Erythrocyte Sedimentation Rate

Updated: Nov 22, 2019
Author: Christopher P Kellner, MD; Chief Editor: Thomas M Wheeler, MD, FCAP 

Reference Range

Normal values for the erthyrocyte sedimentation rate (ESR), as derived using the Westergren method, are as follows[1] :

  • Male: ≤15 mm/hr
  • Female: ≤ 20 mm/hr
  • Child: ≤10 mm/hr
  • Newborn: 0-2 mm/hr




Conditions that may be associated with a highly elevated ESR (>100 mm/hr) include the following:

  • Hypersensitivity vasculitis

  • Giant cell arteritis

  • Waldenström macroglobulinemia

  • Polymyalgia rheumatica

  • Metastatic cancer

  • Chronic infection

  • Hyperfibrogenemia


Collection and Panels

Specifics for collection and panels are as follows:

  • Specimen type: Whole blood

  • Container: Vacutainer, lavender top or black top

  • Collection method: Venipuncture

  • Specimen volume: 4 mL

Related tests

See the list below:

  • C-reactive protein (CRP)

  • Antinuclear antibody (ANA)

  • Rheumatoid factor (RF)




The rate at which red blood cells settle out when anticoagulated whole blood is allowed to stand is known as the erythrocyte sedimentation rate. The ESR is affected by the concentrations of immunoglobulins and acute phase proteins (fibrinogen, C-reactive protein, alpha-1 antitrypsin, haptoglobin), and is a sensitive, but nonspecific, indicator of inflammation and tissue damage.[2, 3, 4]


The ESR is a nonspecific test that is often used as a screening test for patients with unexplained fevers, certain types of arthritis, muscle symptoms, or other vague symptoms of unknown origin.

Significant specific indications for ESR testing include the following:

  • Diagnosis and monitoring of giant cell arteritis

  • Diagnosis and monitoring of polymyalgia rheumatic[5]

  • Monitoring of rheumatoid arthritis

  • Monitoring of systemic lupus erythematosus[6]


Other conditions that may be associated with an elevated ESR include the following:

  • Anemia

  • Other arthritides

  • Other autoimmune disorders

  • Infective endocarditis

  • Inflammatory disease

  • Malignancy (eg, lymphoma, leukemia)

  • Osteomyelitis

  • Pregnancy

  • Renal disease

  • Severe skin infection (eg, erysipelas)

  • Systemic infection

  • Rheumatic fever

  • Thyroid disease

  • Tissue death

  • Tuberculosis