Inflammation and immunity
Bezinkingssnelheid
How fast red blood cells sink in a tube; an old, slow measure of inflammation, mainly useful in rheumatic diseases.
Everything about this testWhat it measures
The erythrocyte sedimentation rate (ESR, the settling of red blood cells) measures how many millimeters the red blood cells sink in one hour in an upright tube. With inflammation, the body makes more proteins such as fibrinogen and antibodies; these make the red blood cells clump together, so they sink faster. The ESR rises more slowly than CRP, usually only after one to two days, and stays raised for weeks after recovery. The normal value rises with age and is higher in women than in men.
- Inflammatory diseases such as rheumatoid arthritis, polymyalgia rheumatica (muscle rheumatism) and giant cell arteritis (inflammation of arteries)
- Long-lasting infections and inflammations
- Rarely: a condition with many abnormal antibodies in the blood, such as Kahler's disease (multiple myeloma)
High
A raised sedimentation rate points to inflammation, infection or a condition with a lot of protein in the blood, but does not say where it is or what the cause is. A strongly raised value fits inflammatory diseases such as polymyalgia rheumatica or giant cell arteritis and serious infections. Rarely: a blood disease such as Kahler's disease. A slightly raised value is common without disease: in older people, during pregnancy and menstruation, with anemia, overweight and kidney diseases. Symptoms that go with an inflammatory disease are stiffness and pain in the shoulders or hips, new headache with pain when chewing, fever, night sweats or weight loss.
Low
A low sedimentation rate is normal and has no meaning. In some conditions the value is extra low, for example with too many red blood cells (polycythemia), with abnormally shaped red blood cells as in sickle cell disease, and with severe heart failure. These causes are found with other tests, not with the ESR itself.
If your result is abnormal
The GP assesses the ESR together with CRP, the blood count and the symptoms. A slightly raised value without explanation is usually repeated after a few weeks; with a strongly raised value, targeted tests follow, such as protein tests in the blood, or, if giant cell arteritis is suspected, a prompt referral to the hospital.
Reliability
The ESR is a not very specific inflammation marker: an abnormal value says something is going on, but not what. According to the Dutch Society for Clinical Chemistry (NVKC), CRP is the better test for most inflammations, because CRP responds faster and is less affected by age, sex, pregnancy and anemia. The ESR remains of value in rheumatic diseases such as polymyalgia rheumatica and giant cell arteritis and in conditions with many abnormal antibodies, and is always assessed together with symptoms and other blood results.
Limitations
- Age, female sex, pregnancy, menstruation, overweight and anemia raise the value without disease; laboratories therefore use age- and sex-specific limits.
- The ESR only rises after one to two days and stays raised for weeks after recovery; the value lags behind the actual course.
- An abnormal number or shape of red blood cells (polycythemia, sickle cell disease) lowers the value and can mask inflammation.
- The result depends on the measurement method; laboratories use different methods and reference values.
How common is this
Polymyalgia rheumatica and giant cell arteritis, the inflammatory diseases for which the ESR is used most, occur almost only in people over 50 and about twice as often in women as in men. A slightly raised sedimentation rate without disease, on the other hand, is very common, especially in older people and women.
Who is this useful for
Useful when a rheumatic inflammatory disease is suspected, for example with stiffness and pain in the shoulders and hips at an older age or with new headache and pain when chewing over the age of 50, and to follow the course of such a disease. When an acute infection is suspected, CRP is more suitable. In adults without symptoms, routine measurement is not useful: a slightly raised value is then usually harmless and a normal value rules out little.
Downsides and risks
- A slightly raised ESR without symptoms is usually harmless, but often leads to follow-up tests that find nothing.
- In older people and women the normal value is higher; using the general limit wrongly shows an abnormality.
Sources
Always discuss an abnormal result with your GP. If a result is strongly abnormal, we try to reach you as soon as possible. Read your result yourself as well and contact your GP if in doubt. A test does not make a diagnosis. Read more about risks and results