I. Mechanism

  1. Acute phase reactants in blood
    1. Nonspecifically bind to Red Blood Cells
    2. Increases sedimentation rate
  2. Measures settling rate of anticoagulated erythrocytes
    1. Height of RBCs that settle in tube within 1 hour
  3. Marker of tissue inflammation
    1. High Sensitivity
    2. Low Specificity
  4. Factors affecting ESR
    1. Older age
    2. Female gender
    3. Pregnancy

II. Dynamics of sedimentation rate

  1. Rises >24 hours after inflammation onset and symptoms
  2. Gradually returns to normal 4 weeks after resolution

III. Normal

  1. Newborn: 0-2 mm/hour
  2. Children: 3-13 mm/hour
  3. Women
    1. Range for ages 18 to 50 years: 1-20 mm/hour
    2. Range for age over 50 years: 1-30 mm/hour
    3. Normal Maximum: (Age in years + 10) / 2
  4. Men
    1. Range for ages 18 to 50 years: 1-15 mm/hour
    2. Range for age over 50 years: 1-20 mm/hour
    3. Normal Maximum: (Age in years) / 2

IV. Indications

  1. Grades acute illness severity in Emergency Setting
    1. 299 Peds patients with Limp, Abdominal Pain, Fever
      1. ESR >50 (n=101): 56% had significant illness
      2. ESR 20-50 (n=109): 27% had significant illness
      3. ESR <20 (n=89): 8% had significant illness
    2. Where significant illness
      1. Rheumatoid Arthritis
      2. Osteomyelitis
      3. Pneumonia
      4. Pyelonephritis
    3. Reference
      1. Huttenlocher (1997) Clin Pediatr 339-44 [PubMed] (or open in [QxMD Read])
  2. Diagnosis of Rheumatic Conditions
    1. Polymyalgia Rheumatica (sensitivity: 80%)
    2. Temporal Arteritis (sensitivity: 95%)
  3. Staging of condition
    1. Rheumatic conditions with waxing and waning course
    2. Rheumatoid Arthritis

V. Falsely decreased ESR (interfere with rouleaux formation)

  1. Severe Leukocytosis
  2. Polycythemia
  3. Red Blood Cell abnormalities
    1. Acanthocytosis
    2. Poikilocytosis
    3. Anisocytosis
    4. Spheocytosis
    5. Sickle cell disease
    6. Microcytosis (e.g. Iron Deficiency Anemia)
  4. Protein abnormalities
    1. Hypofibrinogenemia
    2. Hypogammaglobulinemia
    3. Macroglobulinemia (e.g. Hyperviscosity Syndrome)

VI. Increased ESR in Infectious Disease

  1. Bacterial Infections
  2. Infectious hepatitis
  3. Cat Scratch Disease
  4. Post-perfusion syndrome
  5. Primary Atypical Pneumonia
  6. Tuberculosis
  7. Secondary Syphilis
  8. Leptospirosis
  9. Systemic Fungal Infection

VII. Increased ESR in Hematologic and Neoplastic Disease

  1. Severe Anemia or macrocytosis
  2. Leukemia
  3. Lymphoma
  4. Metastatic tumor
  5. Chronic granulomatous disease

VIII. Increased ESR in Gastrointestinal Disease

IX. Increased ESR in Collagen Vascular Disease

XI. Increased ESR in Miscellaneous disorders

  1. Hypothyroidism
  2. Thyroiditis
  3. Sarcoidosis
  4. Infantile cortical hyperostosis
  5. Trauma from surgery or Burn Injury
  6. Drug Hypersensitivity Reaction

Images: Related links to external sites (from Google)

Ontology: Electron Spin Resonance Spectroscopy (C0013845)

Definition (MSH) A technique applicable to the wide variety of substances which exhibit paramagnetism because of the magnetic moments of unpaired electrons. The spectra are useful for detection and identification, for determination of electron structure, for study of interactions between molecules, and for measurement of nuclear spins and moments. (From McGraw-Hill Encyclopedia of Science and Technology, 7th edition) Electron nuclear double resonance (ENDOR) spectroscopy is a variant of the technique which can give enhanced resolution. Electron spin resonance analysis can now be used in vivo, including imaging applications such as MAGNETIC RESONANCE IMAGING.
Definition (NCI) A spectrometric method, based on measurement of electron spins and magnetic moments, for detecting and estimating free radicals in reactions and in biological systems.
Definition (CSP) technique applicable to the wide variety of substances which exhibit paramagnetism because of the magnetic moments of unpaired electrons; the spectra are useful for detection and identification, for determination of electron structure, for study of interactions between molecules, and for measurement of nuclear spins and moments.
Concepts Laboratory Procedure (T059)
MSH D004578
SnomedCT 146505007, 31247009
English Electron Paramagnetic Resonance, Electron Spin Resonance, Paramagnetic Resonance, Paramagnetic Resonance, Electron, Resonance, Electron Paramagnetic, Resonance, Electron Spin, Resonance, Paramagnetic, Electron paramagnetic resonance spectroscopy, Electron spin resonance measurement, NOS, electron spin resonance spectroscopy, Electron spin resonance, electron paramagnetic resonance spectroscopy, EPR spectroscopy, Electron spin resonance (procedure), ESR - Electron spin resonance, Electron spin resonance measurement (procedure), Electron spin resonance measurement, ESR, ESR Spectroscopy, Spectroscopy, ESR, Spectroscopy, Electron Spin Resonance, Electron Spin Resonance Spectroscopy
French Résonance de spin électronique, RPE (Résonance Paramagnétique Électronique), RSE (Résonance de Spin Électronique), Résonance paramagnétique électronique, Résonance paramagnétique, Résonance électronique de spin, Spectroscopie de résonance de spin électronique, Résonance électronique paramagnétique
Swedish Elektronspinnresonansspektrografi
Czech elektronspinová rezonanční spektroskopie
Spanish Electron spin resonance, Electron spin resonance measurement (procedimiento), medición de resonancia de spin de electrones (procedimiento), medición de resonancia de spin de electrones, Espectroscopia de Resonancia por Spin del Electron, Resonancia Paramagnetica por Electron, Resonancia Paramagnetica, Espectroscopía de Resonancia por Spin del Electrón, Resonancia Paramagnética por Electrón, Resonancia Paramagnética
Finnish ESR-spektroskopia
Italian Risonanza di spin elettronico, Risonanza paramagnetica, Risonanza paramagnetica elettronica, Spettroscopia a risonanza di spin elettronico
Russian PARAMAGNIR, ELEKTRONNYI IADERNYI DVOINOI REZONANS, PARAMAGNITNYI REZONANS, ELEKTRONNOGO PARAMAGNITNOGO REZONANSA SPEKTROSKOPIIA, ELEKTRONNOGO SPINOVOGO REZONANSA SPEKTROSKOPIIA, ELEKTRONNYI PARAMAGNITNYI REZONANS, ENDOR, ПАРАМАГНИР, ПАРАМАГНИТНЫЙ РЕЗОНАНС, ЭЛЕКТРОННОГО ПАРАМАГНИТНОГО РЕЗОНАНСА СПЕКТРОСКОПИЯ, ЭЛЕКТРОННОГО СПИНОВОГО РЕЗОНАНСА СПЕКТРОСКОПИЯ, ЭЛЕКТРОННЫЙ ПАРАМАГНИТНЫЙ РЕЗОНАНС, ЭЛЕКТРОННЫЙ ЯДЕРНЫЙ ДВОЙНОЙ РЕЗОНАНС
Japanese 電子常磁性共鳴, 電子核二重共鳴, 電子スピン共鳴, 常磁性共鳴
Croatian ELEKTRONSKA SPINSKA REZONANCIJA, SPEKTROSKOPSKA, PARAMAGNETSKA REZONANCIJA
Polish Rezonans spinowy elektronowy, Spektroskopia metodą rezonansu spinowego elektronowego
German Elektronenparamagnetische Resonanz, Elektronenspinresonanzspektroskopie, Paramagnetische Resonanz
Dutch Elektronenspinresonantiespectroscopie, Resonatie, elektronenparamagnetische, Resonatie, paramagnetische, Spectroscopie, elektronenspinresonantie
Portuguese Ressonância Paramagnética Eletrônica, Ressonância Paramagnética, Espectroscopia de Ressonância de Spin Eletrônica