ESR Testing, What It Is, Why It Matters To Your Health

ESR testing measures the erythrocyte sedimentation rate, which is how quickly red blood cells settle at the bottom of a blood sample.   It helps your doctor determine if you’re experiencing inflammation from conditions such as autoimmune disease, infection, and cancer.





A doctor draws a small amount of blood and sends it to the lab. There, technicians 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.


Results are based on the amount of plasma at the top of the tube after 1 hour. The measurement is in millimeters per hour (mm/hr).


People whose red blood cells settle faster will have elevated ESR values, indicating to doctors that inflammation and a  medical condition may exist.

The ESR test is nonspecific as it only confirms the presence or absence of inflammatory activity in the body. Doctors then use other lab tests, clinical findings, and the person’s health history alongside 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, 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


ESR: What Your Test Results Mean


The normal reference range for ESR results is 1–13 mm/hr for males and 1–20 mm/hr for females. These values will also vary depending on the person’s age.


People with low ESR values may have:

  • sickle cell anemia, a condition that affects the shape of red blood cells
  • leukemia, a blood cell cancer
  • a high red blood cell count
  • congestive heart failure
  • low levels of the protein fibrinogen in the blood
  • hyper viscosity, an increase in blood thickness
  • a very high white blood cell count



People with moderate level ESR results may have one of the following conditions:


  • rheumatoid arthritis
  • anemia, a reduced number of red blood cells
  • thyroid disease
  • kidney disease
  • red blood cell abnormalities, such as macrocytosis
  • some forms of cancer, such as lymphoma
  • tuberculosis, a type of lung infection
  • bone infection
  • a heart infection
  • a systemic infection


An extremely high ESR value, which can be 100 mm/hr, may indicate one of these conditions:

  • multiple myeloma, a cancer of plasma cells
  • Waldenstrom’s macroglobulinemia, a white blood cell cancer
  • temporal arteritis or polymyalgia rheumatica
  • hypersensitivity vasculitis, which is a reaction to an allergen that results in blood vessel inflammation

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


ESR: Diagnosis Precautions


One precaution in diagnosing disease off an ESR blood test is that slightly higher levels can also occur in pregnancy and advancing age.

However, if the inflammation is corroborated, there are specific treatments. These may include:

  • antibiotics, where there is an infection
  • nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen, diclofenac, and celecoxib
  • corticosteroid medications, such as methyl prednisolone and dexamethasone

NSAIDs and corticosteroids specifically treat inflammation.



An ESR test result outside of the normal range can indicate inflammation in the body. If so, doctors will order further tests and get additional clinical information to make an accurate diagnosis.

On the other hand, there are some non-medical causes of abnormal results, such as pregnancy and aging.

Although doctors cannot diagnose a specific medical condition with an ESR test, the result can establish whether or not there is inflammation in the body.

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