Not medically reviewed
Inflammation
Erythrocyte sedimentation rate (ESR)
Not medically reviewed · Content last updated · 1 min read ·
This is the date the draft was written, not a medical review date.
The distance red cells sediment in one hour in an upright tube, an indirect index of acute-phase proteins (chiefly fibrinogen) that promote rouleaux formation. It is non-specific, rises slowly and falls slowly.
Reference interval
| Conventional (mm/h) | SI (mm/h) | |
|---|---|---|
| Men | 0–15 mm/h | 0–15 mm/h |
| Women | 0–20 mm/h | 0–20 mm/h |
Specimen: Whole blood (EDTA or citrate), Westergren method · Conventional × 1 = SI
Causes of high values
Infection, inflammatory and autoimmune disease (giant cell arteritis, polymyalgia rheumatica, rheumatoid arthritis), malignancy including myeloma, anaemia, pregnancy, renal disease, older age. Very high values (above 100 mm/h) suggest serious disease.
Causes of low values
Polycythaemia, sickle cell disease and other conditions that impair rouleaux formation (spherocytosis, acanthocytosis), severe hypofibrinogenaemia, heart failure, some drugs.
Pre-analytical and method notes
Values rise with age and are higher in women; a common rough upper limit is age divided by 2 for men and (age + 10) divided by 2 for women. Temperature, tube tilt and delay beyond a few hours alter results, and CRP is often preferred for acute processes. Reference intervals vary by laboratory, method and population; use the interval printed on the report.
References
- Rifai N, Horvath AR, Wittwer CT. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Elsevier, 6th edition (2018) — Tier 3 (textbook)
- McPherson RA, Pincus MR. Henry's Clinical Diagnosis and Management by Laboratory Methods. Elsevier — Tier 3 (textbook)
- Loscalzo J, et al.. Harrison's Principles of Internal Medicine. McGraw-Hill, 21st edition (2022) — Tier 3 (textbook)
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