What Does an Elevated Erythrocyte Sedimentation Rate (ESR) Indicate?

There are numerous causes of an elevated erythrocyte sedimentation rate (ESR): various inflammatory diseases—such as rheumatic fever and tuberculosis—can accelerate the ESR, as can chronic glomerulonephritis and liver cirrhosis. Mild ESR elevation may also occur in certain anemic patients. In addition, conditions such as atherosclerosis, diabetes mellitus, nephrotic syndrome, and myxedema—characterized by elevated serum cholesterol levels—may also result in increased ESR.

What Does an Elevated ESR Mean?

The normal ESR range for adult males is 0–15 mm/h, and for adult females, it is 0–20 mm/h. During routine physical examinations, physicians may order an ESR test for certain individuals; some patients may be found to have abnormally elevated ESR values. Also known as the erythrocyte sedimentation rate, ESR reflects the rate at which red blood cells settle in a vertical tube over one hour. This rate depends primarily on plasma viscosity and, more specifically, on the degree of red blood cell aggregation. Greater red blood cell aggregation leads to a faster ESR; conversely, reduced aggregation slows the ESR. Thus, clinically, ESR is commonly used as an indicator of red blood cell aggregability.

Pathologically accelerated ESR is most commonly associated with acute or chronic infections, malignant tumors, and disorders involving tissue degeneration or necrosis (e.g., myocardial infarction, collagen vascular diseases). These conditions often involve alterations in plasma globulin and fibrinogen levels—or the presence of abnormal proteins in circulation—leading to accelerated ESR. Moreover, ESR may also increase in cases of anemia, during menstruation, and after the third month of pregnancy. Therefore, ESR is a nonspecific test and cannot be used alone to diagnose any specific disease.

Causes of elevated ESR are diverse and include various inflammatory diseases—for example, rheumatic fever and tuberculosis—as well as chronic glomerulonephritis, liver cirrhosis, multiple myeloma, lymphoma, and systemic lupus erythematosus. Mild ESR elevation may also occur in certain anemic patients. Additionally, patients with atherosclerosis, diabetes mellitus, nephrotic syndrome, or myxedema—conditions associated with hypercholesterolemia—may exhibit increased ESR.

The above information outlines what an elevated ESR signifies; we hope it proves helpful.