haven’t eaten properly for a long time. I’m losing weight rapidly and very worried. I’m probably deficient in everything.

    This is mostly because of money problems and staying as an In-patient in several Hospitals over the past weeks where I was fed very inadequately.

    I’m very Anemic, and on 80 mg Iron supplements as well as 1000 mcg B12 both daily.

    Very worried if I will be OK? Is an omnivore diet necessary?

    I will do whatever it takes to survive. I hope that there’s help for me.

    I feel that I need to have a test such as what is offered by Whole Health Chicago for the above reasons. I’m doubt that my declining physical health allows any more blood to be taken, and this is the same reason why I don’t have a confirmed diagnosis on my Thyroid, however I seriously need it because this is possibly contributing to my Anemia.

    What do I do?

    I’m living in Australia.

    Please help me. I don’t want to die. Please help me.
14. Dr E says:

    June 23, 2015 at 5:15 pm

    Hi Nikki
    Sorry to hear abut your health challenges. Thyroid disorders (overactive or underactive) can be diagnosed with a simple blood test that requires very little blood. Likewise, key vitamin levels can be tested and you don’t need the SpectraCell test for these. Since you are already in the hospital, your doctors can order these tests for you. Good luck!
15. lee wilson says:

    June 28, 2015 at 8:23 pm

    I had to beg my Doctors to test me for Magnesium and finally they did, i was below minimum requirements. my heart skips disappeared after a few weeks of mag supplement, i had to deal with heart skips for 6 months and going to doctors and the ER. i later discovered that the ER and docs just use a basic blood testing that overlooks dozens of other blood test that can or should be performed.