Why ESR is changing: causes, consequences and what is the norm for men and women

Table of contents
MOSCOW, September 30 – Novosti. ESR, or erythrocyte sedimentation rate, is one of the non-specific blood tests that helps to understand whether an inflammatory process is taking place in the body, but does not indicate its cause. What indicators should be normal in men and women, what does increased and decreased ESR mean, what this may be connected with – in the Novosti material.


Blood in the human body moves through the vessels and is constantly mixed. The erythrocytes in its composition are distributed evenly in the plasma, which is why immediately after the cut, the blood has a uniform red color. If you pour it into a test tube, then after some time it will stratify: the red blood cells will sink to the bottom, and a layer of a yellowish tint will appear on top – this is plasma.
In a healthy person, erythrocytes repel each other, and since they themselves are quite light and are in the plasma in “free flight”, they settle slowly during sedimentation. Under the influence of certain factors, proteins may appear in the plasma, which either should not be in it, or are present, but in small quantities. For example, with some damage (internal and external), the amount of protective proteins-immunoglobulins and fibrinogen increases in the blood. They cling to the surface of red blood cells and cause them to stick together, causing them to settle in the blood more strongly.
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Vacuum tubes for blood sampling in the treatment room - Novosti, 1920, 09/30/2022
Vacuum tubes for blood sampling in the treatment room
It is this behavior of erythrocytes in stagnant blood that characterizes the ESR – the erythrocyte sedimentation rate.

Who appoints the study

A therapist, hematologist, oncologist or infectious disease specialist can prescribe a blood test to determine the ESR. This is especially true in the diagnosis and monitoring of inflammatory, infectious, oncological and autoimmune diseases, as well as in preventive examination of the body along with other types of diagnostics.

Blood analysis

The ESR result can be reflected in the general clinical blood test or it can be prescribed separately, as an additional examination.

Preparation for analysis

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No specific preparation for such an analysis is necessary. It is necessary to donate blood in the morning on an empty stomach or during the day, but not earlier than three hours after the last meal. You can drink clean water without restrictions.

Deciphering the results

In total, there are three possible results: reduced ESR, increased or normal. The value is expressed in mm/h. In many laboratories, on the form with the results, a separate column indicating the norm is prescribed, which will help to decipher the result. But it is more informational in nature, since the ESR norm can vary depending on age, gender and individual characteristics of the organism.

Analysis Methods

In modern laboratory diagnostics, several methods for measuring ESR are used. The total time for all is 1 hour, but the results may vary depending on the method.
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Westergren’s method. This method requires venous blood. The patient is taken 2 ml of blood into a special vacuum tube, where it is mixed with an anticoagulant and “sucked” into a long (30 cm) glass tube. The liquid level should reach 200 mm. Then it is placed in a special tripod and left for 1 hour. The resulting erythrocyte sedimentation rate is recorded either manually or automatically using a special analyzer. This method is preferred, largely due to the fact that venous blood is used for it. It is considered the most suitable for many tests (including the determination of ESR), since microclots can form in capillary blood, which affects the accuracy of the results.
Wintrob’s method. Venous blood is also used for it, but it is not diluted with an anticoagulant, and a shorter tube is used for measurement – 10, not 30 cm. This method is not so common, as it is considered insufficiently accurate.
Panchenkov’s method. This method requires capillary blood in the amount of 100 µl. It is taken directly into a thin glass tube 17.2 cm long, which is pre-washed with anticoagulant. Next, the blood is poured onto the glass, mixed with an anticoagulant and again taken with a tube to the 10 cm mark. This procedure is done 4 more times. After the last mixing, the blood in the tube is placed vertically in a tripod for 1 hour.
CC0 / MechESR / .
Stand with capillary glass tubes for determining the erythrocyte sedimentation rate.  Panchenkov's method - Novosti, 1920, 09/30/2022
Stand with capillary glass tubes for determining the erythrocyte sedimentation rate. Panchenkov’s method


The ESR norm is individual depending on many factors, the main of which are gender and age.

In men

In an adult healthy man, the ESR value varies from 8 to 10 mm / h. In men over 60, the rate increases and the average parameter is 20 mm / h. Although an increase in ESR in itself is not a pathology, additional examinations may be prescribed at a value of 30 mm / h.

Among women

In a healthy adult woman, the ESR is in the range of 10-18 mm / h, the average value is 12 mm / h. In women over 50 years of age, ESR increases, so 14-25 mm / h is considered the norm, and the average value is 12 mm / h.

In pregnant women

During pregnancy, the ESR is measured 4 times. In this case, the value itself will be increased and this does not always indicate the presence of pathology. This is due to the fact that during pregnancy the load on the woman’s body increases and many of its processes are rebuilt, for example, immunity is weakened or hormonal levels change – all this affects the results of the tests. The ESR rate will depend on the trimester:
  • 1 trimester. The norm is considered to be no more than 20 mm / h. At the same time, the ESR does not always increase immediately, on the contrary, it often begins to fall, the lower limit of the norm is 11 mm / h.
  • 2 trimester. ESR increases even more, at this time the norm is 30 mm / h. This is due to the high energy costs of the body.
  • 3rd trimester. At this time and immediately after childbirth, the ESR can reach 45 mm / h, less often – 50 mm / h. This is due to an increase in fibrinogen, a protein responsible for blood clotting.
Changes in ESR in each pregnant woman may differ, since the individual characteristics of the body affect the indicator. However, if in the first two trimesters the ESR rises to 45 mm / h or more, this is an indicator for the doctor to prescribe additional examinations.

In children

The ESR index in children changes throughout their growing up. In the first month of life, it can be in the range of 2-30 mm / h, from 1 year to 6 years – 1-12 mm / h, after 7 years the indicator begins to change and by 8 years the value corresponds to an adult.
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Test tubes with analyzes in the laboratory of the children's hospital - Novosti, 1920, 09/30/2022
Test tubes with analyzes in the laboratory of a children’s hospital

What affects the ESR

The level of ESR can be influenced by both physiological and pathological factors. The main ones include:
  • pregnancy, in particular what trimester;
  • taking contraceptives (in women);
  • time period: ESR in the morning is higher than in the afternoon and evening, while it is still important to take into account age;
  • exposure to acute phase proteins;
  • the time of material sampling for analysis during infectious and inflammatory processes: the ESR value changes a day after the onset of leukocytosis and hyperthermia. For example, on the first day of the disease, the ESR can be 10 mm / h, and after a day – 17 mm / h;
  • the presence in the body of a chronic focus of inflammation;
  • increased blood viscosity;
  • exposure to anisocytes, spherocytes, or macrocytes.

Increased ESR

An increase in ESR does not always indicate the presence of any pathology. This indicator may vary depending on the lifestyle, characteristics of a particular organism and human behavior immediately before the test.
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The reasons

The main reasons for the increase in ESR include:
  • infectious diseases accompanied by inflammatory processes (pneumonia, tuberculosis, rheumatism, syphilis, blood poisoning, etc.);
  • endocrine diseases;
  • inflammatory lesions of the myocardium, heart attack;
  • rheumatoid arthritis;
  • malignant lesions;
  • pathology of the pancreas, liver, intestines and kidneys;
  • hematological pathologies;
  • arsenic and lead intoxication;
  • postoperative condition;
  • injuries and fractures;
  • elevated cholesterol levels;
  • side effects from medications (eg vitamin B, dextran, etc.).


An increase in ESR due to physiological factors resolves on its own and does not require any intervention. In the absence of a causal diagnosis and a prolonged elevated rate, it is worth contacting a doctor for additional examinations and identifying the causative factor. Further consequences will depend only on the course of the root cause of the increase in ESR.
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Elevated ESR in children

As in adults, if the ESR in a child is increased, this may indicate the development of an infectious inflammatory process in the body. If the ESR is determined by Panchenkov, then be sure to pay attention to other changes in the general blood test and the general condition of the child. With an infectious disease, the erythrocyte sedimentation rate in children increases on the second or third day. The main possible causes of increased ESR in a child include:
  • metabolic disorders (hyperthyroidism, hypothyroidism, diabetes, etc.);
  • various blood diseases;
  • systemic and autoimmune diseases (lupus, bronchial asthma, rheumatoid arthritis, etc.);
  • diseases accompanied by tissue breakdown (tuberculosis, oncology, myocardial infarction, etc.).
  • if during and after recovery the ESR remains elevated, this does not indicate any deterioration, on the contrary, this may indicate the normal course of the process. The indicator will not be restored immediately, but if there are doubts, it is necessary to consult a doctor for a second full diagnosis.
Also, ESR in children can increase for fairly harmless reasons, for example:
  • during teething;
  • if the mother violates the diet during breastfeeding;
  • with a lack of vitamins;
  • after taking certain medications;
  • with helminthiasis.
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Reduced ESR

With a slowdown in ESR, a decrease or complete inability of red blood cells (erythrocytes) to combine and form erythrocyte columns is additionally noted.

The reasons

The main reasons for the decrease in ESR include:
  • changes in the acid-base balance of the blood (decrease in pH);
  • release of bile acids;
  • increased blood viscosity (which prevents red blood cells from settling);
  • change in the shape of red blood cells;
  • high levels of bilirubin ;
  • sickle cell anemia;
  • reactive erythrocytosis;
  • insufficient level of fibrinogen;
  • erythremia;
  • chronic circulatory failure.


As in the case of an increase in ESR, a decrease in the indicator is not something pathological and does not lead to certain consequences. It depends on the factor that caused such changes. Physiological causes do not require urgent interventions, and in the case of pathological ones, it is the root cause that needs to be treated, and not the symptom itself.
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False positive ESR tests

The result of the analysis is considered false positive and does not indicate the subject of an infectious disease if:
  • diagnosed with renal failure;
  • have a high degree of obesity;
  • have recently been vaccinated against hepatitis B;
  • an elderly person;
  • violations were committed during the study;
  • there is an increase in the concentration of plasma proteins (with the exception of fibrinogen);
  • course of vitamin A.
CC0 / MechESR / .
Stand with capillary glass tubes for determining the erythrocyte sedimentation rate.  Panchenkov's method - Novosti, 1920, 09/30/2022
Stand with capillary glass tubes for determining the erythrocyte sedimentation rate. Panchenkov’s method

How to bring the level back to normal

Valentin Shishkin, a family doctor, notes that the ESR itself does not need to be brought back to normal, it is necessary to eliminate the disease or the very cause that leads to an increase in the erythrocyte sedimentation rate. In an isolated perception, an increase in this indicator can only be perceived as a screening method, that is, it selects patients who can potentially have some kind of inflammatory process, no matter what nature.
“There are no specific drugs and methods for the treatment of ESR, since this is not a disease. It is just a hematological symptom during a clinical blood test,” the expert added.
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