Are you looking at your blood test and wondering why your erythrocyte sedimentation rate (ESR) is so high? Or maybe you're just wondering what this test is actually looking at and what it actually does?

So in this video, we're going to explore what erythrocyte sedimentation rate (ESR) is and what it actually means in terms of what's going on in the body to create higher or lower levels. ESR, also known as sed rate, measures the rate at which red blood cells settle in a vertical tube of blood over a specified period of time, which is one hour. The process that leads to more or less of the stacking of the red blood cells is greatly influenced by inflammation, especially the immune system and its responses to whatever is going on in the body.

At the cellular and microscopic level, the immune response causes all kinds of different things to happen in the body. On the level of the red blood cells, it causes them to stick or stack together, which leads to a higher ESR or sed rate or erythrocyte sedimentation rate.

How does the immune response actually do this? Well, it has to do with the things that are produced by the immune system when this is occurring. The immune system, of course, is responsible for inflammation and responding to whatever is going on, such as infections and injuries. The signals it produces cause the liver to produce something known as acute phase proteins, including things like globulins and fibrinogen.

Fibrinogen is a relatively large protein that is normally present in the blood at very low levels. During inflammation, however, the concentration of fibrinogen significantly increases, as do these other acute phase proteins. The increased concentration of fibrinogen and the other acute phase proteins alters the surface properties of the red blood cells and the charges on those red blood cells. This process makes the surface of the red blood cells much more sticky.

The stickiness caused by the increased concentration of these proteins and fibrinogen causes them to adhere, stick together, and form a stacking effect of those red blood cells. This aggregation of red blood cells occurs more readily in the presence of these acute phase proteins.

Outside of fibrinogen, other examples of acute phase proteins include serum amyloid A, fibronectin, hepatoglobulin, alpha-1 antitrypsin, alpha-2 macroglobulin, ceruloplasmin, and ferritin. However, the main one affecting the clumping or stacking of red blood cells is fibrinogen. This is a protein that increases when there is tissue damage and leads to increased fibrin levels. Fibrin is needed to make scaffolding so that a clot can more easily form.

So how is the ESR test performed?
A blood sample is taken from your arm and placed in a vertical tube. The tube is then measured over a period of one hour. Any red blood cells that are stacked or clumped together will settle more quickly because they are heavier than the freely moving individual cells. As the red blood cells settle, they form a visible column over time. This column is then measured in millimeters per hour. The faster the red blood cells settle, the higher the millimeters or column is, and the higher your ESR level is.

The ESR test is a nonspecific marker of inflammation because it does not directly measure the cause of inflammation, such as whether you have a bacterial infection, a fungal infection, or some other problem going on. Rather, it reflects the presence of those proteins that we described and the corresponding changes in the properties of the red blood cells that are associated with inflammation.
So the ESR test is mainly looking for whether there is an increased production of globulins in your body. This can be very helpful and important to know because these are the things that the immune system produces when it is fighting something off.

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