What is the normal Erythrocyte Sedimentation Rate (ESR) range?

Normal ESR Range Values

The normal ESR range is typically considered to be below 20 mm/h in men and below 30 mm/h in women, with higher values indicating a greater likelihood of underlying disease. 1

Age and Sex-Based Normal ESR Values

• Women typically have higher baseline ESR values than men, which should be considered when interpreting results 1
• For adults under 60 years of age, normal ESR values are generally:
  • Men: <20 mm/h 1
  • Women: <30 mm/h 1
• In elderly populations, the upper limit of normal ESR may be higher:
  • The upper limit for normal ESR for women through age 60 is about 38 mm/h 2
  • ESR may be as high as 35-40 mm/h in healthy aged persons 3

Clinical Significance of ESR Values

• Moderate elevation of ESR (50-100 mm/h) is more likely to indicate significant underlying disease 1
• In specific conditions, ESR values have different clinical thresholds:
  • Giant cell arteritis: ESR >40 mm/h has high sensitivity (93.2%) 4
  • Temporal arteritis: ESR >100 mm/h has the highest specificity (92.2%) 4
  • Rheumatic fever: ESR ≥30 mm/h is considered elevated in moderate and high-risk populations 5
  • Rheumatic fever: ESR ≥60 mm/h is considered elevated in low-risk populations 5

Factors Affecting ESR Values

• Anemia can artificially elevate ESR values, potentially leading to false positive results 4, 1
• Azotemia (elevated blood urea nitrogen) can also artificially elevate ESR values 4, 1
• Body mass index may affect ESR values, particularly in women with osteoarthritis 2

Clinical Interpretation Considerations

• A normal ESR does not always rule out disease - approximately 25% of elderly patients with malignant or non-malignant disease may have ESR values below the upper limit of normal 3
• In polymyalgia rheumatica, approximately 22% of patients may present with a normal ESR (≤30 mm/h) 6
• When monitoring inflammatory conditions, ESR should be interpreted alongside other clinical and laboratory findings 1

Measurement Methods

• The Westergren method is considered the standard reference method for ESR measurement 7
• Automated methods may be suitable for low ESR values but may need validation by the Westergren method for high ESR values in patients with low hematocrit 7

Understanding these normal ranges and their clinical context helps in properly interpreting ESR results and their significance in various medical conditions.