Reviewed on : 9 Jan 2020

Reviewed by : Gateway Editor on behalf of Beth Harrison

Expires : 9 Jan 2022

The ESR (Erythrocyte sedimentation rate) is an old fashioned test and non-specific marker of inflammation.

It is a measure (in mm/hr) of the rate at which red blood cells in a sample of anticoagulated blood (in EDTA) fall when blood is placed in an upright capillary tube.

Slightly higher in women than men and rises by 5-10mm/hr throughout life – ie the formulae using age/2 for men or (age+10)/2 for women to estimate acceptable ESRs over estimate the rise with age.

Affected by anything that increases plasma proteins – fibrinogen (cancer, inflammation), immunoglobulins (myeloma, inflammatory conditions, chronic infections, HIV), coagulation factors (pregnancy) or alters red cell count – polycythaemia or anaemia.

Uses of ESR :

• As a screening test for Temporal Arteritis or Polymyalgia Rheumatica in the context of a suggestive history.

ESR is not useful in:

• General screening for infection.
• Screening for Myeloma – ESR can be normal in 25% of myeloma.
• General screening of the unwell – it does not distinguish between cancer versus infection versus inflammation.
• General workup of a patient with a suspected rheumatological condition – consider specific tests.
• Investigating patients with anaemia, when the anaemia itself will lead to a rise in the ESR