Blood plasma viscosity inflammation



by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Erythrocyte sedimentation rate (ESR) determination is a simple and inexpensive laboratory blood test that is often ordered when evaluating the patient with arthritis.

The test measures the distance that erythrocytes have fallen after one hour in a vertical column of anticoagulated blood under the influence of gravity. The amount of fibrinogen, and therefore viscosity in the blood directly correlates with the ESR. Although there is an enormous amount of literature concerning the ESR, an elevated value remains a nonspecific finding.

Women and the elderly tend to have higher ESR values. Any condition that elevates fibrinogen (e.g., pregnancy, diabetes mellitus, end-stage renal failure, heart disease, collagen vascular diseases, malignancy) may also elevate the ESR. Anemia and the presence of large red blood cells (macrocytosis) increase the ESR. In anemia, the red blood cell aggregates fall faster. Macrocytic (large) red cells with a smaller surface-to-volume ratio also settle more rapidly.

A decreased ESR is associated with a number of blood diseases in which red blood cells have an irregular or smaller shape that causes slower settling.

In patients with polycythemia, there is an excessive number of red blood cells and this lowers the ESR. An extreme elevation of the white blood cell count as observed in chronic lymphocytic leukemia has also been reported to lower the ESR.

Hypofibrinogenemia, hypergammaglobulinemia associated with dysproteinemia, and hyperviscosity may each cause a marked decrease in the ESR. Drug therapy with non-steroidal anti- inflammatory agents may decrease the ESR.

Researchers have wondered whether other tests, such as measurement of C-reactive protein, may perform better than the ESR. However, the ESR has been shown to be a reliable monitor of acute-phase response to disease after the first 24 hours.

Because an elevated ESR may occur in so many different clinical settings, this finding is meaningless as an isolated laboratory value. In addition, some patients who have malignant tumors, infections or other inflammatory disorders will have normal ESR values. Most unexplained ESR elevations are short-lived and not associated with any specific underlying process. In those instances where disease is present, it will usually become evident after completion of history taking, physical examination and collection of routine laboratory data.



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