• Erythrocyte Sedimentation Rate

    Erythrocyte sedimentation rate (ESR) is a non-specific test for inflammation. It is easy to perform, widely available and inexpensive making it a widely used screening test. It is also used a monitoring tool for response to treatment in conditions in which it is raised (tuberculosis, autoimmune diseases etc).


    The ESR test in performed in the laboratory by placing anticoagulated blood in an upright tube (Westegren's most often). At the end of an hour of this, the rate of the RBC sedimentation is measured.

    Westergren's tubes testing ESR

    Normal value:

    ESR values tend to rise with age and are generally higher in women. ESR is also elevated in the black population and those with anemia.

    A rule of thumb for calculating maximum normal ESR in a person is:

    At birth, the ESR is generally low, 1-2 mm/hr, rising to up to 20 mm/hr by puberty.


    ESR is determined by the interaction between factors that promote (fibrinogen) and resist (negative charge of RBCs - that repel each other) sedimentation. Normal RBCs settle slowly as they do not form rouleaux or aggragate together. Instead, they gently repel each other due to the negative charge on their surfaces.

    Increased rouleaux formation contributes to high ESR. Rouleaux are stacks of many RBCs that become heavier and sediment faster. Plasma proteins, especially fibrinogen, adhere to the red cell membranes and neutralize the surface negative charges, promoting cell adherence and rouleaux formation.

    The aggregated RBCs in the rouleaux formation have a higher ratio of 'mass to surface area' as compared to single RBCs and hence sink faster in plasma.

    ESR of more than 100 mm/hr is strongly associated with serious underlying disorders like connective tissue disease, infections and malignancies.

    Some conditions with very high (>100 mm/hr) ESR:

    1. Multiple myeloma
    2. Connective tissue disorders - SLE, RA and other autoimmune diseases
    3. Tuberculosis
    4. Malignancies
    5. Severe anemia

    Some conditions with low ESR:

    1. Polycythemia
    2. Severe Leukocytosis
    3. Sickle cell disease (anemia)
    4. Hereditary spherocytosis
    5. Congestive cardiac failure
    6. Corticosteroid use
    7. Hypofibrinogenemia

    Note that sickle cell anemia and spherocytosis have low ESR unlike other anemias. This is due to reduced rouleaux formation owing to the abnormally shaped RBCs in this condition.


    Erythrocyte sedimentation rate is a non-specific test and is not diagnostic of any particular disease. It has a high sensitivity but low specificity. Never base a diagnosis solely on an ESR value, either normal or high. Interpretation of the result should always be along with the patient's clinical history, examination findings and results of other tests done.

    If high ESR is encountered without any obvious reasons, patient should be reassured and the test repeated after a reasonable amount of time (a couple of months). There is no need to extensively search for an occult disease without repeating it again.
    This article was originally published in forum thread: Erythrocyte Sedimentation Rate started by Openman View original post
    Comments 148 Comments
    1. Exhausted!'s Avatar
      Exhausted! -
      I am 56, have had a low grade fever on an off for almost two months. I had strep and VERY mild case of shingles four weeks ago. Since then - VERY tired, achy shoulders and knees, chilled and fever sometimes goes to 101-102. ESR is 47. Otherwise healthy - no other known health problems. Any thoughts?
    1. MAT's Avatar
      MAT -
      I am 35yrs old female, my ESR is 35 and CRP normal. I have stiffness in feet, toes, palms, shoulders and pain in joints like knees, lower back when simple stress occurs. I have left working too as I am almost always fatigued and in pain. My weight is normal (height-165cm, 64 Kg)
      I have checked with a Rheumotologist, they have ruled out Arthritis or RA. He has suggested physiotherapy stretch exercises but that doesn't help much.
      Can you please advice whom I should consult and what could this be?
    1. MAT's Avatar
      MAT -
      Quote Originally Posted by rajni View Post
      My ESR results show a level of 41. I am 35 years of age. Lately, I have developed pain over my fingers, toes, elbows, ankles and back. Such that my mobility becomes restricted. Is this condition as result of my ESR readings? Am I to expect a serious problem? Appreciate your opinions on this>
      Hi Rajni, I have an exact similar situation. Mobility is so restricted that even basic chores have become a problem..
      Have you been able to find out any daignosis or next steps? Appreciate if you can share with me..
      Thanks (f35, ESR 35, painful and exhausted!)
    1. nrobles's Avatar
      nrobles -
      my 2.5 year old daughter has a ERYTHROCYTE SEDIMENTATION RATE of 20. Is this significant?
    1. 62 year old concerned's Avatar
      62 year old concerned -
      In 2007 I had an ESR of 13, in 2009 an ESR of 10 and today I have an ESR of 57. My body including muscles and joints have been hurting for the past two months and I am being told that it is arthritis and I am just getting old. Would you be concerned? What recommendations would you have? Thank you
    1. rehan's Avatar
      rehan -
      iam 24 year old male,,my recent esr is 17,,,periviosly it was 12,,does it show any problem..n plz tell me what is the minimum value of esr in TB disease.thankyou.
    1. prabhjot2050's Avatar
      prabhjot2050 -
      my esr rate is 117 m having cough sometimes
    1. AKILAH's Avatar
      AKILAH -
      Im 31yrs old woman with ESR 31..............n me having fever too with rheumatoid factor 179.60
    1. yaz's Avatar
      yaz -
      I am a 29 year old female. I have been having pain in my joints primarily my fingers and knees. My doctor send me for a series of blood test. Every thing was normal with the exception of my ESR SED rate. My rate was 27. Should I be alarmed?

      Most people in my family suffer from rheumatoid arthritis.
    1. Jessdots's Avatar
      Jessdots -
      My 4 year old daughter has an ESR of 27. She was diagnosed with mono 4 months ago. She was feeling better and now she is growing more fatigued and her lymph nodes are swelling very large. Should I have more tests done and which ones?
    1. Tanu Shree's Avatar
      Tanu Shree -
      hello sir I am 26 yrs old and my Esr level is 29 mm and I usually feel ache in my lower abdomen. Pls suggest.
    1. Kshnsarma's Avatar
      Kshnsarma -
      EErythrocyte Sedimentation Rate - age : 68years
      End of first hour : 27mm/hr
      End of second hour : 66mm/hr
      What is it mean. Is there any existing infection or inflamation
      If so what are the remedies.
    1. reaslejohn's Avatar
      reaslejohn -
      Quote Originally Posted by rakeshsharma2012 View Post
      why ESR decreases in case of congestive heart failure ?
      Because body's chronic response to congestive heart failure is to increase erythropoitin which increases overall RBC population density and viscosity. Therefore, RBCs are precipitating much slower in the ESR test. This means a lower ESR result.
    1. Nardin's Avatar
      Nardin -
      Dear sir,
      i am 21 years old and i had diarrhea for the past 2 weeks.
      I did an ESR and 1st hr was 26 and 2nd hr 63 ... should i be concerned?
    1. tfyuguihio's Avatar
      tfyuguihio -
      i am 38 years old. ihave esr 51 mm .i m also having body pain, all other results r normal
      what is the problem.
    1. silver's Avatar
      silver -
      I have a Erythrocyte Sedimentation Rate reading of 90. My liver function reading is twice as high as normal (70). I am 55 yr old female and have recently been treated for breast cancer with chemotherapy, which finished 4 months ago. I now have the 'all clear'. Are the readings anything to be concerned about?
    1. highESR's Avatar
      highESR -
      42 male.. esr 100 hemoglobin 11.8 soluble iron 26.. and this has been so for 1 year at least
      CT and PET scans negative..

      Nobody knows what to diagnose me.. any ideas?
    1. Poornima's Avatar
      Poornima -

      I am 23 yr old and my ESR is 84 according to lab reports.. i have got pain in my joints and heels.. please suggest me what treatment i may have to take to bring it to normal.
    1. Help!'s Avatar
      Help! -
      Hello! I am just 40 with a ESR of 47 but a CRP that is very normal. My CBC was all within normal limits as well. I do have stiffness and pain, but am overweight and have been on my legs for work my entire life. Any thoughts on what to look towards? MD wants me back in a month, trying to gather all info. Thank you!!
    1. Marie Walch's Avatar
      Marie Walch -
      Hi my son is 2 and his esr was 28 about 3 months ago... and now we just had it redone and it is 20. Should I be concerned at all? Because he is only 2 his esr should not be that high right?

      Thank you so much!
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