An erythrocyte sedimentation rate (ESR) test is sometimes called a sedimentation rate test or sed rate test. This blood test doesn't diagnose one specific condition. Instead, it helps your healthcare provider determine whether you're experiencing inflammation.
Your doctor will look at ESR results along with other information or test results to help figure out a diagnosis. The tests ordered will depend on your symptoms.
The ESR test can also be used to monitor inflammatory diseases.
When you're experiencing inflammation, your red blood cells (RBCs) cling together, forming clumps. This clumping affects the rate at which RBCs sink inside a tube where a blood sample is placed.
The test lets your doctor see how much clumping is occurring. The faster and further the cells sink towards the bottom of a test tube, the more likely it is that inflammation is present.
The test can identify and measure inflammation, in general, in your body. However, it doesn't help pinpoint the cause of inflammation. That's why the ESR test is rarely performed alone. Instead, your doctor will likely combine it with other tests to determine the cause of your symptoms.
The ESR test can be used to help your healthcare provider diagnose conditions that cause inflammation, such as:
- autoimmune diseases
- cancers
- infections
The ESR test can help your healthcare provider monitor autoimmune inflammatory conditions, such as:
- rheumatoid arthritis (RA)
- systemic lupus erythematosus (SLE)
Your doctor might also order this test if you have:
- some types of arthritis
- certain muscle or connective tissue problems, such as polymyalgia rheumatica
You might need an ESR test if you experience symptoms of inflammatory conditions such as arthritis or inflammatory bowel disease (IBD). These symptoms can include:
- joint pain or stiffness that lasts longer than 30 minutes in the morning
- headaches, particularly with associated pain in the shoulders
- abnormal weight loss
- pain in the shoulders, neck, or pelvis
- digestive symptoms, such as diarrhea, fever, blood in your stool, or unusual abdominal pain
The ESR test requires little preparation.
However, you should tell your doctor if you're taking any medication therapy. They may ask you to temporarily stop taking it before the test. Certain medications may affect ESR test results.
This test involves a simple blood draw. It should take only a minute or two.
- First, the skin directly over your vein is cleaned.
- Then, a needle is inserted to collect your blood.
- After collecting your blood, the needle is removed and the puncture site covered to stop any bleeding.
The blood sample is taken to a lab, where your blood will be placed in a long, thin tube in which it sits to gravity for one hour. During and after this hour, the laboratory professional processing this test will assess how far the RBCs sink into the tube, how quickly they sink, and how many sink.
Inflammation can cause abnormal proteins to appear in your blood. These proteins cause your RBCs to clump together. This makes them fall more quickly.
Your doctor may order a C-reactive protein (CRP) test at the same time as your ESR test. CRP measures inflammation as well, but it can also help predict your risk for coronary artery disease (CAD) and other cardiovascular diseases.
Having your blood drawn involves minimal risks. Possible complications include:
- bleeding, from very light to excessive
- fainting
- hematoma
- bruising
- infection
- inflammation of the vein
- tenderness
- lightheadedness
You'll probably feel mild to moderate pain when the needle pricks your skin. You might also feel throbbing at the puncture site after the test.
If you're uncomfortable at the sight of blood, you may also experience discomfort seeing blood drawn from your body.
There are two methods for measuring your erythrocyte sedimentation rate.
Westergren method
In this method, your blood is drawn into a Westergren-Katz tube until the blood level reaches 200 millimeters (mm).
The tube is stored vertically and sit at room temperature for an hour.
The distance between the top of the blood mixture and the top of the sedimentation of RBCs is measured.
This is the most used ESR testing method.
Wintrobe method
The Wintrobe method is similar to the Westergren method, except the tube used is 100 mm long and thinner.
A disadvantage of this method is that it's less sensitive than the Westergren method.
ESR test results are measured in millimeters per hour (mm/hr).
The following are considered normal ESR test results:
- Women under age 50 should have an ESR between 0 and 20 mm/hr.
- Men under age 50 should have an ESR between 0 and 15 mm/hr.
- Women over age 50 should have an ESR between 0 and 30 mm/hr.
- Men over age 50 should have an ESR between 0 and 20 mm/hr.
- Children should have an ESR between 0 and 10 mm/hr.
The higher the number, the higher the likelihood of inflammation.
An abnormal ESR result doesn't diagnose any particular disease. It just identifies any potential inflammation in your body and indicates a need to look further.
An abnormally low value would be near 0. (Because these tests fluctuate, and what is ultimately considered to low may vary from one person to the next, it's hard to state an exact value.)
This test isn't always reliable or meaningful. Many factors can alter your results, such as:
- advanced age
- medication use
- pregnancy
Some causes of abnormal ESR test results are more serious than others, but many aren't a huge concern. It's important not to worry too much if your ESR test results are abnormal.
Instead, work with your doctor to find out what's causing your symptoms. They'll usually order follow-up tests if your ESR results are too high or low.
There are multiple causes of a high ESR test result. Some common conditions associated with a higher rate include:
- advanced age
- pregnancy
- anemia
- kidney disease
- obesity
- thyroid disease
- certain types of cancer, including some types of lymphoma and multiple myeloma
An abnormally high ESR can indicate the presence of cancerous tumors, especially if no inflammation is found.
Autoimmune diseases
ESR test results that are higher than normal are also associated with autoimmune diseases, including:
- lupus
- certain types of arthritis, including RA
- Waldenstrom's macroglobulinemia, a rare cancer
- temporal arteritis, a condition in which your temporal artery becomes inflamed or damaged
- polymyalgia rheumatica, which causes muscle and joint pain
- hyperfibrinogenemia, which is too much of the protein fibrinogen in your blood
- allergic or necrotizing vasculitis
Infections
Some types of infection that cause ESR test results to become higher than normal are:
- bone infection
- heart infections causing myocarditis (affects heart muscle), pericarditis (affects tissue around the heart, or the pericardium) and endocarditis (affects the lining of the heart, which can include the heart valves)
- rheumatic fever
- skin infection
- systemic infections
- tuberculosis (TB)
A low ESR test result may be due to:
- congestive heart failure (CHF)
- hypofibrinogenemia, which is too little fibrinogen in the blood
- low plasma protein (occurring in relation to liver or kidney disease)
- leukocytosis, which is a high white blood cell (WBC) count
- polycythemia vera, a bone marrow disorder that leads to the production of excess RBCs
- sickle cell anemia, a genetic disease affecting the RBCs
Depending on your results, your doctor may want to order additional tests, including a second ESR test to verify the results of the first one. These tests can potentially help your doctor to figure out the specific cause of your inflammation.
If you have a condition that falls into one of the categories below, further tests can also help measure the effectiveness of treatments and keep track of your ESR throughout your course of treatment.
An underlying condition
If your healthcare provider suspects that an underlying condition is causing your high ESR, they may refer you to a specialist who can properly diagnose and treat the condition.
Inflammation
If your doctor detects inflammation, they may recommend one or more of the following treatments:
- taking a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn)
- corticosteroid therapy to reduce inflammation
Infection
If a bacterial infection is causing your inflammation, your doctor will likely prescribe an antibiotic to fight this infection.