Is an erythrocyte sedimentation rate (ESR) of 2 mm/h considered abnormal?

Interpretation of ESR Value of 2 mm/h

An erythrocyte sedimentation rate (ESR) of 2 mm/h is not worrying and is considered normal, falling well within the reference range for healthy individuals.

Understanding ESR Values

ESR is a non-specific marker of inflammation that measures the rate at which red blood cells settle in a tube over one hour. The interpretation of ESR depends on several factors:

• Normal ranges:

  • For low-risk populations, an ESR <60 mm/h is considered normal 1
  • For moderate to high-risk populations, an ESR <30 mm/h is considered normal 1
  • A very low ESR (like 2 mm/h) is not associated with any pathological condition

• Clinical significance:

  • ESR is most useful in diagnosing and monitoring conditions like temporal arteritis/giant cell arteritis 1, 2
  • A significantly elevated ESR (>100 mm/h) has a positive likelihood ratio of 3.11 for Giant Cell Arteritis 1, 3
  • Low ESR values have no diagnostic significance

Clinical Relevance of Low ESR Values

When ESR is used diagnostically:

• Inflammatory conditions:

  • In rheumatic diseases like polymyalgia rheumatica, an ESR ≥40 mm/h is typically expected 4
  • For acute rheumatic fever diagnosis, ESR ≥60 mm/h is considered a minor criterion in low-risk populations 1

• Infection monitoring:

  • In periprosthetic joint infections, ESR at cutoffs of 10-15 mm/h has limited sensitivity (0.54-0.78) and specificity (0.46-0.95) 1

• Diabetic kidney disease:

  • ESR is not a primary diagnostic test for microvascular complications in diabetes 1

Limitations of ESR as a diagnostic test:

• ESR is not useful as a screening test in asymptomatic individuals 2
• Normal ESR does not exclude serious disease - approximately 25% of elderly patients with malignant or non-malignant disease may have ESR <20 mm/h 5
• ESR has poor sensitivity for most conditions, making it unreliable for excluding diseases 6

Conclusion

A value of 2 mm/h represents a normal ESR and does not warrant further investigation based on this result alone. ESR should be interpreted in the context of clinical presentation and other laboratory findings. If there are specific symptoms of concern, appropriate targeted testing should be pursued regardless of the normal ESR value.