Erythrocyte Sedimentation Rate (ESR): Test Interpretation

What Is Erythrocyte Sedimentation Rate (ESR)?

The erythrocyte sedimentation rate (ESR) measures how quickly red blood cells (RBCs) settle at the bottom of a test tube. It is a simple blood test used to detect inflammation in the body.

Red blood cells normally settle slowly. However, inflammation causes proteins in the blood to make these cells clump together, making them sink faster. ESR results indicate the presence of inflammation, though they cannot pinpoint the exact cause.

When Is ESR Testing Recommended?

Doctors commonly prescribe ESR testing to investigate suspected inflammation when the exact cause is unclear.

This biomarker is widely used to diagnose and monitor conditions such as autoimmune diseases, infections, and some blood disorders. This test is also used to monitor conditions like arthritis, inflammatory bowel diseases, and systemic infections.

You might need an ESR test if you experience:

• Unexplained fever that persists over time.
• Joint or muscle pain without a clear cause.
• Fatigue that does not improve with rest.
• Headaches that occur frequently or without an obvious trigger.
• Unexplained weight loss.
• Symptoms of autoimmune diseases, such as skin rashes or swelling.

How Is ESR Testing Conducted?

ESR testing involves a simple blood draw performed by a healthcare professional. 

ESR is typically included in broader diagnostic panels such as:

• Complete Blood Count (CBC)
• Comprehensive Metabolic Panel (CMP)
• Arthritis or Rheumatology Panels

No specific preparation is needed for an ESR test. If combined with other tests, fasting may be required. Your doctor will provide clear instructions beforehand.

What Are the Normal ESR Levels?

Normal ESR levels vary based on factors such as age, sex, and the specific method used. General reference ranges are:

For adults using the Westergren method:

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

For children using the Westergren method:

• Newborns: ESR ranges from 0 to 2 mm/hr.
• Children from newborn to puberty: ESR ranges from 3 to 13 mm/hr.

ESR is measured in millimeters per hour [mm/hr].

Note: Units of measurement and normal ranges may differ between laboratories and methods used. Always consult your healthcare provider for accurate interpretation

What Do High ESR Levels Mean?

Elevated ESR levels mean red blood cells settle faster than normal, often due to increased inflammatory proteins in the blood. Common causes include:

• Autoimmune diseases: Conditions like lupus or rheumatoid arthritis increase inflammation.
• Infections: Systemic or localized infections can elevate ESR.
• Cancer: Some cancers, such as lymphoma or multiple myeloma, can raise ESR.
• Kidney or thyroid diseases: Chronic illnesses can impact blood composition.
• Tissue damage: Injuries or trauma lead to inflammation and higher ESR.

ESR values are not only influenced by medical conditions but also by modifiable behaviors (e.g., smoking, low physical activity) and metabolic health (e.g., obesity, metabolic syndrome).

Recommendations

• Follow up with your doctor to identify the underlying cause.
• Manage inflammation with lifestyle changes, such as:
  • Eating an anti-inflammatory diet (rich in fruits, vegetables, and omega-3s).
  • Staying physically active to improve circulation.
  • Reducing stress through mindfulness or relaxation techniques.

Which Specialist Should You Consult?

The type of specialist you consult depends on your symptoms and underlying conditions:

• Rheumatologist: For autoimmune diseases like arthritis or lupus.
• Infectious Disease Specialist: For infections causing abnormal ESR levels.
• Hematologist: For blood disorders such as anemia or polycythemia.
• General Practitioner: For initial evaluation and referrals as needed.

Always discuss your ESR results with a healthcare provider to understand their significance and next steps.