Wisdom Wednesday: What does it mean if your ESR is high?

The ESR test measures the erythrocyte sedimentation rate, which is how quickly red blood cells settle at the bottom of a blood sample. Doctors cannot use the results of the test to diagnose specific disease because many different health conditions can cause the ESR to be high or low.

Doctors call the ESR test a nonspecific test, as it only confirms the presence or absence of inflammatory activity in the body. Doctors typically use other lab tests, clinical findings, and the person’s health history alongside ESR test results to make a diagnosis.

Inflammation usually occurs in the body as a result of underlying medical conditions, such as infection, cancer, or an autoimmune disease. Doctors also use the ESR to monitor conditions like RA, temporal arteritis, polymyalgia rheumatica and systemic vasculitis are responding to treatment.

A small amount of blood is drawn and transferred to a vertical test tube in which the red blood cells will slowly settle at the bottom. This will leave a clear, yellowish fluid at the top, the plasma. The result of the ESR test is the amount of plasma remaining at the top of the test tube after 1 hour.

Red blood cells settle at a faster rate in people with inflammatory conditions. Inflammation increases the number of proteins in the blood and causes red blood cells to clump together and settle more quickly.



Moderate elevation of the ESR may be the result of RA, anemia, thyroid disease, kidney disease, lymphoma, TB, a bone infection, heart infection or systemic infection.

Extremely elevated results (above 100 mm/hr) may indicate multiple myeloma, temporal arteritis, polymyalgia rheumatica or hypersensitity vasculitis.

My Take:
The normal range for ESR is 0-15 mm/hr in men and 0-20 mm/hr in women. In essence, the higher the test result, the more serious the condition. For example, a cold or flu might elevate the ESR to 22 while RA or some other autoimmune disease will test in the 40-50 range. In my clinical experience, all cases I have had with a ESR over 100 were caused by some form of cancer.

I was taught that this non-specific test doesn’t tell you what, when, how or why. It is a measure of quality. Like all other tests results, it must be correlated with history and clinical findings.

Bottom Line:
I run the ESR as an integral part of my routine lab work. It is an inexpensive test that helps me rate the level of inflammation. The test is largely ignored today in favor of more specific inflammatory markers, like the hs-CPR. But I like to compare the specific and non-specific markers of inflammation.

Source: September 13, 2018 NIH