ESR test: normal ranges and what the result means (ENG)
Also known as: ESR
- Updated
- 2026-09-30
- Every number with its source
What ESR is
The erythrocyte sedimentation rate measures how quickly red blood cells settle in a vertical tube over one hour. When inflammation proteins — fibrinogen and immunoglobulins — increase in the blood, red cells clump together and settle faster, so the ESR rises. It is one of the oldest inflammation tests; it is non-specific (it does not show the cause) and it changes more slowly than CRP: the ESR rises over several days and normalises over weeks, while CRP responds within hours. That is why CRP suits an acute infection, and the ESR suits monitoring chronic inflammatory and autoimmune diseases (rheumatoid arthritis, polymyalgia, lupus). The ESR reference limits depend on sex and age, and the result can also be raised by pregnancy or anaemia, so it is interpreted in the light of the patient's age and sex group and of the complete blood count.
Reference ranges
| Group | Range, mm/h | Source | |
|---|---|---|---|
| Men under 50 MedlinePlus medical encyclopedia: ESR | below 15 | MedlinePlus Reviewed 2025-07-01 | |
| Men over 50 MedlinePlus medical encyclopedia: ESR | below 20 | MedlinePlus Reviewed 2025-07-01 | |
| Women under 50 MedlinePlus medical encyclopedia: ESR | below 20 | MedlinePlus Reviewed 2025-07-01 | |
| Women over 50 MedlinePlus medical encyclopedia: ESR | below 30 | MedlinePlus Reviewed 2025-07-01 | |
| Newborns MedlinePlus medical encyclopedia: ESR | 0–2 | MedlinePlus Reviewed 2025-07-01 | |
| Children up to puberty MedlinePlus medical encyclopedia: ESR | 3–13 | MedlinePlus Reviewed 2025-07-01 | |
The MedlinePlus medical encyclopedia gives the ESR range separately by sex and by age. For women under 50 the normal level is below 20 mm/h, and after 50 it is below 30 mm/h. For men in those same age groups the limit is lower — below 15 and below 20 mm/h respectively. For children up to puberty the interval is 3–13 mm/h, and for newborns 0–2 mm/h. When reading a result it matters that it is compared with the interval for your own age and sex group rather than with one general norm, because the interval widens with age in both sexes and its limits can differ slightly depending on the measurement method a particular laboratory uses. Swedish laboratories use similar limits: Unilabs gives below 30 mm for women from 50, while Karolinska University Hospital applies the limit of below 30 mm to women from 60 (younger women: below 20 mm). For older women, 80-year-olds for example, neither of these laboratories gives a separate higher limit.
For children, MedlinePlus gives two separate intervals by age: 0–2 mm/h for newborns, and 3–13 mm/h for children up to puberty. That is considerably below the adult limits — below 15 mm/h for men under 50 and below 20 mm/h after 50, and below 20 mm/h for women under 50 and below 30 mm/h after 50. A child's result should be read against the interval meant for children, not against the adult norm, bearing in mind that after puberty the limits gradually approach adult values, so in adolescence a doctor may assess the result against both intervals.
When the ESR is tested
- With a fever of unclear origin, joint or muscle pain, or headaches
- When an autoimmune or inflammatory disease is suspected — rheumatoid arthritis, polymyalgia, lupus
- When an infection of the bones or heart valves, or tuberculosis, is suspected
- To monitor the effect of treatment in inflammatory diseases
- Alongside CRP — the two complement each other
How to prepare
- No special preparation is needed
- Tell your doctor about pregnancy and about any medicines — they change the result
A raised ESR
A raised ESR indicates inflammation, but not its cause. The most common causes are infections (including of the bones and heart valves, and tuberculosis), autoimmune diseases (rheumatoid arthritis, polymyalgia, lupus), anaemia, kidney and thyroid disease, pregnancy, and some blood disorders (lymphoma, myeloma). A very high ESR calls for a more thorough investigation.
- Infections — of the bones, of the heart valves, tuberculosis, systemic infections
- Autoimmune diseases — lupus, polymyalgia, rheumatoid arthritis
- Anaemia
- Kidney disease
- Thyroid disease
- Pregnancy
- Blood disorders — lymphoma, myeloma
What is usually looked at alongside a raised ESR:
- CRP — together the two show whether the inflammation is acute or chronic
- A complete blood count — anaemia itself raises the ESR
- Symptoms — joints, fever, weight loss — which point to where to look
- Protein fractions and other tests, if the ESR is very high with no clear cause
A low ESR
A low ESR is usually normal. Very low values occur with heart failure, thickening of the blood, a low level of fibrinogen or plasma proteins, polycythaemia, sickle cell anaemia and leukaemia — these are rare situations, and a doctor assesses them.
- A normal state
- Congestive heart failure
- Thickening of the blood (hyperviscosity)
- A low level of fibrinogen or plasma proteins
- Polycythaemia
- Sickle cell anaemia
- Leukaemia
What to do next: usually nothing — if there are no symptoms, a low ESR is not a cause for concern.
ESR and CRP
Both tests show inflammation, but CRP responds within hours and falls again quickly, while the ESR rises over days and normalises over weeks. CRP therefore suits an acute infection, and the ESR suits monitoring chronic inflammatory and autoimmune diseases. The two are often tested together, because they complement each other.
Related pages
Full site in Lithuanian: proactiva.app
Frequently asked questions
›What is a normal ESR?
Per the MedlinePlus medical encyclopedia: for men under 50 it is below 15 mm/h and for older men below 20; for women under 50 below 20 mm/h and for older women below 30. For children up to puberty it is 3–13 mm/h. Laboratory intervals can differ slightly: Karolinska University Hospital in Sweden, for example, gives below 20 mm for women under 60 and below 30 mm from 60.
›ESR 40 — what does it mean?
40 mm/h is above the normal range for all adult groups and indicates inflammation, but not its cause. The most common are infection, an autoimmune disease and anaemia; in women over 50 and during pregnancy the ESR is naturally higher. A doctor assesses it together with CRP, a complete blood count and your symptoms.
›How does the ESR differ from CRP?
Both show inflammation, but CRP responds within hours and falls quickly, while the ESR rises over days and normalises over weeks. CRP suits an acute infection, the ESR suits monitoring chronic inflammatory and autoimmune diseases. They are often tested together.
›Can the ESR be raised without any illness?
Yes. The ESR can rise because of pregnancy or anaemia, not only because of illness, and the normal range also differs by age and sex. So a small rise without symptoms is not always significant — that is for a doctor to decide.
›Do I need to fast before an ESR test?
No, no special preparation is needed. The ESR is often done together with a complete blood count, from the same sample.
Sources
Related markers
This site is not an emergency service. If severe chest or head pain, breathlessness, confusion, difficulty speaking, heavy bleeding or another acute problem has come on suddenly — do not wait for tests, call 112.
This information is not a diagnosis and does not replace a consultation with a doctor. Reference ranges depend on the laboratory, your age and sex — always compare your result with the range printed on your own report.