ESR Blood Test: Normal Range And Possible Reasons For High ESR Levels

Erythrocyte Sedimentation Rate (ESR) tests are frequently carried out as part of routine blood panels. An ESR test is a type of test that measures how fast the red blood cells (RBCs) in your blood settle down inside a test tube. RBCs typically have a slow settling rate. However, if your tests show a high settling rate, i.e., high ESR levels, they may indicate a diseased state in your body, which appears as high ESR symptoms. 

Before we understand what causes high ESR levels, let’s know what an ESR test is and how it is useful.

What is an ESR Test?

ESR is an abbreviation for “Erythrocyte Sedimentation Rate.” ESR blood test is also commonly called a “Sed rate test.” ESR tests calculate how fast the erythrocytes, or red blood cells, in your blood settle down in a test tube. It indirectly measures the level of specific proteins that facilitate the settling down of blood cells. These protein levels provide information about the state of inflammation in your body.

What Do High ESR Levels Mean?

When the body is diseased or infected, the immune system triggers a response to fight the infection, and in doing so, the level of these proteins increases in the body. As these proteins increase, they cause clumping of the RBCs together, which increases their settling rates. (Tishkowski, K. et al., 2022) Therefore, high levels of ESR usually mean that the body is currently fighting a disease or infection.

For certain chronic disorders, like 

• Inflammatory diseases
• Autoimmune diseases
• Chronic kidney diseases
• Arthrits, 

ESR tests are used to monitor the stages of disease and development.

However, the Erythrocyte Sedimentation Rate/ESR test is not diagnostic for any specific disease. It is combined with other tests and symptoms to determine whether there is increased inflammation in the body and, consequently, disease.

When Does The Doctor Recommend an ESR Test?

If your doctor suspects you have an infection, they may recommend the ESR test. However, ESR tests are typically part of routine blood panel screenings, so they do not need to be ordered separately.

What are The Symptoms of High ESR Levels?

Since ESR levels are determinants of disease and infection, high ESR symptoms typically show up in following as symptoms associated with symptoms & illnesses such as:

• Headache
• Fever
• Joint/muscle pain or stiffness
• Loss of appetite
• Abnormal weight loss/weight gain
• Anaemia 

This list of symptoms is not exhaustive. High ESR symptoms can appear different and are best evaluated by a physician. 

What is The Normal Range for ESR Levels?

High ESR levels correspond to high protein levels in the blood that cause faster clumping of RBCs. 

The ESR test measures in millimetres (mm) the distance between the clear liquid (plasma) at the top of the tube and your red blood cells after an hour. The normal range is:

• 0 to 15 mm/hour in men whose age is <50 years
• 0 to 20 mm/hour in men >50 years of age
• 0 to 20 mm/hour in women <50 years of age
• 0 to 30 mm/hour for women above 50 years of age

What Can Cause High ESR Levels?

High ESR levels can be due to several conditions. Most of them are inflammatory diseases, which heighten the immune system’s response and cause high ESR symptoms. Some of them include:

• Inflammatory infections that have invaded the blood, i.e., systemic inflammatory infections. These include infections affecting the bone, heart, skin, lungs, etc. 
• Tissue injury or ischemia (tissues suffering from lack of blood supply)
• Traumatic events or accidents
• Certain types of cancer like leukaemia, myeloma, lymphoma, etc.
• Diabetes
• Heart disease 
• Kidney disease
• Vascular diseases like atherosclerosis, high blood pressure, etc.
• Obesity
• Thyroid disease
• Rheumatic fever
• Autoimmune disorders like lupus, arthritis, etc.

This list of conditions is not exhaustive. High ESR symptoms can also be caused by other conditions depending on gender, medical history, and overall health. 

Medicines like birth control pills, vitamin A supplements, cortisone, methyldopa, quinine, and theophylline may also affect your ESR test results. 

Some conditions, like pregnancy, advanced age, and even anaemia, can result in high ESR levels. Therefore, it is not always necessary that high ESR symptoms are due to any disease or infection. 

What Do I Do if I Have High ESR Levels?

The best thing to do after receiving a report showing high ESR levels is to wait for your physician to make an accurate diagnosis based on your other tests, gender, age, and overall health. Just because you have high ESR levels is not an accurate assessment of an underlying disease or condition in your body. 

For the doctor to make an accurate assessment, it is imperative to provide correct information about your medical history and any medicines you are on - as certain supplements can affect your ESR levels. The normal range of ESR levels is subject to change based on the labs, the tested person, and gender. 

Not just that, a moderate ESR level may be an indicator of pregnancy or menstruation rather than an inflammatory disease, making it necessary for the physician’s diagnosis rather than just the ESR levels. Your physician may also consider ordering more tests to make an accurate diagnosis.