Erythrocyte Sedimentation Rate (ESR) – Definition & Meaning
The erythrocyte sedimentation rate (ESR) is a blood test measuring how quickly red blood cells settle. An elevated result may indicate inflammation or underlying disease.
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The erythrocyte sedimentation rate (ESR) is a blood test measuring how quickly red blood cells settle. An elevated result may indicate inflammation or underlying disease.
What is the Erythrocyte Sedimentation Rate?
The erythrocyte sedimentation rate (ESR), also known as the sed rate or blood sedimentation rate, is a simple laboratory test used in routine diagnostics. It measures how quickly red blood cells (erythrocytes) sink to the bottom of a vertically positioned tube containing anticoagulated blood over the course of one hour. The result is expressed in millimetres per hour (mm/h).
The ESR is considered a non-specific marker of inflammation: it indicates that an inflammatory or pathological process may be occurring in the body, without identifying the exact cause.
How Does the Test Work?
When inflammation is present, the body produces increased amounts of certain proteins known as acute-phase proteins (e.g., fibrinogen). These cause red blood cells to clump together and sink more rapidly. The more pronounced the inflammatory response, the higher the ESR value.
The measurement is performed using the standardised Westergren method: blood is mixed with an anticoagulant and drawn into a narrow glass tube. After 60 minutes, the distance (in mm) that the red blood cells have settled is recorded.
Reference Values
Normal ESR values depend on age and sex:
- Men under 50: up to 15 mm/h
- Men over 50: up to 20 mm/h
- Women under 50: up to 20 mm/h
- Women over 50: up to 30 mm/h
Mildly elevated values can also occur without serious disease, for example during pregnancy or in older adults.
Causes of Elevated ESR
An elevated ESR can point to a wide range of conditions, including:
- Bacterial or viral infections
- Autoimmune diseases (e.g., rheumatoid arthritis, systemic lupus erythematosus)
- Inflammatory bowel diseases (e.g., Crohn's disease, ulcerative colitis)
- Cancers (e.g., lymphoma, multiple myeloma)
- Kidney disease
- Anaemia
- Pregnancy
Causes of Low ESR
Very low ESR values are less commonly clinically significant but may occur in conditions such as:
- Polycythaemia (elevated red blood cell count)
- Sickle cell anaemia
- Heart failure
- Use of certain medications (e.g., aspirin, corticosteroids)
Diagnosis and Clinical Relevance
The ESR is frequently ordered as part of a routine blood panel or general laboratory workup. Because it is non-specific, it is typically interpreted alongside other laboratory results, such as C-reactive protein (CRP), a full blood count, and other inflammatory markers.
The ESR plays a particularly important diagnostic role in monitoring chronic conditions such as rheumatoid arthritis and temporal arteritis (giant cell arteritis). It is also useful for monitoring treatment response: a falling ESR during therapy suggests that the treatment is working effectively.
When to See a Doctor
If an elevated ESR is detected during a routine check-up, medical evaluation is recommended. This is especially important when additional symptoms are present, such as persistent fatigue, fever, joint pain, or unexplained weight loss. In such cases, prompt consultation with a healthcare professional is advised.
References
- Sox, H. C., Liang, M. H. - The erythrocyte sedimentation rate: guidelines for rational use. Annals of Internal Medicine, 1986; 104(4): 515-523.
- Westergren, A. - Die Senkungsreaktion. Ergebnisse der inneren Medizin und Kinderheilkunde, 1924.
- National Institute for Health and Care Excellence (NICE) - Blood tests: ESR. NICE, 2023. Available at: https://www.nice.org.uk
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