What is a normal ESR?
10 or less for men and 12 or less for women aged 17 to 50. That’s at one NHS lab, and the limit rises with age. But another result can explain a high one.
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What is a normal ESR?
For adults aged 17 to 50, one NHS lab counts 10 mm/hr or less as normal for men. For women it’s 12 or less.
The limit goes up with age. In healthy people, ESR is higher in women than in men, and it rises with age in both.
| Age | Men | Women |
|---|---|---|
| 17 to 50 | 10 or less | 12 or less |
| 51 to 60 | 12 or less | 19 or less |
| 61 to 70 | 14 or less | 20 or less |
| Over 70 | 30 or less | 35 or less |
Source: York and Scarborough NHS
Labs differ. Another NHS lab uses 2 to 10 for men and 2 to 16 for women aged 16 to 60.
So a woman of 45 with an ESR of 14 is above one lab’s limit and inside the other’s. Check your number against the range printed next to it on your report.
What does an ESR blood test show?
ESR stands for erythrocyte sedimentation rate. Erythrocytes are red blood cells. The test shows how fast your red cells sink in a tall, thin tube.
How the ESR test works
- 1
A blood sample
Taken from a vein in your arm. No fasting needed.
- 2
A tall, thin tube
The lab stands your blood upright.
- 3
Cells sink
Inflammation makes red cells clump. Clumps are heavier, so they sink faster.
- 4
Your result
Given in mm/hr: how many millimetres the cells sink in an hour. A faster sink means a higher number.
Sources: MedlinePlus; Lab Tests Online UK
Think of ESR as a smoke alarm. It can tell you there’s smoke, but not which room it’s in or what’s burning.
An ESR test alone can’t say which condition is causing inflammation. Doctors use it with other tests to look for infections, cancers and autoimmune diseases, where the immune system attacks your own body.
So a high ESR is a sign for your doctor to look further.
For rheumatoid arthritis, ESR can help show how much inflammation there is, but no blood test can prove or rule it out. See autoimmune blood tests.
What can raise ESR besides inflammation?
Like an alarm set off by toast, ESR can go up without inflammation. The most useful result to check is on the same form.
That other result is your haemoglobin, the protein in red blood cells that carries oxygen. Low haemoglobin means anaemia, and anaemia is a common cause of high ESR. You’ll find it on your full blood count.
| What | Effect on ESR |
|---|---|
| Anaemia | Often raises it. A common cause of a high ESR. |
| Periods and pregnancy | Can raise it for a while. |
| Older age | A moderate rise. |
| Kidney failure | Raises it. |
| Myeloma, a tumour that makes large amounts of antibodies | Usually very high, even without inflammation. |
| The pill, vitamin A and some other medicines | Can raise it. |
| Aspirin, steroids and quinine (a malaria medicine) | May lower it. |
Source: Lab Tests Online UK
Take any of these medicines? Tell whoever reads your result. Never stop or change a prescribed medicine without your prescriber.
A low ESR is not usually important. But a normal one doesn’t rule a problem out, so if you still feel unwell, say so.
More on low haemoglobin: anaemia blood tests.
ESR vs CRP: what’s the difference?
Both are signs of inflammation. Your doctor may ask for CRP and a full blood count at the same time as ESR.
| ESR | CRP | |
|---|---|---|
| What it is | How fast red cells sink | C-reactive protein, measured in your blood |
| How fast it changes | Slower to rise and to fall | Faster, at the start and as it settles |
| What else moves it | Many things, such as anaemia, age and pregnancy | Fewer things |
Source: Lab Tests Online UK
So why test both? Take polymyalgia rheumatica (PMR), which causes pain and stiffness in the muscles around your shoulders, neck and hips.
In PMR, ESR may be normal while CRP is raised. That’s why the NHS says both are usually done together. If both are normal, PMR is unlikely.
Got a CRP result too? See CRP blood test results and inflammation blood tests.
What happens after a high ESR?
It depends on how you feel. One high ESR with no symptoms usually isn’t enough for a doctor to make a decision. They may repeat it after several weeks or months.
A very high ESR usually has an obvious cause, such as an infection. Your doctor may then do other tests, based on your symptoms.
Already have a long-term inflammatory condition? ESR can help track it.
A falling ESR can mean treatment is working. A rising one can mean more inflammation or a poor response.
Before you talk to your GP about a high ESR
- Find the range printed next to your ESR and write it down.
- Check your haemoglobin on the same full blood count.
- Ask whether CRP was tested too, and what it showed.
- List your medicines, including the pill, vitamin A, aspirin and steroids.
- Note any headaches, jaw pain, sight changes or morning stiffness lasting longer than 45 minutes.
- Ask whether a repeat test after several weeks or months makes sense.
Sources: Lab Tests Online UK; NHS: PMR; NHS: temporal arteritis
Aching joints as well? See blood tests for joint pain.
When to speak to a GP
One NHS lab says ESR is most useful in an urgent check for temporal arteritis. That’s where the arteries at the side of your head become inflamed. Act quickly if:
- You think you might have temporal arteritis: frequent, severe headaches, pain or tenderness at your temples or scalp, jaw pain while eating or talking, or vision problems such as double vision or loss of vision in 1 or both eyes. Ask for an urgent GP appointment or get help from NHS 111. It can lead to stroke and blindness if not treated quickly.
- You have problems with your vision. The NHS says you should have a same-day appointment with an eye specialist at a hospital eye department.
- You have pain and stiffness for more than a week. The NHS says to see a GP.
- You’re 60 or over with lasting bone pain, particularly back pain, or a broken bone with no clear cause. NICE says to offer blood tests for myeloma, which can include ESR.
- You had one high ESR with no clear cause. Ask whether to repeat it after several weeks or months.
See also blood test reference ranges.