What is an Erythrocyte Sedimentation Rate Test?

Erythrocyte sedimentation rate (ESR) test is a blood test that detects the rate at which erythrocytes (red blood cells) from a blood sample descend and settle at the bottom of a test tube. Under normal conditions, erythrocytes take a long time to settle. However, in the presence of inflammation or cell damage, erythrocytes clump together, which makes them heavier, thereby increasing the rate at which they settle. ESR value rises when erythrocytes settle faster. An ESR value higher or lower than the standard indicates the presence of disease.

ESR is not a diagnostic test. That means it does not aid in detecting a particular disease. It is a simple, cost-effective and non-specific test that indicates the presence or absence of inflammatory conditions anywhere in the body. Other tests must be performed in addition to ESR to identify the exact cause of inflammation.

  1. Why is Erythrocyte Sedimentation Rate Test performed?
  2. How do you prepare for Erythrocyte Sedimentation Rate Test?
  3. How is Erythrocyte Sedimentation Rate Test performed?
  4. What do the test results mean?

ESR is performed in individuals who are suspected of having an inflammatory condition, e.g., arthritis that causes pain and inflammation in the joints or inflammatory bowel disease that causes symptoms of the digestive tract. ESR is generally recommended in the presence of the following symptoms:

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No special preparations are needed for this test.

Before undergoing the test, ensure that you have informed your doctor about any prescription or over-the-counter medications, vitamins, herbs or supplements that you take. The doctor must also be informed about any meal taken before the test and addictions such as to alcohol. Also, information about any current conditions such as pregnancy or ongoing periods should be provided for the correct evaluation of your blood reports.

It is a simple test that takes less than five minutes. An experienced laboratory specialist collects a blood sample from a vein in your arm by inserting a small needle into the vein. A small quantity of blood is then withdrawn into a sterile vial or a test tube. A momentary pricking pain is felt when the needle goes in the vein.

There is a minimal risk of pain, lightheadedness and bruising at the site of injection with the test. However, most of the time, these symptoms disappear quickly. Rarely, an infection may occur at the site of withdrawal of blood.

Results of the ESR test measure the amount of clear fluid (called plasma) at the top of the test tube after an hour of sedimentation. ESR is represented as millimetre per hour.

Normal results:

Normal values of ESR are:

  • 0 to 10 mm/h in children
  • 0 to 15 mm/h in men younger than 50 years
  • 0 to 20 mm/h in men older than 50 years and women younger than 50 years
  • 0 to 30 mm/h in women older than 50 years of age

Abnormal results:

An ESR value that is higher than normal indicates the presence of inflammatory conditions. Some of the common causes of moderately elevated ESR include:

  • Infection
  • Anaemia
  • Pregnancy
  • Ageing
  • Kidney disease
  • Multiple myeloma

Elevated ESR value can also be due to autoimmune disorders such as:

A lower than normal ESR value indicates the presence of blood disorders such as:

  • Sickle cell anaemia
  • Leukocytosis, increased white blood cell count that is higher than normal
  • Polycythemia

The interpretation of the test results varies depending on parameters like age, gender, the method used to perform the test and medical history of the individual. Moderately elevated ESR values do not confirm the presence of inflammation as they may occur due to factors such as pregnancy.

Some medications may alter ESR values, and your doctor should be informed about the use of such medications. Medicines like aspirin, oral contraceptives, methyldopa, dextran, theophylline, penicillamine, procainamide, cortisone, and vitamin A can increase ESR, whereas quinine, aspirin and steroids may decrease ESR.

Sometimes a repeat ESR is recommended with a time gap between the tests. This is done to monitor disease progression and the effect of treatment. An upward trend in ESR indicates increasing inflammation or inadequate response to treatment.

ESR is not a diagnostic test but indicates the presence of an inflammatory condition in the body. In the case of abnormal ESR values, the doctor will recommend other laboratory tests to identify the cause of inflammation.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. This information is purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.


  1. Lab Tests Online.. Washington D.C.: American Association for Clinical Chemistry; c2001–2017. Erythrocyte Sedimentation Rate (ESR)
  2. National Heart, Lung, and Blood Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Blood Tests: risks and types
  3. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2017. Health Encyclopedia: Erythrocyte Sedimentation Rate
  4. Lab Tests Online-Au; Australasian Association of Clinical Biochemist; ESR: need for the test and supporting tests

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