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What is Erythrocyte Sedimentation Rate (ESR) Test for Blood?

If a medical expert suspects a high level of inflammation in a body, they might recommend a blood test known as the Erythrocyte Sedimentation Rate (ESR) Test. This blood test helps to monitor inflammatory diseases. Based on ESR levels, different illnesses could be diagnosed, and the efficacy of therapies could be monitored.

Continue reading this article to learn more about the ESR test, including its purpose, how to interpret the results and the different types of ESR tests that exist.

Team Digit

What is an ESR Test?
Why is it Needed?
When to Get an ESR Test?
Different Types of ESR Tests
Who Should Get an ESR Test?
Procedure for the ESR Test
Preparation for the ESR Test
How is ESR Measured?
How to Read Results?
Normal Range of ESR Test
Symptoms of High ESR
What If ESR is High?
Causes of High ESR
Symptoms of Low ESR
What If ESR is Low?
Causes of Low ESR
Frequently Asked Questions

What Is an ESR Test?

An ESR test is the measurement of how quickly the red blood cells in a blood sample sinks to the bottom of the test tube. The full form of ESR is the erythrocyte sedimentation rate. It is also known as the sed rate. Usually, the red blood cells should settle down slowly. If the RBCs settle down faster than the normal rate, it might indicate inflammation in the body. Inflammation may be a symptom of an immune disorder, a chronic disease or other health conditions.

What Is the Need for an ESR Test?

The ESR test determines if a person has a condition that causes inflammation. The conditions include vasculitis, inflammatory bowel disease or arthritis. It is also used in order to monitor any existing condition. Your doctor may recommend you an ESR test if you have the signs of inflammatory conditions. These include –

Headaches
Fever
Weight loss
Loss of appetite
Anaemia
Shoulder or neck pain
Joint stiffness

When Should I Get the ESR Test?

Deciding when to get an ESR test can feel a bit confusing. It’s all about knowing the right time to check in on your health so you and your doctor can stay on top of any potential issues.

Inflammation Symptoms: In case you have a fever that you cannot explain, joint pain, stiffness, or other problems that imply an infection or inflammation.
Autoimmune Disease Diagnosis: When there is suspicion of diseases such as lupus and rheumatoid arthritis, which are characterised by chronic inflammation.
Chronic Condition Monitoring: It helps assess how severe and progressive chronic inflammatory diseases are among individuals.
Undiagnosed Symptoms Assessment: The fact that symptoms such as loss of weight, fatigue, and general discomfort persist for a long time without a clear cause.
Treatment Evaluation: This will help determine the efficiency of treatments for infections or inflammatory illnesses over time.

What Are the Different Types of ESR Tests?

When it comes to measuring the ESR, there are generally two main methods used. Broadly, there are two ways of measuring the ESR. They are as follows:

1. Westergren Method

It is the most common type of ESR test. In this test, a person's blood is taken out in a Westergren-Katz tube till the blood level touches 200 millimetres. The tube is kept vertically at room temperature for an hour. Then, the distance between the top of the blood mixture and top of the sedimentation of red blood cells is measured.This method is highly accurate and widely used due to its sensitivity to inflammation and disease.

2. Wintrobe Method

This method is the same as the Westergren method. However, the tube is thinner and 100 millimetres long. The drawback of this method is that it is less sensitive compared to the Westergren method.It may be used in specific circumstances where the Westergren method is not available, but it is generally less preferred for its lower sensitivity and accuracy.

Who Should Take an ESR Test?

Any individual experiencing signs of inflammatory disorders such as IBD (inflammatory bowel disease) or arthritis should take an ESR test. The symptoms of inflammatory disorders include –

Stiffness or joint pain which lasts more than thirty minutes in the morning
Headaches associated with vision changes and pain in temples
Sudden weight loss
Pain in shoulders, pelvis or neck
Digestive disorders such as diarrhoea, fever, blood in stool, unusual pain in the abdomen

What is the Procedure for the ESR Test?

It is very easy to administer the ESR test. Here, we will discuss what you should anticipate when going for it.

Step 1: Getting Prepared: Generally, people need no specific preparations for this kind of test, although your doctor may ask you not to take certain medications before the procedure.

Step 2: Drawing Blood: a healthcare professional will clean the skin with an antiseptic and then use a needle to collect a blood sample from one of your veins.

Step 3: Processing Blood: The blood is collected in a tube and sent to the laboratory, where it’s placed into a long, thin tube to observe how fast red cells fall after that.

Step 4: Interpretation of Results: The rate at which RBCs settle down is measured in millimetres per hour (mm/hr). Higher values can indicate inflammation or other types of disease.

Step 5: Post-test Care: The puncture site will be covered with a dressing. This means there is no downtime, as you are allowed to go about your normal activities instantly.

How to Prepare for an ESR Test?

An erythrocyte sedimentation rate test needs a little preparation. Individuals must tell their doctor if they are using any medications. They might ask to stop taking medicine temporarily before the test. Several medications affect the test results. For example, nonsteroidal anti-inflammatory drugs, steroids and statins might result in false low ESRs. However, no one should stop using any prescribed medications before the consultation with the doctor. Furthermore, fasting before the test is unnecessary.

How is ESR Measured in Blood Tests?

A blood sample is taken from a vein in your arm, usually the one inside the elbow, and then placed into a tall, thin tube. The tube is left undisturbed for about one hour, allowing the red blood cells to settle at its bottom.

After that, healthcare professionals measure how far they have fallen as millimetres per hour (mm/h). An elevated ESR may mean inflammation or other health issues and can help doctors determine if certain conditions are present and how severe they may be.

How to Read an ESR Test Report?

The results of erythrocyte sedimentation rate are calculated in millimetres per hour (mm/hr). The faster the sedimentation rate, the greater the degree of inflammation or the presence of an underlying condition. The greater the value, the higher the chances of inflammation. Typically, females have higher levels of ESR than males.

Normal ranges may vary based on age, gender, and health status, so it's crucial to interpret these values in the context of individual health conditions and symptoms.

Normal Range of ESR in Blood Test

ESR’s normal range depends on age, gender, and the laboratory where it was performed. Typically, women have slightly higher ESR levels than men, meaning that with age, the normal range might increase.

ESR levels can indicate different health statuses ranging from normal to potentially high or low, which may require further medical evaluation. Normal and abnormal sed rate test results are mentioned in the table below:

Gender and Age	Normal Test Results	Abnormal Test Results
Females under 50	Between 0 and 20 mm/hr	Greater than 20
Males under 50	Between 0 and 15 mm/hr	Greater than 15
Females over 50	Between 0 and 30 mm/hr	Greater than 30
Males over 50	Between 0 and 20 mm/hr	Greater than 20
Children	Between 0 and 10 mm/hr	Greater than 10

Symptoms of High ESR

You might have some telltale symptoms if your doctor suspects a high ESR. Knowing these signs will inform you when further evaluation should be done.

Symptom	Description
Fatigue	Persistent tiredness and lack of energy that doesn't improve with rest, often affecting daily activities.
Unexplained Weight Loss	Losing weight without any diet or physical activity changes may indicate an underlying health issue.
Fever	Elevated body temperature that persists, often signalling an infection or an inflammatory condition.
Joint Pain	Pain, stiffness, and swelling in the joints are frequently caused by inflammation or autoimmune disorders.
Muscle Aches	General discomfort or pain in the muscles which can be related to infections, overuse, or systemic illness.
Headaches	Frequent or severe headaches that might be due to inflammation, stress, or other underlying health problems.
Night Sweats	Excessive sweating during sleep is commonly linked to infections, hormonal imbalances, or chronic conditions.

What Should You Do If You Have High ESR?

If the sedimentation rate of your blood is very high, you should work with the doctor to identify the cause of high ESR and treat the underlying conditions, if any. However, there are several lifestyle changes and strategies listed below that will help you prevent high ESR –

Lead a hygienic and healthy lifestyle to stay protected from infections.
Exercise regularly to decrease inflammation and ESR levels.
Include gluten-free vegan, lacto-vegetarian foods, fish oil, Vitamin A and E in your daily diet.
Lose weight to decrease the ESR levels.
Use drugs that fight inflammation to reduce the ESR levels. These drugs include Tocilizumab, Levamisole, NSAIDs and Cortisone.

Disclaimer: Make sure to use drugs and supplements after consulting your doctor.

What Are the Causes of High ESR?

There are multiple causes of high ESR results. The conditions which cause high ESR are as follows –

Condition	Description
Localised and Systemic Infectious and Inflammatory Diseases	Infections and inflammation affect specific areas or the entire body, increasing ESR levels as the immune system responds to these conditions.
Ischemia or Tissue Injury	Reduced blood flow to tissues causes damage and inflammation, leading to elevated ESR levels as the body attempts to repair the affected areas.
Certain Cancers like Multiple Myeloma and Lymphoma	These cancers often trigger inflammatory responses in the body, leading to a rise in ESR levels as part of the body’s reaction to the malignancy.
Old Age	As people age, natural changes in the body, including increased inflammation, can result in higher ESR levels, even in the absence of acute illness.
Pregnancy	Hormonal and physiological changes during pregnancy naturally elevate ESR levels, reflecting the body’s adaptation to support the developing foetus.
Obesity	Adipose tissue expansion in obesity is associated with chronic low-grade inflammation, which can raise ESR levels in affected individuals.
Thyroid Diseases	Conditions like hypothyroidism and other thyroid-related disorders can influence ESR levels due to their impact on metabolism and immune function.
Autoimmune Diseases such as Lupus, Polymyalgia Rheumatica, Waldenstrom’s Macroglobulinemia, Temporal Arteritis, and Necrotizing Vasculitis	These chronic autoimmune conditions cause ongoing inflammation throughout the body, leading to persistently high ESR levels as part of the disease process.
Infections such as Myocarditis, Rheumatic Fever, Skin Infections, and Tuberculosis	These infections cause significant inflammation in the affected tissues or organs, resulting in elevated ESR levels as the body fights the infection.

Symptoms of Low ESR

Symptoms indicating low ESR may sometimes include experiencing a low ESR. Knowing these signs will enable you to comprehend your condition better, thus communicating effectively with your physician when necessary.

Symptom	Description
Fatigue	A persistent feeling of tiredness and lack of energy that does not improve with rest, often making daily activities difficult to manage.
Weakness	A pervasive sense of physical powerlessness, where the body feels drained and unable to perform even routine tasks effectively.
Pale Skin	A noticeable lightening of the skin tone often indicates a reduced number of red blood cells, which can affect the skin's natural colour.
Shortness of Breath	Experiencing difficulty breathing, wheezing, or becoming breathless with minimal exertion due to decreased oxygen levels in the blood.
Dizziness or Lightheadedness	Frequent episodes of feeling faint or unsteady, often due to insufficient oxygen reaching the brain, leading to potential falls or fainting.
Rapid Heartbeat	An abnormally fast or racing heartbeat is often a response to low oxygen levels in the blood, as the heart works harder to circulate oxygen.
Cold Hands and Feet	A sensation of coldness in the extremities, typically due to poor circulation or reduced blood flow, may also cause numbness.

What If ESR in Blood is Low?

A low ESR usually means no significant inflammation or infection in your body. Nevertheless, low ESR can be normal sometimes, particularly when you are otherwise healthy.

However, it might also indicate medical conditions like polycythaemia (excessive red blood cells), various types of anaemia, or other rare diseases. One should consider his/her general health and symptoms to evaluate the meaning of a low ESR.

Consulting with a healthcare provider is essential to understanding the implications of a low ESR result and determining whether further investigation or treatment is needed.

What Are the Causes of Low ESR?

Low ESR levels can occur for a variety of reasons, often linked to underlying health conditions. The following conditions generally cause low ESR:

Condition	Description
Congestive Heart Failure	A chronic condition where the heart struggles to pump blood effectively, leading to abnormal circulation and potentially lower ESR levels due to poor heart function.
Low Plasma Protein	Reduced levels of plasma proteins, which are essential for maintaining blood viscosity and clotting, can result in a decreased ESR as the blood's ability to settle is impaired.
Hypofibrinogenemia	This condition is marked by low levels of fibrinogen, a crucial protein for blood clotting. Low fibrinogen levels can cause a significant reduction in ESR since fibrinogen contributes to blood cell aggregation.
High White Blood Cell Count	An elevated white blood cell count, often a sign of infection or inflammation, may adversely affect ESR, causing it to be lower than normal as white cells interfere with red cell settling.
Polycythaemia Vera	A rare blood disorder characterised by an overproduction of red blood cells, leading to thicker blood and a lower ESR because the increased cell mass hampers sedimentation.
Sickle Cell Anaemia	A genetic disorder where abnormally shaped red blood cells cause blockages in blood vessels and result in a lower ESR, as these cells do not settle easily during the test.

Therefore, the ESR test is a blood test that helps your doctor measure the inflammation in the body. Generally, it is done with other tests to treat or diagnose a variety of inflammatory diseases. Based on the result of the test, the doctor might recommend more testing or refer to a specialist. Individuals experiencing inflammatory disease symptoms must consult with their doctor at the earliest.

FAQs about ECR in Blood Tests

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What is the meaning of ESR 60?

An ESR value of 60 mm/hr means high systemic inflammation in people with inflammatory disease. This suggests that there may be significant inflammation or an underlying condition that needs further evaluation.

Should I worry if my ESR level is high?

If the ESR level is above 100 mm/hr, it's a reason to worry. However, anything lesser than that is normal. However, levels below that generally fall within a normal range and are less likely to indicate a serious issue.

What does a normal ESR value indicate?

A normal ESR means a person has no significant inflammatory or infectious diseases. It can, therefore, be used to exclude or monitor inflammatory disorders.

Can ESR levels be affected by medications?

Yes, certain medications, such as corticosteroids, can decrease ESR rates by lessening inflammation. This may disrupt the integrity of using ESR to measure inflammation.

How often should ESR be tested?

ESR testing frequency depends on individual health status and physician recommendation. It is also done during regular checkups to monitor chronic inflammation.

What is considered a high ESR level?

Men are considered to have high values when their rates reach above 20 mm/hr. At the same time, women exhibit similar results, with figures above 30 mm/hr showing a probability of some inflammation. A persistent increase requires further medical attention.

Can ESR levels fluctuate?

Yes, fluctuations in ESR can occur due to factors like acute infections, chronic illnesses, and even stress. Such changes are normal but must be considered in the context of general well-being.

Does anaemia affect ESR levels?

Yes, anaemia can lead to higher ESR levels due to changes in the properties of red blood cells. These changes affect the rate at which red blood cells settle in a tube.

What conditions are commonly associated with high ESR levels?

Conditions such as rheumatoid arthritis, lupus, and chronic infections are commonly associated with elevated ESR levels. High ESR is often used to monitor these inflammatory conditions.

Is fasting required before an ESR test?

No, fasting is not required before an ESR test. It is a straightforward blood test that does not need special preparation or dietary restrictions.

Can high ESR levels indicate cancer?

Yes, elevated ESR levels can be associated with cancers such as lymphoma and multiple myeloma. However, high ESR alone is not diagnostic for cancer and requires additional testing.

How can I lower my ESR levels?

Lowering ESR involves addressing the underlying cause of inflammation or infection. Treatment options may include medication, lifestyle changes, and managing specific health conditions effectively.

Can ESR levels be normal in the presence of a serious condition?

Yes, ESR levels might be normal despite the presence of serious conditions. This underscores the importance of using ESR with other diagnostic tests and clinical evaluations.

Is an ESR test compulsory when applying for health insurance?

In most cases, an ESR test is not mandatory. However, depending on your age, health status, and medical background, the insurer may request that you undergo the test. This is more common for applicants over 60 to help determine premium rates and coverage limits in a medical insurance policy.