erythrocyte sedimentation rate (ESR)

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Reference interval

  • male: 0-15 mm/hr, age < 50 years
  • female: 0-20 mm/hr, age < 50 years
  • male: 0-20 mm/hr, age > 50 years
  • female: 0-30 mm/hr, age > 50 years

Men: < age/2, women: < (age + 10)/2

Corrected ESR for anemia: ESR - [A - Hct] x 1.75

A is 45 for males, 42 for females

Clinical significance

The ESR correlates with the fibrinogen plus immunoglobulin level & depends upon rouleaux formation of erythrocytes. Poikilocytosis tends to inhibit sedimentation; obstructive liver disease which tends to flatten erythrocytes enhances sedimentation.

The ESR should not be used to screen asymptomatic patients for disease. The ESR is often normal in patients with neoplasms, infection, & connective tissue disease.

ESR is useful & is indicated for the diagnosis & monitoring of temporal arteritis & polymyalgia rheumatica. Values in excess of90 mm/hr are observed with these disorders. The ESR is of little diagnostic value in rheumatoid arthritis, but may be useful in monitoring disease activity when the clinical findings are equivocal.

The zeta sedimentation ratio (ZSR) is not affected by anemia, whereas the Westergren method is affected.

Do NOT use Wintrope sedimentation rate. Plateau effect at a value of about 55.

Also see C-reactive protein in serum/plasma


* upper limit of reference interval[2] = (age + 10)/2




ESR generally normal with:

More general terms

Additional terms

Component of


  1. Clinical Guide to Laboratory Tests, 3rd edition, NW Tietz ed, WB Saunders, Philadelphia, 1995
  2. 2.0 2.1 2.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 17, American College of Physicians, Philadelphia 1998, 2015
  3. Brahn E, Scoville CD Biochemical markers of disease activity. Baillieres Clin Rheumatol 1988 2:153 PMID:
  4. Sedimentation Rate, Westergren Laboratory Test Directory ARUP:
  5. Hale AJ, Ricotta DN, Freed JA Evaluating the Erythrocyte Sedimentation Rate. JAMA. Published online March 19, 2019 PMID:

Patient information

erythrocyte sedimentation rate (ESR) patient information