Erythrocyte Sedimentation Rate Test

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WHAT IS ERYTHROCYTE SEDIMENTATION RATE TEST? (Erythrocyte sedimentation rate test CPT code 85652) Erythrocyte sedimentation rate test is a blood test that guides your doctor in determining if you are experiencing any inflammation.  An ESR test can also be used to monitor inflammatory diseases. Inflammation is part of the immune system response. Sometimes, it can be… Read More

Erythrocyte Sedimentation Rate Test


(Erythrocyte sedimentation rate test CPT code 85652)

Erythrocyte sedimentation rate test is a blood test that guides your doctor in determining if you are experiencing any inflammation. 

An ESR test can also be used to monitor inflammatory diseases. Inflammation is part of the immune system response. Sometimes, it can be a reaction to an infection or injury. Other times, it may be a sign of chronic disease, an immune disorder, or other medical conditions. 

An ESR test measures how quickly red blood cells (RBCs) settle at the bottom of a test tube that contains a blood sample. Ordinarily, RBCs (erythrocytes) settle relatively slowly. If the rate is faster than normal, it may indicate inflammation in the body. 

Other names for ESR are sedimentation and SED rate.


Erythrocyte sedimentation rate test is used for the following purposes:

  • To determine if you have a condition that causes inflammation, including:
  • Arthritis.
  • Vasculitis.
  • Inflammatory bowel disease (IBD).
  • ESR tests can also be used to monitor an existing health condition.


An ESR test might be necessary if you experience symptoms of inflammatory conditions such as arthritis or inflammatory bowel disease (IBD). 

Such symptoms may include:

  • Fever.
  • Diarrhea.
  • Abdominal pain.
  • Blood in your feces.
  • Abnormal loss of weight.
  • Shoulder, neck, or pelvis pain.
  • Headaches followed with shoulder pain.
  • Joint pain/stiffness (above 30mins in the morning).


There are two methods for the ESR test:

  • Westergren Method

It involves drawing your blood sample into a Westergren-Katz tube until the blood level reaches 200mm. The length between the top of the blood mixture and the top of the sedimented red blood cells is measured. This is the most commonly used ESR testing method.

  • Wintrobe Method

The tube used in this method is 100mm long and thinner than the Westergren-Katz tube. The demerit of this method is that it is less sensitive than the Westergren method.


The complications of an erythrocyte sedimentation test include:

  • Bruising.
  • Fainting.
  • Infection.
  • Hematoma.
  • Tenderness.
  • Lightheadedness.
  • Vein inflammation.
  • Bleeding at the injection site.
  • Mild to moderate pain when the needle enters your skin.


The preparation for the ESR test is simple:

  • No fasting is needed.
  • Tell your doctor your present medication therapy.
  • You may have to temporarily stop the medication before the test.
  • Certain meds may affect your ESR test results.


The test simply involves a blood sample drawn from your vein, taking only about 2 minutes.

  • A nurse or lab technician locates a vein in your arm.
  • The skin directly over your vein is cleaned with a disinfectant.
  • A needle is inserted into the vein to collect your blood.
  • The needle is removed after collecting the blood.
  • The puncture site is covered up to avoid bleeding.
  • The blood sample is then sent to the lab for processing.
  • In the lab, the blood is placed in a long, thin tube and left seated to gravity for an hour.
  • Within this time, and after, the lab technician will be assessing how far the red blood cells sink into the tube, how quickly they sink, and at the end, how many sink.
  • Abnormal proteins caused by inflammation will make the red blood cells clump together, and thus fall more quickly.


  • Normal ESR Test Results

Erythrocyte sedimentation rate test results are measured in millimeters per hour (mm/hr). The following are considered normal ESR test results:



100 men under age 50


Men under age 50


100 men above age 50


Men above age 50





The higher the number is equal to the higher the likelihood of inflammation. 

  • Abnormal ESR Test Results

When the ESR test result is abnormal, it does not diagnose any particular disease. It just identifies any potential inflammation in your body. An abnormally low value would be near zero. Further tests need to be carried out to know the actual condition involved. ESR test isn’t always reliable or meaningful. 

Many factors can alter your results, such as:

  • Medications.
  • Old age.
  • Pregnancy.
  • High ESR Test Results:

Some common causes of high ESR test results include:

  • Advanced age.
  • Pregnancy.
  • Obesity.
  • Anemia.
  • Thyroid disease.
  • Kidney disease.
  • Certain cancers such as some types of lymphoma and multiple myeloma.

An abnormally high ESR can depict the presence of cancerous tumors, especially when inflammation is not present. 

ESR test results that are higher than normal are also associated with autoimmune disease, including:

  • Lupus.
  • Polymyalgia rheumatics.
  • Allergic (necrotizing) vasculitis.
  • Some types of arthritis, such as RA.
  • Hyperfibrinogenemia (high blood fibrinogen).
  • Temporal arthritis (due to inflamed temporal artery).
  • Waldenstrom’s macroglobulinemia (which is rare cancer).

Infections can also cause higher-than-normal ESR test results. Such infections include:

  • Tuberculosis.
  • Skin infection.
  • Bone infection.
  • Rheumatic fever.
  • Systemic infections.
  • Heart infection-causing:
  • Myocarditis.
  • Pericarditis.
  • Endocarditis.
  • Low ESR Test Results:

Some health conditions lead to low ESR results, such as:

  • Low plasma protein.
  • Congestive heart failure (CHF).
  • Leukocytosis (high white blood cell count).
  • Hypofibrinogenemia (low fibrinogen in the blood).
  • Sickle cell anemia (a genetic disease affecting red blood cells).
  • Polycythemia vera (bone marrow disorder featured by excess RBC production).

RBC = Red blood cell.

After The Test,

Your result may prompt your doctor to order some additional tests, including a second ESR test, to verify the result of the first one. These tests may throw more light, thereby making the specific cause of your inflammation known. They will also help your doctor know the kind of treatment options.

  • Inflammation.

If inflammation is detected, the following medications may be recommended:

  • Non-steroidal anti-inflammatory drugs (NSAID), such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn).
  • Corticosteroid therapy to reduce inflammation.
  • Infection.

Your doctor may likely prescribe antibiotics to fight the infections.

  • Other underlying conditions

Your doctor will recommend an appropriate treatment option or refer you to a specialist.


  • What happens if ESR is high?

A high ESR is a sign of a disease that causes inflammation in your body. Some conditions and medications can affect the speed at which RBCs fall, thereby affecting the test results. These include anemia and some types of arthritis.

  • What is a normal ESR?

The normal range for ESR is 0─20mm/hr (for men above 50 years), 0─15mm/hr (for men under 50 years), 0─30mm/hr (for women above 50 years), 0─20mm/hr (for women under 50 years), and 0─10mm/hr (for children).

  • Is ESR higher in females?

ESR is higher in females because the non-inflammatory conditions that cause high ESR occur mostly during menstruation or pregnancy. These conditions include anemia, kidney issues, obesity, and aging. People tend to an age when pregnant.

  • Is fasting required for the ESR test?

A small preparation is needed for the test. You may not need to fast. Endeavor to tell your doctor about the medications you’re taking. You may likewise have to stop taking them temporarily before the test.

  • How much blood is needed for the ESR test?

The minimum blood volume needed for the ESR test is 2ml of blood. This volume doesn’t allow repeat testing.