Erythrocyte Sedimentation Rate (ESR)
Significance, Normal Values and Westergren Method
Submitted to: Mam Shaiza Tamour
Department: Pharmacy
Subject: Physiology
Submitted by: Hoorain Aqdas
Date: 14 March 2026
Introduction
Erythrocyte Sedimentation Rate (ESR) is a commonly used laboratory test that helps
detect the presence of inflammation in the body. It measures the rate at which red
blood cells settle at the bottom of a vertical tube containing anticoagulated blood
within one hour. When inflammation occurs, certain proteins increase in the plasma
which cause red blood cells to stick together and settle more quickly.
ESR is considered a non-specific test because it does not diagnose a particular
disease. However, it is very helpful for doctors to detect inflammation, monitor
disease progression and evaluate the effectiveness of treatment. Due to its simplicity
and low cost, ESR is widely used in medical laboratories around the world.
Significance of ESR
The ESR test plays an important role in clinical diagnosis because it provides
information about inflammatory processes in the body.
1. Detection of inflammation: Many inflammatory conditions such as rheumatoid
arthritis and infections cause increased ESR levels.
2. Monitoring chronic diseases: ESR is useful in monitoring diseases such as
autoimmune disorders and chronic infections.
3. Detection of infections: Bacterial infections often lead to an increased ESR value.
4. Monitoring treatment: Doctors use ESR levels to determine whether treatment is
effective.
5. Supporting diagnosis: ESR is often used with other laboratory tests to support
clinical diagnosis.
Although ESR cannot identify a specific disease, it helps doctors understand
whether an inflammatory condition may be present in the body.
Normal Values of ESR
Normal ESR values vary according to age and sex and are measured in millimeters
per hour (mm/hr).
Adult men: 0–15 mm/hr
Adult women: 0–20 mm/hr
Children: 0–10 mm/hr
Elderly individuals: slightly higher values may occur.
Several factors can influence ESR values such as pregnancy, anemia, age and certain
medications. ESR values may increase during pregnancy or in conditions where
plasma proteins are elevated. Very low ESR values may be seen in conditions such
as polycythemia or sickle cell anemia.
Westergren Method
The Westergren method is the most widely accepted and standardized method used
for measuring ESR. It is recommended internationally because of its accuracy and
reliability.
Principle:
The test is based on the principle that red blood cells settle in anticoagulated blood
under the influence of gravity. The distance the cells fall in one hour represents the
ESR value.
Apparatus required:
Westergren tube, Westergren stand, sodium citrate anticoagulant, syringe or
pipette, and blood sample.
Procedure:
1. Collect venous blood from the patient.
2. Mix the blood with sodium citrate anticoagulant in a ratio of 4:1.
3. Fill the Westergren tube up to the marked level.
4. Place the tube vertically in the Westergren stand.
5. Leave the tube undisturbed for one hour.
6. After one hour, measure the distance between the plasma level and the red blood
cell column.
7. Record the result in millimeters per hour.
Precautions:
The tube must remain vertical, the blood sample should be fresh, and the
anticoagulant ratio must be correct to obtain accurate results.
Factors Affecting ESR
Several physiological and pathological factors influence ESR results. Age, gender and
pregnancy are physiological factors that may increase ESR values. Pathological
factors include infections, inflammatory diseases, autoimmune disorders, cancers
and anemia.
Technical errors can also affect ESR results. Improper tube placement, vibrations,
incorrect blood-anticoagulant ratio and delayed testing may produce inaccurate
results. Therefore, careful handling and proper laboratory technique are necessary
for reliable measurements.
Conclusion
Erythrocyte Sedimentation Rate is an important laboratory test used to detect
inflammation and monitor various diseases. Although it is not specific for a single
disease, it provides useful information when combined with other diagnostic tests.
The Westergren method is considered the standard method for ESR determination
due to its reliability and accuracy. Understanding ESR significance, normal values
and the correct laboratory procedure is essential for students and healthcare
professionals working in medical laboratories.
References
1. Bishop, M. L., Fody, E. P., & Schoeff, L. E. Clinical Chemistry: Principles, Techniques
and Correlations.
2. Henry, J. B. Clinical Diagnosis and Management by Laboratory Methods.
3. World Health Organization Laboratory Guidelines.
4. Medical Laboratory Technology textbooks and standard biochemistry manuals.