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ESR blood test

ESR (erythrocyte sedimentation rate) blood test is used to measure the distance that RBCs settle in unclotted blood. Blood sample is monitored for an hour in a specially-marked test tube. The levels of ESR indicate any inflammatory or malignant disease. This test is often used to diagnose rheumatologic ailments, tuberculosis or tissue necrosis. Elevated levels of blood ESR may be indicative of rheumatoid arthritis, thyroid disease, kidney disease, syphilis or tuberculosis. Pregnancy, infection and old age can bring about elevated levels of blood ESR. Extremely low levels of ESR may suggest sickle cell anemia, Hypofibrinogenemia (Fibrinogen deficiency), CHF or hyperviscosity. ESR is a non-specific inflammation marker and may need to be supported with other diagnostic tests for medical decisions. ESR blood test is often suggested along with CRP blood test to check for arthritis since they both check for proteins associated with inflammation. However, a normal value of ESR does not rule out disease.


ESR is also known as Acute Phase Reactant Test as it reacts to severe conditions - infections or trauma. The Erythrocyte Sedimentation rate increases, some times directly in relation to a rise in body temperature and increase in white blood cell count. ESR reaches a peak after many days and usually it lasts longer than high temperature or increased white blood cell count.

Many diseases induce the body to make abnormal proteins that cause the red blood cells to clump together and stack up which results in a column called as Rouleaux. In such a situation as the red cells are heavier, they fall faster and settle further resulting in higher ESR.

ESR Results - Normal values (Westergren method):

  • Newborn : 0-2 mm/hr
  • Women < 50 years: 0-25 mm/hr
  • Men < 50 years old: 0-15 mm/hr
  •  Women 50 years and above: 0-30 mm/hr
  •  Men 50 years and above: 0-20 mm/hr

The highest ESR levels are usually seen in a cancer involving white blood cells - Multiple Myeloma and Rheumatoid disease. Other diseases which elevate the ESR : infections, anemia, kidney disease, inflammatory conditions, white blood cell disorders, cancer and autoimmune diseases.

Any disease or condition which affects the shape and size of RBC decreases the ESR. Diseases that cause the body to make less protein or extra red blood cells will also decrease the ESR. Some medicines such as anticonvulsant, and oral contraceptives may increase the ESR while drugs like Cortisone and Quinine may decrease the ESR.


CRP blood test

CRP (C-Reactive Protein) blood test measures the levels of a special protein produced by the liver during infection or acute inflammation. Usually blood does not contain CRP. CRP blood tests are often done to diagnose rheumatic fever, cancer, tuberculosis, pneumonia or heart attack. Often CRP test is suggested along with ESR blood test to check for rheumatoid arthritis and lupus. Pregnant women or women on oral contraceptives may notice positive CRP in the blood. Since CRP blood test is indicative of inflammation in the blood, it is an important predictor of heart problems.


High-sensitive CRP

This blood test aids in detecting the risk of developing myocardial infarction. In patients suffering acute coronary syndrome, the hsCRP test can predict the risk of developing cardiovascular disease or ischemia. The reference range for hsCRP:

Low Risk: < 1 mg/L

Average Risk: 1 - 3 mg/L

High Risk: >3 mg/L

Acute inflammation: >10 mg/L



Hodgkin's Disease

Hodgkin's Disease refers to a condition that was first described by British physician Thomas Hodgkin. Hodgkin's disease or Hodgkin's lymphoma is a malignant growth of lymph cells. This uncommon form of cancer of the lymph system is characterized by abnormal growth of cells in the lymph system thereby spreading beyond it. It progressively compromises the body's immune system. While Hodgkin's disease can occur to a person at any time of his life, it is noticed in early adulthood or late adulthood. Usually, Hodgkin's disease begins in the lymph nodes and may spread to other parts of the body. The difference between Hodgkin's disease and non-Hodgkin's lymphoma is that tumors in Hodgkin's syndrome contain large cells called Reed-Sternberg cells.


Patients suffering from Hodgkin's disease notice painless swelling in the lymph nodes of the neck, armpit or groin. There may be fever and fatigue. The patient loses weight and feels drained of energy. Unexplained itching and lower back pain may also be noticed.


Most often diagnosis of Hodgkin's lymphomas is made during physical check-ups. A biopsy is done to test for the presence of Reed-Sternberg cells that are characteristic to Hodgkin's lymphomas. Blood test will reveal abnormal blood cell count and ESR. Bone marrow aspiration is done to aid diagnosis and treatment. Cellular activity can be traced with Positron Emission Tomography (PET) scan. Treatment for Hodgkin's disease depends on the stage that the disease is in. This determines the extent and region of lymph nodes that have been affected.


Radiation therapy is resorted to when a limited area is affected by Hodgkin's disease. Here high-energy rays are used to kill cancer cells and stop their proliferation. Often it is used in combination with chemotherapy. Chemotherapy may involve a combination of drugs that work together.

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Collection of Pages - Last revised Date: May 21, 2019