Factors Influencing RBC Sedimentation

Proteins and Lipids Causing Increased ESR

• Increased

  • cholesterol

  • fibrinogen

  • gamma globulins

• decreased albumin

Proteins and Lipids Causing Decreased ESR

• Increased

  • albumin

  • glucose

  • bile salts

  • phospholipids,

• decreased

  • fibrinogen

  • gamma globulins

RBC Factors Causing Increased ESR

• Anemia

• Macrocytosis

RBC Factors Causing Decreased ESR

• Polycythemia

• Anisocytosis (marked)

• Microcytosis

• Acanthocytosis

• Hemoglobin C

• Sickle cells

• Spherocytosis

• Thalassemia

WBC Factors Influencing ESR

• Increased ESR: Leukemia

• Decreased ESR: Leukocytosis (marked)

Drugs Increasing ESR

• Dextran

• Heparin

• Penicillamine

• Procainamide

• Theophylline

• Vitamin A

Drugs Decreasing ESR

• Adrenocorticotropic hormone (corticotropin)

• Cortisone

• Ethambutol

• Quinine

• Salicylates

Clinical Conditions Increasing ESR

• Inflammatory conditions (increased fibrinogen, alpha globulins, beta globulins)

• Infections (acute/chronic)

• Subacute bacterial endocarditis

• Acute heavy metal poisoning

• Collagen vascular diseases

• Diabetes mellitus

• End-stage renal failure

• Hepatitis

• Gout

• Malignancy

• Menstruation

• Multiple Myeloma

• Waldenström's macroglobulinemia

• Myocardial infarction

• Rheumatic fever

• Rheumatoid arthritis

• Syphilis

• Temporal arteritis

• Nephrosis

• Tuberculosis

• Adults over 60 y.o. (decreased albumin)

• Pregnancy

Clinical Conditions Decreasing ESR

Cachexia, Congestive heart failure, Newborn status

Technical Factors Falsely Increasing ESR

• Refrigerated sample NOT returned to room temperature

• High room temperature

• Vibration

• Tilted ESR tube (tilt as little as 3° can cause error up to 30%)

Technical Factors Falsely Decreasing ESR

• Clotted blood sample

• Delay in testing

• Bubbles in ESR column

• Low room temperature

• Narrow ESR column diameter