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    Erythrocyte sedimentation rate; Sed rate; Sedimentation rate

    ESR stands for erythrocyte sedimentation rate. It is commonly called a "sed rate."

    It is a test that indirectly measures how much inflammation is in the body.

    How the Test is Performed

    A blood sample is needed. For information on how this is done, see: Venipuncture

    The blood sample is sent to a lab. The test measures how fast red blood cells called erythrocytes fall to the bottom of a tall, thin tube.

    How to Prepare for the Test

    There are no special preparations needed.

    How the Test Will Feel

    When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

    Why the Test is Performed

    A "sed rate" is often ordered for someone who is having unexplained fevers, certain types of arthritis, muscle symptoms, or other vague symptoms that cannot be explained.

    Once a diagnosis has been made, this test may be used to monitor whether the illness is becoming more active or flaring up.

    This test can be used to monitor inflammatory diseases or cancer. It is a screening test, which means it cannot be used to diagnose a specific disorder.

    However, it is useful for detecting and monitoring:

    • Autoimmune disorders
    • Certain forms of arthritis
    • Inflammatory diseases that cause vague symptoms
    • Tissue death
    • Tuberculosis

    Normal Results

    Adults (Westergren method):

    • Men under 50 years old: less than 15 mm/hr
    • Men over 50 years old: less than 20 mm/hr
    • Women under 50 years old: less than 20 mm/hr
    • Women over 50 years old: less than 30 mm/hr

    Children (Westergren method):

    • Newborn: 0 to 2 mm/hr
    • Newborn to puberty: 3 to 13 mm/hr

    Note: mm/hr. = millimeters per hour

    Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

    What Abnormal Results Mean

    Although it can help diagnose some illnesses, an abnormal ESR does not prove that you have a certain condition. Other tests are almost always needed.

    An increased ESR rate may be due to:

    • Anemia
    • Cancers such as lymphoma or multiple myeloma
    • Kidney disease
    • Pregnancy
    • Thyroid disease

    The immune system helps protect the body against harmful substances. In autoimmune disorder is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue. ESR is often higher than normal in people with an autoimmune disorder.

    Common autoimmune disorders include:

    • Lupus
    • Rheumatoid arthritis in adults or children

    Very high ESR levels occur with less common autoimmune disorders, including:

    • Allergic vasculitis
    • Giant cell arteritis
    • Hyperfibrinogenemia (increased fibrinogen levels in the blood)
    • Macroglobulinemia - primary
    • Necrotizing vasculitis
    • Polymyalgia rheumatica

    An increased ESR rate may be due to some infections, including:

    • Body-wide (systemic) infection
    • Bone infections
    • Infection of the heart or heart valves
    • Rheumatic fever
    • Severe skin infections, such as erysipelas
    • Tuberculosis

    Lower-than-normal levels occur with:

    • Congestive heart failure
    • Hyperviscosity
    • Hypofibrinogenemia (decreased fibrinogen levels)
    • Low plasma protein (due to liver or kidney disease)
    • Polycythemia
    • Sickle cell anemia


    Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

    Other risks associated with having blood drawn are slight but may include:

    • Excessive bleeding
    • Fainting or feeling light-headed
    • Hematoma (blood accumulating under the skin)
    • Infection (a slight risk any time the skin is broken)


    Kushner I, Ballou SP. Acute-phase reactants and the concept of inflammation. In: Firestein GS, Budd RC, Harris ED, et al, eds. Kelley's Textbook of Rheumatology. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 52.

    Pisetsky DS. Laboratory testing in the rheumatic diseases. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 278.


          A Closer Look

            Tests for ESR

            Review Date: 6/1/2011

            Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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