Erythrocyte Sedimentation Rate (ESR) Test Overview

The erythrocyte sedimentation rate (ESR) test measures the erythrocyte sedimentation rate, which is how quickly red blood cells settle at the bottom of a blood sample.

Doctors cannot use the results of the test to diagnose a specific disease because many different health conditions can cause the ESR to be high or low.

ESR test is a nonspecific test, as it only confirms the presence or absence of inflammatory activity in the body. Doctors usually use other lab tests, clinical findings, and the patient’s health history along with ESR test results to make a diagnosis.

Inflammation usually occurs in the body as a result of underlying medical conditions, such as infection, cancer, or an autoimmune disease.

Doctors also use the ESR test to monitor how conditions, such as those below, are progressing or responding to treatment.

  • Rheumatoid Arthritis (RA) an autoimmune condition that causes inflammation in the joints
  • Temporal arteritis, a type of blood vessel inflammation
  • Polymyalgia rheumatica, a complication of temporal arteritis
  • Systemic vasculitis, inflammation of the lining of the blood vessels


Preparation for Erythrocyte Sedimentation Rate (ESR) Test

The ESR test does not require much preparation.

However, the patients must inform their doctor if they are taking any medications. Your doctor may ask you to temporarily stop taking it before the test.

Certain medications may affect ESR test results. For example, steroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and statins may cause possible false lower ESRs. However, you should not stop taking any prescription medications unless your doctor instructs otherwise.

Procedure for Erythrocyte Sedimentation Rate (ESR) Test

The ESR test measures the rate at which the red blood cells, or erythrocytes, in a sample of blood settle at the bottom. This process of settling is called sedimentation.

A doctor will draw a small amount of blood from the patient’s vein and send it to a laboratory. At the lab, the technicians will transfer the blood to a vertical test tube in which the red blood cells will slowly settle at the bottom. This will leave a clear, yellowish fluid at the top, which is blood plasma.

The result of the test will depend on the amount of plasma at the top of the tube after 1 hour. The measurement will be in millimeters per hour (mm/hr).

Red blood cells settle at a faster rate in patients with inflammatory diseases. These conditions trigger an inflammatory process in the body, which leads to an increase in the number of proteins in the blood. This increase causes red blood cells to clump together and settle more quickly.

Individuals whose red blood cells settle faster will have elevated ESR values, indicating to doctors that a medical condition may be present.

Types of Erythrocyte Sedimentation Rate (ESR) Test

Following are two methods for measuring the erythrocyte sedimentation rate:

Westergren Method

This is the most common ESR method. In this type of test, your blood is drawn into a Westergren-Katz tube until the blood level reaches 200 millimeters (mm).

The tube is stored vertically and sits at room temperature for an hour. The distance between the top of the blood mixture and the top of the sedimentation of RBCs is measured.

Wintrobe Method

The Wintrobe method is similar to the Westergren method, except the tube used is 100 mm long and thinner.

A disadvantage of this method is that it’s less sensitive than the Westergren method.

Normal Erythrocyte Sedimentation Rate (ESR) Test Results

ESR test results are measured in millimeters per hour (mm/hr). The higher the number, the higher the likelihood of inflammation. Overall, females naturally have higher ESR levels.

Normal ESR test results are as follows:

Normal ESR test results Abnormal ESR test results
Females under 50 between 0 and 20 mm/hr. greater than 20
Males under 50 between 0 and 15 mm/hr. greater than 15
Females over 50 between 0 and 30 mm/hr. greater than 30
Males over 50 between 0 and 20 mm/hr. greater than 20
Children between 0 and 10 mm/hr. greater than 10

Also, ESR test results that are higher than 100 mm/hr could indicate a more “active” disease, such as cancer, diabetes, or heart disease.

Results of Erythrocyte Sedimentation Rate (ESR) Test

The result of the ESR test is the amount of plasma remaining at the top of the test tube after 1 hour.

The test is not specific to a particular condition, which means that doctors have to use the results alongside other clinical information to make an accurate diagnosis and determine whether or not the individual has a disease.

The normal reference range for ESR results is 1–13 mm/hr for males and 1–20 mm/hr for females. These values can also vary depending on the person’s age. People with ESR results outside the standard range may have a medical condition.

Low levels

Patients with low ESR values may have:

  • A very high white blood cell count
  • A high red blood cell count
  • Congestive heart failure
  • Hyper viscosity, an increase in blood thickness
  • Sickle cell anemia, a condition that affects the shape of red blood cells
  • Leukemia, a blood cell cancer
  • Low levels of the protein fibrinogen in the blood


Moderately Elevated Results

A moderately elevated ESR may not always indicate a disease.

However, it is possible that patient whose ESR value is slightly high may have one of the following conditions:

Extremely Elevated Results

An extremely high ESR value, which is one above 100 mm/hr, may indicate one of the following diseases:

Usually, doctors compare the ESR test result with other test results to confirm a suspected diagnosis. They will also consider the symptoms and signs that a patient is experiencing and their personal and family medical history.


Abnormal Erythrocyte Sedimentation Rate (ESR) Test

An abnormal ESR result does not diagnose any specific disease. It just identifies potential inflammation in the body and indicates a need to look further.

An abnormally low value would be near 0. It’s hard to state an exact value because these tests fluctuate, and what is ultimately considered too low may vary from one patient to the next.

This test isn’t always reliable or meaningful. Many factors can affect your results, such as:

  • Medication Use
  • Menstruation
  • Older age
  • Pregnancy

Some causes of abnormal ESR test results are more serious than others, but many are not a big concern. It’s important not to worry too much if your ESR test results are abnormal.

Instead, work with your doctor to find out what’s causing your symptoms. They’ll usually order follow-up tests if your ESR results are too high or low.


Causes of High Erythrocyte Sedimentation Rate (ESR) Test Results

There are multiple causes of a high ESR test result. Some common conditions associated with a higher rate include the following:

An abnormally high ESR can indicate the presence of cancerous tumors, especially if no inflammation is found.

Autoimmune Diseases

ESR test results that are higher than normal are also associated with autoimmune diseases, including:

  • Allergic or necrotizing vasculitis
  • Certain types of arthritis, including rheumatoid arthritis (RA)
  • Hyperfibrinogenemia, which is too much of the protein fibrinogen in your blood
  • Lupus
  • Polymyalgia rheumatica, which causes muscle and joint pain
  • Temporal arteritis, a condition in which your temporal artery becomes inflamed or damaged
  • Waldenstrom’s macroglobulinemia, a rare type of cancer

Infections

Some types of infection that cause ESR test results to become higher than normal are:

  • Bone infection
  • Heart infections causing myocarditis (affects heart muscle), pericarditis (affects tissue around the heart, or the pericardium), and endocarditis (affects the lining of the heart, which can include the heart valves)
  • Rheumatic fever
  • Skin infection
  • Systemic infections
  • Tuberculosis (TB)


Other Tests That May be Performed with the ESR Test

Your doctor may order a C-reactive protein (CRP) test at the same time as your ESR test. CRP tests measure inflammation as well, but they can also help predict your risk of coronary artery disease (CAD) and other cardiovascular diseases.

Additionally, your doctor may order a complete blood count (CBC) test to look for other signs of inflammation or infection.

Risks of Erythrocyte Sedimentation Rate (ESR) Test

The ESR test is simple and quick, taking just a few minutes to complete. The procedure is very safe and poses few risks.

Possible complications include the following:

  • Bruising
  • Bleeding, from very light to excessive
  • Fainting
  • Hematoma
  • Inflammation of the vein
  • Infection
  • Lightheadedness
  • Tenderness

Patients who take the test may feel a slight sting when the needle pricks the arm. Some individuals may bleed slightly where the needle pierces the skin, and others may feel temporarily faint or dizzy.

After the test, patient may get a small bruise at the puncture site or experience mild soreness in the arm, which can last for a few days. In more sensitive patients, this bruising may turn into a hematoma.

Some patients may be may also experience discomfort seeing blood drawn from your body.

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