ESR: An Affordable and Reliable Test for Inflammation

The Biomarker Handbook is a curated series that seeks to provide readers with insights on each biomarker we cover in our blood test packages and its relation to our body.

Inflammation is the body’s immune response to injury– it plays a vital role in wound healing and immune system boosting. There is a biomarker known as ESR which tracks the level of inflammation in our body. You and your doctor will be able to manage the disease before complications arise.

What is ESR?

Erythrocyte sedimentation rate (ESR) is a common test that measures the level of inflammation present in the body. The test works by measuring how quickly red blood cells settle at the bottom of a test tube containing the blood sample, also known as the sedimentation of red cells. Generally, these blood cells fall slowly but the presence of inflammation activates a clotting protein called fibrinogen, among other acute phase reactants. As a result, red cells stick together, become heavier, and fall down more quickly.

Although ESR test is not used to diagnose a specific condition, it tells the doctor if there is a presence of inflammation in your body. While there are better options for this purpose, many doctors recommend ESR for general screening, because it is faster and more affordable.

Importance of Tracking ESR

In detecting the level of inflammation in our body, ESR is very useful in certain clinical situations. While ESR itself does not diagnose any specific disease or ailment, it helps doctors rule certain medical diseases, including systemic vasculitis, temporal arteritis, infections, cancers, and autoimmune diseases. It is also used for monitoring lupus, rheumatoid arthritis, and polymyalgia rheumatica.

When your doctor orders ESR, make sure you inform him/her about medications you’re taking. You may be required to temporarily discontinue the use of certain medications prior to the test, as they can alter ESR results and make test result less reliable.

The results of the ESR test are given in millimeters per hour (mm/hr). Normal ESR ranges are displayed in the table below.

Age ESR range
Women under 50 Under 20 mm/hr
Men under 50 Under 15 mm/hr
Women over 50 Under 30 mm/hr
Men over 50 Under 20 mm/hr
Newborns Under 2 mm/hr
Children pre-puberty 3-13 mm/hr


Signs and Symptoms to Watch Out For

Signs and symptoms of abnormal ESR levels depend on the underlying condition causing the inflammation, but in most cases patients experience:

  • Fever
  • A headache
  • Weight loss
  • Anemia
  • Loss of appetite
  • Joint stiffness
  • Neck or shoulder pain
  • Redness
  • Fatigue
  • Muscle stiffness

Consequences of Abnormal ESR Levels

It is important to mention that abnormal ESR results do not pinpoint where the inflammation is. However, coupled with the medical history and physical examination findings, further investigation will help identify the underlying problem.

Low levels could be a result of:

  • Sickle cell anaemia – an inherited disorder where an insufficient level of healthy red cells are present Red cells are rigid, sticky, and shaped like crescent moons or sickles
  • Polycythaemia – a blood cancer characterised by excessive production of red blood cells by the bone marrow
  • Low plasma protein – abnormally low levels of protein in the blood (caused by liver or kidney disease)
  • Leukocytosis – an increase in the total number of white blood cells due to any cause
  • Congestive heart failure – a chronic progressive condition that affects the pumping power of heart muscles

Some conditions associated with high levels are:

  • Infections– either bacterial, viral, or fungal. These can be located in any part of the body, localised to one system (skin, heart, joint) or general (systemic)
  • Autoimmune diseases– immune system attacks its own cells such as blood vessels (arteritis), joints (arthritis), etc.
  • Inflammatory bowel disease – a term that refers to a chronic inflammation of the digestive tract
  • Tumours

Ways to Balance ESR Levels

Balancing ESR levels requires timely and adequate management of the underlying condition that leads to inflammation. One can fight inflammation with healthy lifestyle measures. These include a well-balanced diet and intake of anti-inflammatory foods, weight management, regular physical activity, getting enough sleep, as well as yoga and meditation. Doctor-recommended treatments revolve around addressing the underlying condition via medications such as NSAIDs, corticosteroids, or other drugs depending on the cause of the problem.

When to See the Doctor

You should see the doctor if you experience symptoms associated with the inflammation as mentioned above. In addition, you need to see your doctor regularly if you already have a condition that causes inflammation.

Further Testing to Check Ailments Linked to Abnormal ESR Levels

ESR is often used as part of a complete metabolic screening panel. If abnormal, your doctor may continue with further investigations according to the medical consult and physical examination findings: urine culture, ANF test, rheumatoid factor, CBC, among others.


The ESR test helps doctors detect the presence of inflammation in the body. The test is not performed to diagnose a specific disease. Rather, it serves as an additional tool in the process of diagnosis and helps doctors monitor your health problem.

If you want to find out more about inflammation and how it can be treated, take a look at our lifestyle article here!

Interested in other biomarkers? Check out the rest of The Biomarker Handbook.

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