ESR

How the Test is Performed

A blood sample is needed. For information on how this is done, see: Venipuncture

The blood sample is sent to a lab. The test measures how fast red blood cells called erythrocytes fall to the bottom of a tall, thin tube.

How to Prepare for the Test

There are no special preparations needed.

How the Test Will Feel

When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the Test is Performed

A "sed rate" is often ordered for someone who is having unexplained fevers, certain types of arthritis, muscle symptoms, or other vague symptoms that cannot be explained.

Once a diagnosis has been made, this test may be used to monitor whether the illness is becoming more active or flaring up.

This test can be used to monitor inflammatory diseases or cancer. It is a screening test, which means it cannot be used to diagnose a specific disorder.

However, it is useful for detecting and monitoring:

• Autoimmune disorders
• Certain forms of arthritis
• Inflammatory diseases that cause vague symptoms
• Tissue death
• Tuberculosis

Normal Results

Adults (Westergren method):

• Men under 50 years old: less than 15 mm/hr
• Men over 50 years old: less than 20 mm/hr
• Women under 50 years old: less than 20 mm/hr
• Women over 50 years old: less than 30 mm/hr

Children (Westergren method):

• Newborn: 0 to 2 mm/hr
• Newborn to puberty: 3 to 13 mm/hr

Note: mm/hr. = millimeters per hour

Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

Although it can help diagnose some illnesses, an abnormal ESR does not prove that you have a certain condition. Other tests are almost always needed.

An increased ESR rate may be due to:

• Anemia
• Cancers such as lymphoma or multiple myeloma
• Kidney disease
• Pregnancy
• Thyroid disease

The immune system helps protect the body against harmful substances. In autoimmune disorder is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue. ESR is often higher than normal in people with an autoimmune disorder.

Common autoimmune disorders include:

• Lupus
• Rheumatoid arthritis in adults or children

Very high ESR levels occur with less common autoimmune disorders, including:

• Allergic vasculitis
• Giant cell arteritis
• Hyperfibrinogenemia (increased fibrinogen levels in the blood)
• Macroglobulinemia - primary
• Necrotizing vasculitis
• Polymyalgia rheumatica

An increased ESR rate may be due to some infections, including:

• Body-wide (systemic) infection
• Bone infections
• Infection of the heart or heart valves
• Rheumatic fever
• Severe skin infections, such as erysipelas
• Tuberculosis

Lower-than-normal levels occur with:

• Congestive heart failure
• Hyperviscosity
• Hypofibrinogenemia (decreased fibrinogen levels)
• Low plasma protein (due to liver or kidney disease)
• Polycythemia
• Sickle cell anemia

Risks

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

• Excessive bleeding
• Fainting or feeling light-headed
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Alternative Names

Erythrocyte sedimentation rate; Sed rate; Sedimentation rate

References

Kushner I, Ballou SP. Acute-phase reactants and the concept of inflammation. In: Firestein GS, Budd RC, Harris ED, et al, eds. Kelley's Textbook of Rheumatology. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 52.

Pisetsky DS. Laboratory testing in the rheumatic diseases. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 278.

Update Date: 6/1/2011

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.