A sedimentation rate blood test (erythrocyte sedimentation rate, ESR, or sed rate) measures how quickly red blood cells collect at the bottom of a container, revealing information about general inflammation levels in the body. It's non-specific and is part of screening for a variety of conditions.
A sedimentation rate, or erythrocyte sedimentation rate blood test, is a common blood test that is used to detect and monitor inflammation in the body. The sedimentation rate is also called the erythrocyte sedimentation rate because it is a measure of the red blood cells (erythrocytes) sedimenting in a tube over a given period of time. The sedimentation rate is often abbreviated as "sed rate" or ESR. Although this test measures a general state of inflammation, it is not specific to what causes the inflammation. It is elevated in inflammatory diseases, including arthritis, as well as in autoimmune diseases, such as lupus. It can also be elevated due to other conditions such as certain cancers and Graves' disease.
A sed rate blood test is used to detect inflammation in the body. It can also be used to follow the progress of a disease.
A sed rate blood test is a simple test that does not require any specific preparations. Unlike other blood tests, it is not necessary to fast before an ESR test, and you are even allowed to take your usual medications before the test. However, you must inform your health care provider about any medications you are taking, including over-the-counter prescriptions and vitamins because some drugs may interfere with the test results. It is advisable to wear clothing with sleeves that can be quickly rolled up to expose your arm for the blood draw. You must be hydrated before the test.
A sed rate test is a simple and safe process with very few risks. When a needle is inserted into a vein to draw blood, it may cause a brief prickly pain at the puncture site; sometimes, it may cause bruising or bleeding at the site. Though it is uncommon, some people may feel lightheaded or faint. Rarely, some may develop an infection at the needle insertion site. However, these side effects are very rare and subside quickly without any complications.
All specialties of medicine can order this simple blood test while evaluating symptoms in order to determine whether or not there is inflammation in the body.
A sedimentation rate is performed by measuring the rate at which red blood cells (RBCs) settle in a test tube. The RBCs become sediment in the bottom of the test tube over time, leaving the blood serum visible above. The classic sedimentation rate is simply how far the top of the RBC layer has fallen (in millimeters) in one hour. The sedimentation rate will be higher in the presence of increased inflammation.
During a sed rate test, a needle is inserted into a vein in your arm to draw blood. The blood sample collected in a test tube is then processed to assess how quickly red blood cells fall to the bottom of the tube after one hour. The blood-filled tube is placed still in a tall, thin, vertical tube. Gravity pulls the red blood cells to the bottom. During this process, the rate of sedimentation is measured in millimeters per hour. The ESR is a nonspecific test done to identify inflammation caused by infections, autoimmune diseases, or cancer. The results are usually available within a few hours to a day.
A sed rate test is a relatively simple test, and you are sent home within a few minutes after the test is done. Your health care provider will provide you with a diagnosis depending on your symptoms and the test results. If the sed rate is within normal range and no other symptoms are present, further action may not be necessary. However, an increased ESR requires further testing to determine the underlying cause of inflammation. Additional blood tests such as C-reactive protein (CRP) test, a full blood count, or tests for autoimmune diseases may be advised. Imaging studies, such as X-rays or MRIs, may also be recommended.
The results of an ESR test are measured in millimeters per hour (mm/hour), indicating the rate at which red blood cells settle at the bottom of a test tube over an hour. A high ESR test result indicates the presence of inflammation in the body. However, since the ESR test is nonspecific and doesn't diagnose a specific disease, your health care provider interprets the results alongside other clinical exams, laboratory tests, and symptoms to identify potential causes of inflammation. A high ESR test result may indicate active infection, autoimmune diseases, arthritis, inflammatory bowel disease, heart and kidney diseases, or cancer . A low ESR result may indicate conditions such as sickle cell disease, polycythemia, heart failure, and kidney problems.
The normal sedimentation rate (Westergren method) is 0-15 millimeters per hour for males and 0-20 millimeters per hour for females. The sedimentation rate may normally be slightly higher in the elderly. The range of normal results can sometimes vary slightly with different laboratories. Here is the normal range for the sedimentation rate chart.
| Gender and Age | Sed Rate (mm/hour) |
| Males younger than 50 | 0 to 15 |
| Males older than 50 | 0 to 20 |
| Females younger than 50 | 0 to 20 |
| Females older than 50 | 0 to 30 |
A high sedimentation rate suggests the presence of inflammation in the body, but it doesn’t pinpoint a specific disease. It rather indicates an underlying inflammatory process, such as infection, autoimmune disorders, or chronic conditions such as arthritis.
Though a high sedimentation rate in a child also denotes an ongoing inflammation, it may indicate more serious issues including juvenile idiopathic arthritis, rheumatic fever, and bacterial and viral infections. Evaluation by a health care provider is essential to determine the underlying cause and appropriate management for the child's condition.
An ESR value of 70 mm/hour is generally considered high and signifies significant inflammation, which may be associated with various medical conditions including infection, autoimmune diseases, heart disease, and cancer. However, the interpretation of ESR results may vary depending on factors such as age, gender, and individual health status, so it's important to consult with a health care provider for proper evaluation and interpretation of test results.
The ESR is often used as a marker to identify active inflammation and disease activity in rheumatoid arthritis patients. As rheumatoid arthritis is a chronic inflammatory disorder that affects the joints, monitoring ESR allows health care providers to assess the present state of disease activity and change treatment strategies as needed to successfully manage symptoms and prevent joint damage.
A low ESR value may suggest that there is little or no inflammation in the body. However, a very low ESR may indicate a serious underlying condition, such as polycythemia, sickle cell anemia, a high white blood cell count, heart failure, or kidney or liver problems.
If your ESR value reaches 100 mm/hour, it indicates the presence of active infection or severe inflammatory diseases, including autoimmune diseases (su ch as rheumatoid arthritis) or systemic infections, which require immediate attention. As an ESR does not diagnose a specific disease, it’s crucial to undergo various assessments and diagnostic procedures that can help identify underlying causes, such as rh eumatoid arthritis, cancer, vascular diseases, and diseases affecting major organs such as heart, kidney, or liver.
The seriousness of an elevated ESR depends on the underlying condition responsible for the inflammation. Some conditions linked to a high ESR may be mild and easily treatable, while others may be more serious and require immediate medical attention. So, if you have a high ESR, consult a health care provider, as they can assess the underlying cause and tailor treatment accordingly.
Reducing high ESR is nothing but reducing inflammation in the body. Once the underlying cause for the inflammation is established, receiving necessary treatment through medicines will help reduce ESR. In addition to medical treatment, maintaining a healthy lifestyle also helps reduce inflammation. This involves eating a well-balanced diet that’s rich in anti-inflammatory foods including fruits, vegetables, whole grains, nuts, and omega-3 fatty acids. Regular exercise, managing stress through meditation, yoga, and getting enough sleep may also assist with reducing inflammation.
Firestein, Gary S., et al. Kelley's Textbook of Rheumatology, 9th Edition. Philadelphia, PA: Saunders.
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