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How to read your medical test report: Erythrocyte Sedimentation Rate (ESR)

All you need to know about reading your erythrocyte sedimentation rate (ESR) report.

Written by Dr Anitha Anchan |Published : April 7, 2016 6:22 PM IST

Inflammation defends the body against infection and injury. Our body initiates an inflammatory response towards anything that it recognizes as harmful and prevents further damage to the body. But in some diseases, there is a chronic inflammatory response that can last for several months or even years.

Certain proteins are released from the site of inflammation and circulate in the blood. Detecting these markers in the blood can help diagnose inflammation.

Erythrocyte Sedimentation Rate (ESR) what is it?

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The erythrocyte sedimentation rate (ESR) is the rate at which the red blood cells settle down in an hour. This blood test helps detect inflammation in the body. It is a nonspecific test because neither does it show where the inflammation is nor does it indicate what is causing it.

Fibrinogen is a key regulator of inflammation in disease [1]. It is released in high amounts during inflammation. Together with the immunoglobulins, it causes the RBCs to stack or aggregate (rouleau formation). The rouleau formation makes the RBCs heavier causing them to settle down faster. For the test, your blood sample is placed in a tube under specified conditions and the rate at which the RBCs settle down is measured. The result is expressed as millimeters/hour (mm/hr). ESR can be measured by two classic methods Westergren and Wintrobe. To standardize the measurement, the International Council for Standardization in Hematology (ICSH) has adopted Westergren procedure as the gold standard [2].

When is an ESR recommended?

Infections, tumors or autoimmune diseases can cause inflammation. Your doctor may recommend an ESR test when you have symptoms that are suspected of causing inflammation in your body. The test aids in establishing the diagnosis and monitoring of selected inflammatory diseases like temporal arteritis, polymyalgia rheumatica, etc. It may be used to predict relapse in patients with Hodgkin's disease [3].

Reading your ESR report

The ESR values increase with age. The rate tends to be higher in women especially during menstruation and pregnancy. The normal value ranges of ESR may vary marginally among different labs.

Normal value range: [4]

1. Men

Below 50yr old: 0 to 15mm/hr

Above 50yr old: 0 to20mm/hr

2. Women

Below 50yr old: 0-20mm/hr

Above 50yr old: 0-30mm/hr

3. Children

At birth: 0 to 2 mm/hr

From birth to puberty: 3 to 13 mm/hr

High ESR values are seen in inflammations, infections, collagen diseases, kidney failure, cancers and autoimmune diseases. ESR is a good predictor of Kawasaki disease5. Very high values may be seen in tuberculosis or multiple myeloma. Drugs such as methyldopa, oral contraceptives, dextran, and theophylline can increase ESR.

Low ESR values may be seen in hypofibrinogenemia, polycythemia and sickle cell anemia. Drugs like aspirin, cortisone, etc. can decrease ESR. Decreasing ESR values during disease monitoring may indicate a declining inflammation due to a favorable response to treatment.


1: Davalos D, Akassoglou K. Fibrinogen as a key regulator of inflammation in disease. Semin Immunopathol. 2012 Jan;34(1):43-62. doi: 10.1007/s00281-011-0290-8. Epub 2011 Oct 31. Review. PubMed PMID: 22037947.

2. Jou JM, Lewis SM, Briggs C, Lee SH, De La Salle B, McFadden S; International Council for Standardization in Haematology. ICSH review of the measurement of the erythocyte sedimentation rate. Int J Lab Hematol. 2011 Apr;33(2):125-32. doi: 10.1111/j.1751-553X.2011.01302.x. Epub 2011 Feb 25. PubMed PMID: 21352508.

3. Brigden ML. Clinical utility of the erythrocyte sedimentation rate. Am Fam Physician. 1999 Oct 1;60(5):1443-50. PubMed PMID: 10524488.

4. B ttiger LE, Svedberg CA. Normal erythrocyte sedimentation rate and age. Br Med J. 1967 Apr 8;2(5544):85-7. PubMed PMID: 6020854; PubMed Central PMCID: PMC1841240.

5. Xiu-Yu S, Jia-Yu H, Qiang H, Shu-Hui D. Platelet count and erythrocyte sedimentation rate are good predictors of Kawasaki disease: ROC analysis. J Clin Lab Anal. 2010;24(6):385-8. doi: 10.1002/jcla.20414. PubMed PMID: 21089168.

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