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

Normal Range for Erythrocyte Sedimentation Rate (ESR)

The normal ESR values are typically considered elevated when they exceed 20 mm/h in men and 30 mm/h in women, with higher values indicating a greater likelihood of underlying disease. 1

Age and Sex-Based Normal Ranges

• ESR values vary by age and sex, with women typically having higher baseline values than men 1
• In low-risk populations for rheumatic fever, ESR ≥60 mm/h is considered elevated 2, 1
• In moderate and high-risk populations for rheumatic fever, ESR ≥30 mm/h is considered elevated 2, 1

Clinical Interpretation of ESR Values

• Moderate elevation of ESR (50-100 mm/h) is more likely to indicate significant underlying disease 1
• ESR values >100 mm/h have high specificity (92.2%) for conditions like giant cell arteritis 1, 3
• In elderly patients, ESR may be as high as 35-40 mm/h even in healthy individuals 4

ESR Values in Specific Conditions

• In giant cell arteritis:
  • ESR >40 mm/h has high sensitivity (93.2%) 1, 3
  • ESR >50 mm/h has a sensitivity of 87.5% 3
  • ESR >100 mm/h has the highest specificity (92.2%) 3
• In Kawasaki disease, ESR is often above 40 mm/h and commonly reaches levels of at least 100 mm/h 1
• In osteomyelitis with diabetes-related foot infections, ESR ≥70 mm/h has a sensitivity and specificity of 81% and 80%, respectively 1

Factors Affecting ESR Values

• Anemia and azotemia can artificially elevate ESR values 1, 3
• In patients with polymyalgia rheumatica, approximately 20% may have an ESR lower than 40 mm/h 5
• ESR values may not always be elevated in relation to disease, with about 25% of elderly patients with malignant or non-malignant disease having ESR values below 20 mm/h 4

Measurement Considerations

• The Westergren method is the standard reference method for ESR measurement 6
• Automated methods correlate well with the Westergren method for low-ESR values but may need validation by the standard method for high-ESR values 6
• ESR values at 30 minutes strongly correlate with 60-minute measurements (r=0.926), allowing for potential shortening of the test time 7

Clinical Utility and Limitations

• ESR is particularly useful in monitoring conditions such as giant cell arteritis, polymyalgia rheumatica, and Kawasaki disease 1
• An ESR of 70 mm/h or higher has good specificity for underlying pathology (infection, malignancy, or inflammation) but poor sensitivity (<30%) for any specific disease 8
• Normal ESR values cannot exclude disease, especially in elderly patients 4