erythrocyte sedimentation rate

赤血球沈降速度 ESR

WordNet

1. be worthy of or have a certain rating; "This bond rates highly"
2. amount of a charge or payment relative to some basis; "a 10-minute phone call at that rate would cost $5" (同)charge per unit
3. a magnitude or frequency relative to a time unit; "they traveled at a rate of 55 miles per hour"; "the rate of change was faster than expected"
4. a quantity or amount or measure considered as a proportion of another quantity or amount or measure; "the literacy rate"; "the retention rate"; "the dropout rate"
5. assign a rank or rating to; "how would you rank these students?"; "The restaurant is rated highly in the food guide" (同)rank, range, order, grade, place
6. estimate the value of; "How would you rate his chances to become President?"; "Gold was rated highly among the Romans" (同)value
7. give (hair) the appearance of being fuller by using a rat
8. a pad (usually made of hair) worn as part of a womans coiffure
9. any of various long-tailed rodents similar to but larger than a mouse
10. catch rats, especially with dogs
11. desert ones party or group of friends, for example, for ones personal advantage
12. employ scabs or strike breakers in
13. standing or position on a scale

PrepTutorEJDIC

1. 〈C〉『割合』,『率』 / 〈C〉《the~,a~》『速度』(speed),進度 / 〈C〉『値段』,『相場』;料金 / 〈U〉等級(class),(…)等 / 《複数形ぃ》《英》地方税 / (…の金額に)…‘の'『値段を決める』,見積もる《+『名』+『at』+『名』》 / …‘を'『評価する』,みなす / 《米話》…‘に'値する,‘の'価値がある / 『評価される』;みなされる
2. …‘を'どなりつける
3. 『ネズミ』 / ひきょう者,裏切り者 / ネズミをつかまえる / 《話》(人を)裏切る,密告する《+『on』+『名』〈人〉》
4. 〈C〉〈U〉（品質・技量などによる）格づけ,評価 / 〈C〉（個人・会社の経済的な）信用度 / 〈C〉(トン・馬力による)(船舶・車)の等級 / 〈C〉(テレビ・ラジオの)視聴率
5. 沈殿,堆積;沈殿(堆積)作用
6. 赤血球

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/05/01 04:54:01」(JST)

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Erythrocyte sedimentation rate
Diagnostics
Westergren pipet array on StaRRsed automated ESR analyzer

The erythrocyte sedimentation rate (ESR), also called a sedimentation rate or Westergren ESR, is the rate at which red blood cells sediment in a period of one hour. It is a common hematology test, and is a non-specific measure of inflammation. To perform the test, anticoagulated blood was traditionally placed in an upright tube, known as a Westergren tube, and the rate at which the red blood cells fall was measured and reported in mm/h.

Since the introduction of automated analyzers into the clinical laboratory, the ESR test has been automatically performed.

The ESR is governed by the balance between pro-sedimentation factors, mainly fibrinogen, and those factors resisting sedimentation, namely the negative charge of the erythrocytes (zeta potential). When an inflammatory process is present, the high proportion of fibrinogen in the blood causes red blood cells to stick to each other. The red cells form stacks called 'rouleaux,' which settle faster. Rouleaux formation can also occur in association with some lymphoproliferative disorders in which one or more immunoglobulins are secreted in high amounts. Rouleaux formation can, however, be a normal physiological finding in horses, cats, and pigs.

The ESR is increased by any cause or focus of inflammation. The ESR is increased in pregnancy, inflammation, anemia or rheumatoid arthritis, and decreased in polycythemia, sickle cell anemia, hereditary spherocytosis, and congestive heart failure. It may be increased in kidney cancer. The basal ESR is slightly higher in females.

History

This test was invented in 1897 by the Polish doctor Edmund Biernacki. In some parts of the world the test continues to be referred to as Biernacki's Reaction (Polish abbreviation: OB = Odczyn Biernackiego.) In 1918 the Swedish pathologist Robert Sanno Fåhræus declared the same and, along with Alf Vilhelm Albertsson Westergren, are eponymously remembered for the Fåhræus-Westergren test (abbreviated as FW test; in the UK, usually termed Westergren test), which uses sodium citrate-anti-coagulated specimens.

Uses

Diagnosis

It can sometimes be useful in diagnosing some diseases, such as multiple myeloma, temporal arteritis, polymyalgia rheumatica, various auto-immune diseases, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease and chronic kidney diseases. In many of these cases, the ESR may exceed 100 mm/hour.

It is commonly used for a differential diagnosis for Kawasaki's disease and it may be increased in some chronic infective conditions like tuberculosis and infective endocarditis.

Stages in erythrocyte sedimentation:

There are 3 stages in erythrocyte sedimentation 1) Stage 1  : Rouleaux formation - First 10 minutes 2) Stage 2  : Stage of sedimentation or settling - 40 mins 3) Stage 3  : Stage of packin - 10 minutes , sedimentation slows and cells start to pack at the bottom of the tube

Disease severity

It is a component of the PCDAI (Pediatric Crohn's Disease Activity Index), an index for assessment of severity of inflammatory bowel disease in children.

Monitoring response to therapy

The clinical usefulness of ESR is limited to monitoring the response to therapy in certain inflammatory diseases such as temporal arteritis, polymyalgia rheumatica and rheumatoid arthritis. It can also be used as a crude measure of response in Hodgkin's lymphoma. Additionally, ESR levels are used to define one of the several possible adverse prognostic factors in the staging of Hodgkin's lymphoma.

Normal values

Note: mm/hr. = millimeters per hour.

Westergren's original normal values (men 3mm and women 7mm) made no allowance for a person's age and in 1967 it was confirmed that ESR values tend to rise with age and to be generally higher in women. Values are increased in states of anemia, and in black populations.

Adults

The widely used rule calculating normal maximum ESR values in adults (98% confidence limit) is given by a formula devised in 1983:

This formula is no longer credited. Other studies show only a small dependence of ESR on age and much lower values, as seen in the following:

ESR reference ranges from a large 1996 study of 3,910 healthy adults:

Age	20	55	90
Men—5% exceed	12	14	32
Women—5% exceed	18	21	23

Children

Normal values of ESR have been quoted as 1 to 2 mm/hr at birth, rising to 4 mm/hr 8 days after delivery, and then to 17 mm/hr by day 14.

Typical normal ranges quoted are:

• Newborn: 0 to 2 mm/hr
• Neonatal to puberty: 3 to 13 mm/hr, but other laboratories place an upper limit of 20.

Relation to C-reactive protein

C-reactive protein is an acute phase protein produced by the liver during an inflammatory reaction. Since C-reactive protein levels in the blood rise more quickly after the inflammatory or infective process begins, ESR is often replaced with C-reactive protein measurement. There are specific drawbacks, however: for example, both tests for ESR and CRP were found to be independently associated with a diagnosis of acute maxillary sinusitis so in some cases the combination of the two measurements may improve diagnostic sensitivity and specificity. Several studies investigated the differential diagnostic values of ESR and CRP in inflammatory disease, and concluded ESR is a potential meaningful biomarker for disease differentiation.

References

External links

• Mediscuss on ESR
• American Family Physician article on ESR
• ESR at Lab Tests Online

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

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English Journal

• Coenzyme q10, copper, zinc, and lipid peroxidation levels in serum of patients with chronic obstructive pulmonary disease.

• Tanrikulu AC, Abakay A, Evliyaoglu O, Palanci Y.SourceDepartment of Chest Disease, Medical Faculty, Dicle University, Diyarbakir, Turkey, cetintanrikulu@hotmail.com.
• Biological trace element research.Biol Trace Elem Res.2011 Nov;143(2):659-67. Epub 2010 Nov 16.
• Severity of chronic obstructive pulmonary disease (COPD) exacerbation is associated with increased level of copper (Cu), zinc (Zn), and lipid peroxidation (malodialdehyde, MDA). The aim of this study was to investigate the levels of lipid peroxidation, Coenzyme Q10 (CoQ10), Zn, and Cu in the COPD ex
• PMID 21080098

• Importance of specimen length during temporal artery biopsy.

• Ypsilantis E, Courtney ED, Chopra N, Karthikesalingam A, Eltayab M, Katsoulas N, Tang TY, Ball RY.SourceDepartment of Surgery, Queen Elizabeth Hospital, King's Lynn, UK; Department of Surgery, Conquest Hospital, Hastings, UK. makypsi@yahoo.com.
• The British journal of surgery.Br J Surg.2011 Nov;98(11):1556-60. doi: 10.1002/bjs.7595. Epub 2011 Jun 27.
• BACKGROUND: Variations in surgical technique of temporal artery biopsy (TAB) performed for diagnosis of giant cell arteritis (GCA) may contribute to high false-negative rates. This was a retrospective analysis of a large database that explored potential associations between specimen length and diagn
• PMID 21706476

Japanese Journal

• A Case of Adult Onset Stills Disease Complicated with Cryptogenic Organizing Pneumonia

• Sato Hiroshi,Yokoe Isamu,Nishio Shinya,Onishi Tsubasa,Takao Tadashi,Kobayashi Yasuyuki,Haraoka Hitomi
• Internal Medicine 50(3), 247-251, 2011
• … The laboratory data showed marked increases in white blood cell count, an erythrocyte sedimentation rate, and C reactive protein, ferritin, and liver dysfunction. …
• NAID 130000413102

• ^<18>F-fluorodeoxyglucose-positron emission tomography (FDG-PET) 検査が早期診断と治療効果の判定に有用であった側頭動脈炎の1例

• 鮫島 謙一,中谷 公彦,塩山 実章,木下 浩二,楠 進,斎藤 能彦,船内 正憲
• 日本臨床免疫学会会誌 = Japanese journal of clinical immunology 33(6), 324-328, 2010-12-31
•   症例は61歳，女性．平成20年1月中旬に左側頭部に疼痛が出現，2月中旬から39℃台の発熱が出現してきたため，同年3月に当院神経内科に紹介された．神経学的所見や髄液所見で異常所見を指摘されず，不明熱の精査を目的に同年3月13日に当科に紹介された．入院時，意識は清明で，左側頭部に圧痛を認めたが，同部位に怒脹や発赤は認めなかった．入院時の血液検査では白血球数と血小板数の増加（WB …
• NAID 10027754289

Related Links

• Erythrocyte sedimentation rate - Wikipedia, the free encyclopedia

The erythrocyte sedimentation rate (ESR), also called a sedimentation rate or Biernacki Reaction, is the rate at which red blood cells sediment in a period of 1 hour. It is a common hematology test that is a non-specific measure of inflammation. ...

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★リンクテーブル★

リンク元	「赤血球沈降速度」「ESR」「血沈検査」「blood sedimentation」
関連記事	「rate」「rat」「sedimentation」「sedimentation rate」「erythrocyte」

「赤血球沈降速度」

　　[★]

sedimentation

英

erythrocyte sedimentation rate, ESR

同

赤沈, 血沈 blood sedimentation rate, BSR

関

[[]]

概念

• 抗凝固剤を加えた全血中の赤血球が自然凝集により沈降する速度。
• 自然凝集は正電荷または負電荷をもつ血漿蛋白質のバランスを反映する。
• 炎症により正電荷をもつ蛋白質が増加し、負電荷をもつ蛋白質が減少するので、炎症のマーカーとして用いられている。

大きいほど赤血球同士が凝集して沈降する速度が高まっていることを示す

基準値

一時間値で評価

全血+クエン酸(臨床検査法提要第32版 p.1790)

M：2-10 mm

F：3-15 mm

• 男性で10mm/h以上、女性で15mm/h以上で赤沈促進と判定

赤沈の起こるメカニズム (OLM.138)

• 赤沈に関与する成分は以下の通り

• 負に帯電：赤血球、アルブミン　→　増加により赤沈↓
• 正に帯電：αグロブリン(α1-グロブリン)、γグロブリン、フィブリノゲン　→　増加により赤沈↑

• 赤血球は負に帯電しており、電気的反発力により凝集塊の形成が妨げられている。赤血球数が増加すると、赤血球同士が反発しあうことで赤沈が遅れ、赤沈が減少する。
• アルブミンは負に帯電しており、赤血球同士を反発させることで凝集を妨げる。これにより赤沈が遅れ、赤沈が減少する。
• 正に帯電した物質の存在により赤血球の電荷が打ち消され、赤血球の凝集が促進される。これにより赤沈が増加する。

測定方法 (OLM.137)

• Westergren法
• 3.28%(109mmol/l)クエン酸ナトリウム(Na3C6H5O7･H2O)液と血液を1:4の割合に混合し、内径2.55±0.15mm、前腸300±1.5mmのWestergren肝に吸い上げ、これを正確に垂直に立てて18-25℃に整地し、1時間後に赤沈地を記録する。

赤沈値の解釈 (OLM.138)

赤沈の亢進

• 1. 技術的間違い：ピペットを傾斜させた場合
• 2. 赤血球数の減少

• 血液希釈状態
• 循環血漿量の増加：妊娠
• 貧血
• 3. フィブリノゲン・αグロブリンの増加
• 妊娠
• 炎症性疾患：感染症、膠原病活動期、悪性腫瘍など
• ストレス：大手術、外傷など

• 4. 免疫グロブリンの増加

• 多クローン性増加：肝疾患、慢性感染症、膠原病、悪性腫瘍、その他
• 単一クローン性増加：骨髄腫、マクログロブリン血症、良性M蛋白血症

• 5. アルブミンの減少・消失

• ネフローゼ症候群

赤沈亢進とCRP陰性

• 急性炎症回復期
• 貧血
• ネフローゼ症候群
• 妊娠
• 多発性骨髄腫　　→　　CRPが陰性かどうかは疑わしい。典型例や軽症例、病初期では陰性ということか。成書にはCRPについての記載はない(HIM WCH)。進行期にはCRP陽性となる(参考1,2)。
• 慢性甲状腺炎　　→　　自己抗体の増加
• 原発性マクログロブリン血症
• 高フィブリノゲン血症

赤沈の遅延

• 1. 赤血球数の増加

• 血液濃縮状態：脱水症
• 多血症

• 2. フィブリノゲンの減少

• 無フィブリノゲン血症
• 線溶亢進
• 播種性血管内凝固症候群 DIC

• 3. 免疫グロブリンの減少

• 無γグロブリン血症

参考

• 1. 多発性骨髄腫

http://ganjoho.jp/public/cancer/data/myeloma_diagnosis.html

• 2. 多発性骨髄腫

http://www.med.osaka-cu.ac.jp/labmed/page086.html

「ESR」

　　[★]

• 電子スピン共鳴 electron spin resonance
• 赤血球沈降速度 erythrocyte sedimentation rate

「血沈検査」

　　[★]

英

erythrocyte sedimentation rate、blood sedimentation

関

血沈、赤血球沈降速度

「blood sedimentation」

　　[★]

• 血沈、血沈検査

関

erythrocyte sedimentation rate

「rate」

　　[★]

• n.

• (全体に対する部分などの割合を示す)率　　　⇔　(率を率で除すような比 ratioとは区別するでしょう)

• vi.

• 格付けされる、等級に分けられる
• 影響力がある、重要な地位にある

• vt.

• ～を値踏みする、～の価格を査定する
• (～の重要性や価値を)評価する
• (性能などによって)～を格付けする(等級に分ける)
• (金融)(不動産の)課税額を決める
• ～に値する、～の価値がある

　 　 　 　 　 　 　 　

「rat」

　　[★]

• n.

• (げっ歯類)ラット、(マウスも含めての総称)ネズミ、ラットの

関

laboratory rat、mouse、Norway rat、Rattus、Rattus norvegicus

　 　 　 　 　 　 　

「sedimentation」

　　[★]

• n.

• 沈降、沈積、堆積。沈降分離、沈殿法

関

centrifugation、precipitate、precipitation、sediment

　

「sedimentation rate」

　　[★]

• 沈降速度

関

sedimentation velocity

「erythrocyte」

　　[★] 赤血球 red blood cells