MedlinePlus Medical Encyclopedia: ESR

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ESR

Contents of this page:
Alternative names Definition How the test is performed How to prepare for the test How the test will feel	Why the test is performed Normal Values What abnormal results mean What the risks are Special considerations

Alternative names

Erythrocyte sedimentation rate; Sed rate; Sedimentation rate

Definition Return to top

ESR (erythrocyte sedimentation rate) is a nonspecific screening test for various diseases. This 1-hour test measures the distance (in millimeters) that red blood cells settle in unclotted blood toward the bottom of a specially marked test tube.

How the test is performed Return to top

Blood is drawn from a vein, usually from the inside of the elbow or the back of the hand. The puncture site is cleaned with antiseptic, and a band or blood pressure cuff is placed around the upper arm to apply pressure and cause the veins below the band to fill with blood.

A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. During the procedure, the band is removed to restore circulation. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.

In infants or young children:
The area is cleaned with antiseptic and punctured with a sharp needle or a lancet. The blood may be collected in a pipette (small glass tube), on a slide, onto a test strip, or into a small container. A bandage may be applied to the puncture site if there is any continued bleeding.

How to prepare for the test Return to top

There are no food or fluid restrictions.

Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child's age, interests, previous experiences, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child's age:

Infant test or procedure preparation (birth to 1 year)
Toddler test or procedure preparation (1 to 3 years)
Preschooler test or procedure preparation (3 to 6 years)
Schoolage test or procedure preparation (6 to 12 years)
Adolescent test or procedure preparation (12 to 18 years)

How the test will feel Return to top

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 Return to top

The erythrocyte sedimentation rate (ESR) can be used to monitor inflammatory or malignant disease, rheumatic fever, and heart attack. Although it is a screening test (not considered diagnostic for any particular disorder), it is useful in detecting and monitoring tuberculosis, tissue necrosis (death), rheumatologic disorders, or an otherwise unsuspected disease in which symptoms are vague or physical findings are minimal.

Normal Values Return to top

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.
Neonatal to puberty: 3 to 13 mm/hr.

Note: mm/hr. = millimeters per hour.

What abnormal results mean Return to top

Elevated values occur with:

Kidney disease
Pregnancy
Rheumatic fever
Rheumatoid arthritis
Severe anemia
Syphilis
Systemic lupus erythematosus
Thyroid disease
Tuberculosis

Markedly elevated values occur with:

Giant cell arteritis
Multiple myeloma
Macroglobulinemia - primary
Hyperfibrinogenemia (elevated fibrinogen levels in the blood)
Necrotizing vasculitis
Polymyalgia rheumatica

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

Additional conditions that may affect test results:

Allergic vasculitis
Atrial myxoma, left
Atrial myxoma, right
Autoimmune hepatitis
Endometritis
Eosinophilic fasciitis
Erysipelas
Juvenile rheumatoid arthritis
Legionnaire's disease
Osteomyelitis
Pelvic inflammatory disease (PID)
Pericarditis, post-MI
Retroperitoneal fibrosis
Skin lesion of blastomycosis
Subacute thyroiditis
Systemic sclerosis (scleroderma)

What the risks are Return to top

Excessive bleeding
Fainting or feeling lightheaded
Hematoma (blood accumulating under the skin)
Infection (a slight risk any time the skin is broken)
Multiple punctures to locate veins

Special considerations Return to top

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.

Update Date: 8/4/2003

Updated by: Lisa Christopher, M.D., Division of Rheumatology, Johns Hopkins Hospital, Baltimore, MD. Review provided by VeriMed Healthcare Network.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.