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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.


Hypoglycemia

Low blood sugar or hypoglycemia is not a disease but a health condition. For diabetics, it can result in serious complications. Almost all alcoholics have low blood sugar. Too low or too high blood sugar affects normal functioning of the body. The level varies from person to person under different circumstances. Generally, blood sugar level between 50 and 60 mg/dl is referred to as mild hypoglycemia, whereas that between 20 and 50 mg/dl is moderate hypoglycemia. A value that is lower than 20 mg/dl can prove to be fatal.


Symptoms of hypoglycemia

Those experiencing low blood sugar may have a combination of symptoms at any given time. These may include weakness, sweating, headache, nervousness, unclear thinking or feeling uneasy. After the initial warning, in the absence of remedial measures, the symptoms can progress to seizure, and even damage to the brain or death in extreme cases.

Causes of hypoglycemia


  • Poor eating habits.

  • Unhealthy diet.

  • Intake of certain medicines particularly ones that may inhibit the liver and pancreas' respective functions.

  • Drinking large amounts of beer, wine or hard liquor, particularly on an empty stomach.

  • Certain types of tumor growth with particular reference to those that grown on organs that manage body's insulin such as liver or pancreas.

  • Abnormal development of certain hormones wherein the body produces too much insulin (hyperinsulism), resulting in a rapid depletion of body's glucose. This in turn can lead to sudden lowering of blood sugar.

  • Liver disease, kidney disease or other serious illness.

  • People who have early diabetes mellitus or pre-diabetes.

Treating low blood sugar

Home monitoring devices or blood glucose monitoring devices are available. It is a quantitative test that helps find out the amount of glucose present in blood sample. The results can be obtained in few minutes.

The immediate action, for non-diabetics is to have a tablespoon of sugar, honey or syrup which relieves the symptoms in 10 to 15 minutes. Drinking fruit juice or a cup of milk also help in normalizing blood sugar levels. Candy or glucose tablets, if available also help to control blood sugar levels. Don't eat too much and wait for about 15 minutes before eating again.

If the symptoms have cleared and if the next meal is scheduled within 30 minutes or less, go ahead and eat on schedule. If it's due much later, have a snack to reduce the risk of recurrence. In extreme circumstances, be prepared to seek emergency help.


Abnormal liver enzyme

Abnormal liver enzyme detection and estimation provides a comprehensive foundation for the identification of inflammatory diseases associated with the liver. These values are raised when liver cells are damaged. Routine liver function test helps in the estimation and detection of abnormal liver enzymes.


In many cases liver enzyme abnormalities are caused because of hepatocellular injury. This condition results when the liver cells are damaged producing leaky membranes. The intracellular enzymes enter the blood stream as a result of these leaky membranes. The predominant intracellular liver enzymes which are analyzed indicating the hepatocellular damage are aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Hepatitis is one of major causes for the hepatocellular damage.


Cholestasis is another condition, resulting in the production of abnormal liver enzymes. It is caused because of biliary obstruction or hepatic infiltration. The resulting enzymes produced because of these conditions include alkaline phosphatase (ALT) and gamma glutamyl transpeptidase (GGT).


Risk factors due to abnormal liver enzymes

The risk factors pertaining to the onset of liver disease are based upon factors such as behavior, medications and systemic illness. The patients categorized based on the behavior include IV drug users, history of multiple sex partners, alcohol abuse and tattoos. The patients categorized based on the medication include acetaminophen and anticonvulsant drug users. Systemic conditions such as diabetes, auto immune diseases, obesity and metastatic cancers are major risk factor indicatives of hepatocellular damage which elevate the abnormal liver enzyme values.


Liver function test

Alanine aminotransferase (ALT): It is also known as serum glutamic pyruvic transaminase (SGPT) analysis. It helps in the detection of hepatocellular damage due underlying conditions such as hepatitis. The reference range for the ALT test is 9 -72 u/l.

Alkaline phosphatase (ALP): This test used in the detection of biliary obstruction in liver and also bone disorders. The results are correlated with other liver function tests to diagnose liver cell damage. The reference range is 38-126 u/l

Aspartate aminotransferase (AST): AST is also used in the detection of liver cell damage and membrane leakage of the liver cells. The reference range is 8- 50 u/l.

Bilirubin: Bilirubin diagnostic test is administered to detect conditions such as cirrhosis, hepatitis and presence of gall stones. It is predominantly ordered in the case of newborns to detect the incidence of jaundice. The reference range for total bilirubin is 0.2-1.3 mg/dl.

Albumin: Albumin test signifies the presence of liver disorder or nephrotic syndrome. Low albumin levels indicate the presence of liver damage. The reference range is 3.9- 5.0 g/dl.

Lactate dehydrogenase (LDH): LDH values indicate the presence of tissue damage. It is used to detect tissue damage associated liver, kidney and cardiac origins. The reference range for LDH is 313-618 u/l.

Comprehensive metabolic panel (CMP): Comprehensive metabolic panel pertaining to liver disease is very significant in the detection of underlying liver disorders such as hepatitis especially in newborns. It also helps in the identification of liver damage caused because of alcohol consumption.

Gamma glutamyl transferase (GGT): This test acts as a precursor for the estimation of alkaline phosphatase values pertaining to hepatocellular damage and biliary obstruction. GGT and ALP tests are interrelated in case of hepatic and bone disorders.

Total protein: Total protein levels are measured by evaluating the albumin and globulin ratios. The reference range for total protein is 6.3- 8.2 g/dl. The decrease in total protein value indicates the onset of liver or kidney disease.

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Collection of Pages - Last revised Date: August 24, 2019