Erythrocyte Sedimentation Rate (ESR)
- Also Known As:
- Sed Rate
- Sedimentation Rate
- Westergren Sedimentation Rate
- Wintrobe Sedimentation Rate
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At a Glance
When To Get Tested?
When your health practitioner thinks that you might have a condition causing inflammation; when you have signs and symptoms associated with temporal arteritis, systemic vasculitis, polymyalgia rheumatica, or rheumatoid arthritis such as headaches, neck or shoulder pain, pelvic pain, anemia, poor appetite, unexplained weight loss, and joint stiffness
A blood sample drawn from a vein in your arm
Test Preparation Needed?
What is being tested?
Erythrocyte sedimentation rate (ESR or sed rate) is a test that indirectly measures the degree of inflammation present in the body. The test actually measures the rate of fall (sedimentation) of erythrocytes (red blood cells) in a sample of blood that has been placed into a tall, thin, vertical tube. Results are reported as the millimeters of clear fluid (plasma) that are present at the top portion of the tube after one hour.
When a sample of blood is placed in a tube, the red blood cells normally settle out relatively slowly, leaving little clear plasma. The red cells settle at a faster rate in the presence of an increased level of proteins, particularly proteins called acute phase reactants. The level of acute phase reactants such as C-reactive protein (CRP) and fibrinogen increases in the blood in response to inflammation.
Inflammation is part of the body’s immune response. It can be acute, developing rapidly after trauma, injury or infection, for example, or can occur over an extended time (chronic) with conditions such as autoimmune diseases or cancer.
The ESR is not diagnostic; it is a non-specific test that may be elevated in a number of these different conditions. It provides general information about the presence or absence of an inflammatory condition.
There have been questions about the usefulness of the ESR in light of newer tests that have come into use that are more specific. However, ESR test is typically indicated for the diagnosis and monitoring of temporal arteritis, systemic vasculitis and polymyalgia rheumatica. Extremely elevated ESR is useful in developing a rheumatic disease differential diagnosis. In addition, ESR may still be a good option in some situations, when, for example, the newer tests are not available in areas with limited resources or when monitoring the course of a disease.
How is the test used?
The erythrocyte sedimentation rate (ESR or sed rate) is a relatively simple, inexpensive, non-specific test that has been used for many years to help detect inflammation associated with conditions such as infections, cancers, and autoimmune diseases.
ESR is said to be a non-specific test because an elevated result often indicates the presence of inflammation but does not tell the health practitioner exactly where the inflammation is in the body or what is causing it. An ESR can be affected by other conditions besides inflammation. For this reason, the ESR is typically used in conjunction with other tests, such as C-reactive protein.
ESR is used to help diagnose certain specific inflammatory diseases, including temporal arteritis, systemic vasculitis and polymyalgia rheumatica. (For more on these, read the article on Vasculitis.) A significantly elevated ESR is one of the main test results used to support the diagnosis.
This test may also be used to monitor disease activity and response to therapy in both of the above diseases as well as some others, such as lupus.
When is it ordered?
An ESR may be ordered when a condition or disease is suspected of causing inflammation somewhere in the body. There are numerous inflammatory conditions that may be detected using this test. For example, it may be ordered when arthritis is suspected of causing inflammation and pain in the joints or when digestive symptoms are suspected to be caused by inflammatory bowel disease.
A health practitioner may order an ESR when an individual has symptoms that suggest polymyalgia rheumatica, systemic vasculitis, or temporal arteritis, such as headaches, neck or shoulder pain, pelvic pain, anemia, poor appetite, unexplained weight loss, and joint stiffness. The ESR may also be ordered at regular intervals to assist in monitoring the course of these diseases.
Before doing an extensive workup looking for disease, a health practitioner may want to repeat the ESR.
What does the test result mean?
The result of an ESR is reported as the millimeters of clear fluid (plasma) that are present at the top portion of the tube after one hour (mm/hr).
Since ESR is a non-specific marker of inflammation and is affected by other factors, the results must be used along with other clinical findings, the individual’s health history, and results from other laboratory tests. If the ESR and clinical findings match, the health practitioner may be able to confirm or rule out a suspected diagnosis.
A single elevated ESR, without any symptoms of a specific disease, will usually not give enough information to make a medical decision. Furthermore, a normal result does not rule out inflammation or disease.
Moderately elevated ESR occurs with inflammation but also with anemia, infection, pregnancy, and with aging.
A very high ESR usually has an obvious cause, such as a severe infection, marked by an increase in globulins, polymyalgia rheumatica or temporal arteritis. A health practitioner will typically use other follow-up tests, such as blood cultures, depending on the person’s symptoms. People with multiple myeloma or Waldenstrom’s macroglobulinemia (tumors that make large amounts of immunoglobulins) typically have very high ESRs even if they don’t have inflammation.
When monitoring a condition over time, rising ESRs may indicate increasing inflammation or a poor response to a therapy; normal or decreasing ESRs may indicate an appropriate response to treatment.
How long will it take for my ESR result?
That depends on the laboratory performing the test. Results may be available the same day or, if the sample is sent to a reference laboratory, it may take a day or two for your results.
Traditional ESR tests are read by a technician one hour after the test is started. Newer methods can be read at 20-30 minutes; and there are now commercial rapid tests available that use a centrifugal method and can be read five minutes after setup. This new method is being used more widely to shorten waiting times for patients, particularly in emergency departments.
What other tests might my doctor order besides ESR?
Your health practitioner may order the C-reactive protein (CRP) test as well as other general tests, such as a comprehensive metabolic panel (CMP) or a complete blood count (CBC), at the same time as the ESR. ESR and C-reactive protein (CRP) are both markers of inflammation. Generally, ESR does not change as rapidly as does CRP, either at the start of inflammation or as it resolves. CRP is not affected by as many other factors as is ESR, making it a better marker of inflammation. However, because ESR is an easily performed test, many healthcare practitioners still use ESR as an initial test when they think a patient has inflammation.
Examples of other tests that may be ordered based on your symptoms include antinuclear antibody (ANA), rheumatoid factor (RF), fibrinogen or serum protein electrophoresis. An elevated ESR is typically a result of two types of proteins, globulins or fibrinogen. Depending on your medical history, signs, symptoms and what your health practitioner suspects is the cause, he or she may order a fibrinogen level (a clotting protein that is another marker of inflammation) and a serum protein electrophoresis to determine which of these (or both) is causing the elevated ESR. If severe infection is suspected, a blood culture may be done.
What do changes in my ESR mean?
Changes in the ESR may indicate the presence or abatement of infection or inflammation. If you have a chronic inflammatory disease, the ESR may fluctuate with the degree of severity or clinical course of your condition.
Is there anything else I should know?
A low ESR can be seen with conditions that inhibit the normal sedimentation of red blood cells, such as a high red blood cell count (polycythemia), significantly high white blood cell count (leukocytosis), and some protein abnormalities. Some changes in red cell shape (such as sickle cells in sickle cell anemia) also lower the ESR.
Women tend to have a higher ESR, and menstruation and pregnancy can cause temporary elevations.
In a pediatric setting, the ESR test is used for the diagnosis and monitoring of children with rheumatoid arthritis or Kawasaki disease.
Health Professionals – LOINC
LOINC Observation Identifiers Names and Codes (LOINC®) is the international standard for identifying health measurements, observations, and documents. It provides a common language to unambiguously identify things you can measure or observe that enables the exchange and aggregation of clinical results for care delivery, outcomes management, and research. Learn More.
Listed in the table below are the LOINC with links to the LOINC detail pages. Please note when you click on the hyperlinked code, you are leaving Testing.com and accessing Loinc.org.
|LOINC||LOINC Display Name|
|30341-2||ESR (Bld) [Velocity]|
|43402-7||ESR 15 minute reading (Bld) [Velocity]|
|82477-1||ESR Photometric method (Bld) [Velocity]|
|18184-2||ESR 2H Westergren method (Bld) [Velocity]|
|4537-7||ESR Westergren method (Bld) [Velocity]|
|4538-5||ESR Wintrobe method (Bld) [Velocity]|
|4539-3||Erythrocyte sedimentation rate Zeta Zetafuge (Bld) [Velocity]|
Sources Used in Current Review
(Aug 1, 2014) Kellner C, Erythrocyte Sedimentation Rate, Medscape Reference. Available at
https://emedicine.medscape.com/article/2085201-overview#a4. Accessed March 2018
Caylor T, Recognition and Management of Polymyalgia Rheumatica and Giant Cell Arteritis, Am Fam Physician. 2013 Nov 15;88(10):676-684. Available online at
https://www.aafp.org/afp/2013/1115/p676.html. Accessed March 2018
(October 2017) Giant Cell Arteritis – Temporal Arteritis, Arup Consult. Available online at
https://arupconsult.com/content/giant-cell-arteritis. Accessed March 2018
(Dec 30, 2017) Mayo Clinic, Sed Rate (Erythrocyte Sedimentation Rate),
https://www.mayoclinic.org/tests-procedures/sed-rate/about/pac-20384797. Accessed March 2018
(©2018) Quest Diagnostics, Sed Rate by Modified Westergren. Available at
Accessed March 2018
Sources Used in Previous Reviews
Henry’s Clinical Diagnosis and Management by Laboratory Methods. 22nd ed. McPherson R, Pincus M, eds. Philadelphia, PA: Saunders Elsevier: 2011, Pp 519-521.
Wu a, et al. Antiquated Tests Within the Clinical Pathology Laboratory. Am J Manag Care. 2010;16(9):e220-e22. Available online at http://www.ajmc.com/publications/issue/2010/2010-09-vol16-n09/AJMC_10sep_Wu_Xcl_e220to227 through http://www.ajmc.com. Accessed February 2014.
(November 2012) Saenger A, Block D. C-Reactive Protein and Erythrocyte Sedimentation Rate Testing: Should Both Be Ordered? Mayo Clinic Communique. Available online at http://www.mayomedicallaboratories.com/articles/communique/2012/11utiliz.html through http://www.mayomedicallaboratories.com. Accessed February 2014.
(September 30, 2013) Fran Lowry. Inflammatory Markers Elevated in Patients With Stable Pain. Medscape Medical News. Available online at http://www.medscape.com/viewarticle/811874 through http://www.medscape.com. Accessed February 2014.
(Updated: Feb 15, 2012) Lin J. Erythrocyte Sedimentation Rate. Medscape Reference article. Available online at http://emedicine.medscape.com/article/2085201-overview#a30 through http://emedicine.medscape.com. Accessed February 2014.
Curvers J, et al. Evaluation of the Ves-Matic Cube 200 Erythrocyte Sedimentation Method Comparison With Westergren-Based Methods. (2010) American Journal of Clinical Pathology, 134, 653-660. Available online at http://ajcp.ascpjournals.org/content/134/4/653.long through http://ajcp.ascpjournals.org. Accessed February 2014.
(February 18, 2003) Paget S. CRP and Inflammatory Diseases. Medscape Reference. Available online at http://www.medscape.com/viewarticle/449312 through http://www.medscape.com. Accessed February 2014.
Stojan G, et al. Erythrocyte sedimentation rate is a predictor of renal and overall SLE disease activity, Lupus. 2013 July; 22(8): 10. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3703841/ through http://www.ncbi.nlm.nih.gov. Accessed February 2014.
Kermani TA, et al. Utility of erythrocyte sedimentation rate and C-reactive protein for the diagnosis of giant cell arteritis. Semin Arthritis Rheum. 2012 Jun;41(6):866-71. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3307891/ through http://www.ncbi.nlm.nih.gov. Accessed February 2014.
Brigden, M (October 1, 1999). Clinical Utility of the Erythrocyte Sedimentation Rate. American Family Physician: American Academy of Family Physicians. Available online at http://www.aafp.org/afp/991001ap/1443.html through http://www.aafp.org.
Shojania, Kam (2000). Rheumatology: 2. What laboratory tests are needed? Canadian Medical Association Journal: CMAJ 2000, 162(8):1157-63. Available online at http://www.cma.ca/cmaj/vol-162/issue-8/1157.htm#ery through http://www.cma.ca.
MEDLINEplus (October 3, 2001). Medical Encyclopedia: ESR. U.S. National Library of Medicine, Bethesda, MD. MEDLINEplus. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003638.htm.
Thomas, Clayton L., Editor (1997). Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].
Pagana, Kathleen D. & Pagana, Timothy J. (1999). Mosby’s Diagnostic and Laboratory Test Reference 4th Edition: Mosby, Inc., Saint Louis, MO.
Zlonis M: The mystique of the erythrocyte sedimentation rate – a reappraisal of one of the oldest laboratory tests still in use. Clin Lab Med 1993;13:787-800.
Henry’s Clinical Diagnosis and Management by Laboratory Methods. 21st ed. McPherson R, Pincus M, eds. Philadelphia, PA: Saunders Elsevier: 2007, 465-466.
Pagana K, Pagana T. Mosby’s Manual of Diagnostic and Laboratory Tests. 3rd Edition, St. Louis: Mosby Elsevier; 2006, 233-235.
Cha CH, et al (Aug 24, 2009). Erythrocyte Sedimentation Rate Measurements by TEST 1 Better Reflect Inflammation Than Do Those by the Westergren Method in Patients With Malignancy, Autoimmune Disease, or Infection. American Journal of Clinical Pathology. 2009;131(2):189-194. Available online at http://www.medscape.com/viewarticle/707423 through http://www.medscape.com. Accessed April 2010.
(May 7, 2009) Medline Plus Medical Encyclopedia: ESR. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003638.htm. Accessed April 2010.