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ESR

Inflammation Biomarker

Sample Needed

Collection Type: Blood

Body System

Related System: Inflammation

Overview

The erythrocyte sedimentation rate (ESR) measures how quickly red blood cells settle in a vertical tube over one hour. It is a nonspecific marker of inflammation: elevated acute‑phase proteins (fibrinogen, immunoglobulins) promote red cell stacking (rouleaux) and faster settling. ESR is used to detect or monitor inflammatory, infectious, autoimmune, and some malignant conditions (for example temporal arteritis, rheumatoid arthritis, systemic infections, and some cancers). Symptoms that commonly prompt testing include unexplained fever, weight loss, persistent fatigue, new localized pain or stiffness, and signs of systemic inflammation. ESR tends to be higher in older adults and in women, and it is increased by anemia, pregnancy and certain chronic diseases.

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Test Preparation

Overnight fasting is preferred but not mandatory

Why Do I Need This Test

Profile: Inflammation - Symptoms: persistent fever, unexplained malaise, new-onset joint pain/stiffness, suspected systemic inflammation - Used to help diagnose/monitor: autoimmune diseases (e.g., rheumatoid arthritis, temporal arteritis, polymyalgia rheumatica), infections, some malignancies, and to follow response to therapy - Reasons for abnormal levels: acute or chronic inflammation, infection, anemia, pregnancy, malignancy, chronic kidney disease - Biological meaning: elevated ESR reflects increased acute‑phase proteins and systemic inflammation; low ESR may reflect polycythemia or low fibrinogen - Lifestyle/family: smoking, obesity may influence inflammation; family history of autoimmune disease may prompt earlier testing

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Understanding Test Results

Values above the age/sex‑specific ranges indicate inflammation but are nonspecific.
Mild elevations (up to about 2× the upper limit, e.g., 20–60 mm/hr depending on baseline) may reflect chronic inflammatory conditions, mild infection, or anemia.
Moderate elevations (roughly 60–100 mm/hr) suggest more active inflammation, significant infection, or autoimmune flares.
Very high ESR (>100 mm/hr) raises concern for severe bacterial infection, systemic vasculitis (eg, temporal arteritis), occult malignancy, or severe connective tissue disease and usually prompts urgent evaluation.
Low ESR (below the lower limit) is uncommon and may result from polycythemia, sickle cell disease, hypofibrinogenemia, or marked leukocytosis; it does not often indicate a problem by itself.
ESR should be interpreted alongside clinical findings and other tests (e.g., CRP) because it is an indirect and relatively slow marker of inflammation.

Normal Range

Men <50 years: 0–15 mm/hr; Men ≥50 years: 0–20 mm/hr; Women <50 years: 0–20 mm/hr; Women ≥50 years: 0–30 mm/hr; Children: 0–10 mm/hr

FAQs

Q: What does a high ESR mean?

A: A high ESR (erythrocyte sedimentation rate) indicates increased inflammation or tissue damage. It’s a non‑specific marker that can rise with infections, autoimmune diseases (e.g., rheumatoid arthritis, temporal arteritis), some cancers, pregnancy, anemia, or aging. Elevated ESR suggests further evaluation—clinical correlation and additional tests (CRP, CBC, imaging, specific serologies) are needed to determine the underlying cause and guide treatment.

Q: What to do if ESR is high?

A: If your ESR is high, don't panic. Discuss results with your healthcare provider so they can correlate symptoms and order further tests (CBC, CRP, infection screens, autoimmune markers, imaging). Management targets the underlying cause—antibiotics for infections, anti‑inflammatory or immunosuppressive treatments for autoimmune conditions—and monitoring ESR over time. Follow medical advice and report new or worsening symptoms promptly.

Q: Is ESR high risk?

A: A high ESR (erythrocyte sedimentation rate) is a nonspecific marker of inflammation, not a disease itself. It can indicate infection, autoimmune conditions, chronic inflammatory disorders, or some cancers. The level alone doesn't determine risk; clinical context, symptoms, age, and other tests (like CRP and imaging) guide risk assessment and management. Very high or rapidly rising ESRs are more concerning and need urgent review.

Q: Is an ESR of 40 high?

A: An ESR of 40 mm/hr is generally considered elevated for most adults. Normal ESR is roughly up to 15 mm/hr in men and 20 mm/hr in women (values rise with age). A result of 40 suggests inflammation, infection, autoimmune disease, or other causes but is non‑specific. Clinical context, repeat testing and additional tests (e.g., CRP, imaging) are needed—discuss with your doctor.

Q: Does high ESR mean heart problems?

A: High ESR is a non-specific marker of inflammation and does not by itself mean you have heart problems. It can be raised in infections, autoimmune diseases, cancers and sometimes in heart conditions such as endocarditis, pericarditis or after myocardial infarction. Further tests (CRP, ECG, cardiac enzymes, imaging) and clinical assessment are needed to determine cardiac involvement; see your doctor.

Q: What cancers cause high ESR?

A: An elevated ESR is nonspecific but can occur with cancers—particularly hematologic malignancies like multiple myeloma, lymphomas (Hodgkin and non‑Hodgkin) and leukemias—and with many metastatic solid tumors (commonly breast, lung, gastrointestinal and prostate). Advanced, widespread or inflammatory tumors (including renal cell and ovarian cancer) more often produce a high ESR; clinical correlation and further testing are required.