What Happens if Erythrocyte Sedimentation Rate (ESR) is High? 

Introduction

Your blood can reveal a lot about what’s happening inside your body, and there are several parameters which help detect the same. One such commonly used indicator is the ESR or Erythrocyte Sedimentation Rate, which helps assess the presence of inflammation or infection in the body.  ESR measures how quickly your red blood cells (erythrocytes) settle at the bottom of a test tube. When there is inflammation in the body, the red blood cells tend to clump with each other and settle more quickly, resulting in a higher ESR value. 

In this blog, let’s explore the causes of high ESR, what does high ESR indicates, how it’s diagnosed, and how to reduce ESR. But before that, let’s understand what ESR is, what the normal range looks like, and which values are considered abnormal.  

What is ESR?

ESR is a measure of how quickly your red blood cells settle to the bottom of a test tube, which is related to the presence of inflammation in your body. Inflammation is how your body reacts to injury, infection, or other health issues like immune disorders, certain cancers, or blood problems. 

Normally, red blood cells fall slowly, but when there’s inflammation, they stick together. These clusters are heavier, so they settle more quickly. The speed at which they fall helps doctors assess the level of inflammation. The faster the cells settle, the more inflammation is likely present. However, the ESR values do not reveal the exact cause of the inflammation². 

ESR values along with a detailed history, physical examination and other investigations can help diagnose and monitor conditions that cause inflammation such as infections or autoimmune conditions. It can also help doctors track how well treatment is working². 

Normal ESR Range

ESR is recorded in millimeters per hour (mm/hr). Its normal values are: 

• 0 to 15 mm/hr in men under 50. 
• 0 to 20 mm/hr in women under 50. 
• 0 to 20 mm/hr in men over 50. 
• 0 to 30 mm/hr in women over 50. 
• 0 to 10 mm/hr in children. 

Please note the normal values can differ based on factors like age, sex, overall health, and even the lab conducting the test³. 

Your ESR value gives information about the inflammation in your body. However, a value outside the typical range doesn’t always mean something is wrong. It’s best to talk to your doctor to understand what your results mean for you. 

What Does a High ESR Indicate?

A high ESR may point to several underlying conditions. It can be associated with infections, such as osteomyelitis (bone infection) or septic arthritis (joint infection)_, autoimmune conditions like rheumatoid arthritis_, or Inflammatory disorders, such as systemic lupus erythematosus (SLE) and inflammatory bowel disease (IBD). It may also be elevated during flares or relapses of chronic inflammation⁴, and specific conditions like pregnancy, diabetes mellitus, end-stage kidney disease, heart disease, and certain cancers³. 

However, a high ESR is not always due to inflammation. Certain non-inflammatory conditions can also affect it. For example, anaemia (low red blood cell count) makes RBCs clump more easily, which increases ESR⁴. 

While ESR is a helpful clue, it’s a non-specific test, meaning it doesn’t pinpoint the exact cause. Your doctor will consider it along with other tests and symptoms to understand what’s going on in your body. 

Common Symptoms of a High ESR

If your ESR is higher than normal, your body might be telling you something. Below are some common signs and symptoms that may be present along with a raised ESR:

• Headaches: May be seen in infections or inflammatory diseases such as vasculitis (Condition affecting the blood vessels)⁵. 
• Joint swelling or pain: Present in inflammatory diseases like rheumatoid arthritis, gout, lupus, or psoriatic arthritis⁶. 
• Unexplained fever: In case of infections or some inflammatory diseases⁷. 
• Unexplained weight loss: Sometimes seen in autoimmune conditions like rheumatoid arthritis and polymyalgia rheumatica⁸. 
• Neck or shoulder pain: Common in conditions like polymyalgia rheumatica causing pain and stiffness in shoulders, neck, and hips⁹.  
• Anaemia: While this can be caused by many factors such as iron deficiency, chronic disease, or vitamin B12 deficiency, chronic inflammation can contribute to anaemia of chronic disease¹⁰. 
• Fatigue or tiredness: Due to anaemia¹⁰ or chronic inflammatory conditions like rheumatoid arthritis⁶. 
• Skin rashes or lesions:  Sometimes occur in inflammatory diseases such as vasculitis, which affects blood vessels¹¹. 

While the symptoms associated with high ESR may seem non-specific at first, it is always advisable to seek medical help when you experience the earliest symptoms to diagnose your condition.   

Causes of High ESR 

ESR can be influenced by a variety of factors. For instance, women generally have slightly higher ESR values compared to men, and factors like aging and pregnancy can also contribute to an increase. However, certain medical conditions may also cause ESR levels to rise due to increased inflammation in the body. These illnesses may include³: 

• Infections: Serious infections, especially in bones or joints, can raise ESR. 
• Rheumatoid arthritis: Swelling and pain in the joints often cause a higher ESR. 
• Lupus (SLE): An autoimmune disease that attacks your own body, raising ESR levels. 
• Cancer: Certain cancers, particularly blood or bone marrow cancers (e.g., lymphoma, leukaemia, myeloma), can lead to a high ESR. 
• Kidney problems: Long-term kidney disease may increase ESR. 
• Polymyalgia rheumatica & giant cell arteritis: Conditions in older adults that cause muscle pain and headaches, often with very high ESR. 
• Heart disease: Inflammation in the heart or blood vessels may cause a higher ESR. 
• Diabetes: Poorly controlled diabetes can trigger hidden inflammation, which may raise ESR. 
• Thyroid issues: Problems with the thyroid (hypo or hyperthyroidism) can lead to an increased ESR. 
• Bone infection (osteomyelitis): ESR can help diagnose and track treatment for bone infections. 

While an elevated ESR can indicate the presence of underlying conditions, it is not a definitive diagnosis on its own. It is important to look at your full health picture, such as symptoms, history, and other tests to identify the cause of the inflammation. 

Risks of High ESR

If you’re wondering what happens if erythrocyte sedimentation rate is high for long, note that it means there is active inflammation in your body, especially when the underlying cause is undiagnosed and untreated. This can indicate an increased risk of certain medical conditions or higher chances of complications from persistent infections and inflammatory conditions, also possibly having a poorer prognosis (treatment outcome) in some cases. Let’s have a detailed look at these.  

• Multiple organ dysfunction: Chronic high ESR, especially in untreated autoimmune diseases, can reflect advancing inflammation in the body that may start affecting multiple organs¹². 
• Heart disease: High ESR can indicate an increased risk of heart disease and stroke, as it shows the presence of ongoing inflammation which is linked to heart-related issues. Although, there are more specific markers for determining heart disease risk like the C-Reactive Protein¹³. 
• Kidney disease: Elevated ESR levels in certain kidney problems like chronic kidney disease or AAV (ANCA-Associated Vasculitis, which causes inflammation in the small blood vessels of the kidney) can indicate more serious kidney damage and a higher risk of complications, especially in older adults¹³. 
• Cancer: High ESR can also be found in people with certain cancers, like lung cancer, which may help doctors spot potential risks¹⁴. Consistently high ESR values in cancer patients are also related to poorer prognosis in various cancers¹⁵. 
• Permanent Joint Damage: High ESR levels can indicate serious inflammation in conditions like arthritis, and if not treated early, it can cause long-term damage to the joints¹⁶. 
• Fatigue and Pain: High ESR levels in conditions like infections, rheumatoid diseases, or cancers can lead to persistent fatigue and pain due to inflammation affecting the body and nervous system¹⁷. 

It is important to receive timely high ESR treatment to manage the underlying causes and reduce the risks associated with high ESR. 

Diagnosis and Further Evaluation

To measure the sedimentation rate of red blood cells, an ESR test is done. This test makes use of a small sample of your blood which is placed in a test tube and watched for the settling of your red blood cells. There are several methods to perform the ESR test: 

• Westergren method: This is the most widely used and reliable method. Blood is placed in a long (200 mm), thin tube, and the distance the red blood cells fall in one hour is measured. It’s often considered the gold standard for ESR testing due to its accuracy. 
• Wintrobe method: This uses a shorter (100 mm), narrower tube, making it less sensitive compared to the Westergren method but still used in some labs. 
• Micro-ESR and automated ESR analysers: These make use of more advanced techniques that can give quicker and more consistent results.  

While the ESR test helps doctors check if there is inflammation in the body, it doesn’t point to any specific condition. When checking your ESR results, do remember the following: 

• A slightly high ESR isn’t always a reason to worry it can happen due to aging, pregnancy, periods, or even a lab error³. 
• The ESR test alone doesn’t confirm any disease, so it should always be combined with other tests and a proper check-up³. 
• If the ESR is only a little high and there are no other signs of illness, doctors might suggest waiting or doing a few more tests³.
• If someone feels fine, it’s usually okay to repeat the ESR test after a few months instead of going for more tests right away³. 
• A very high ESR (above 100 mm/hr) can sometimes mean a serious issue like an infection, cancer, or inflammatory disease. These require timely high ESR treatment to prevent complications³. 
• If the ESR stays high for a long time, doctors might check further to see if there’s a hidden problem³.

Doctors always look at your ESR result along with your symptoms, physical examination results and other test findings. This helps them decide the right next steps for your care. 

Ways to Manage High ESR

If your ESR levels are high, it is important to identify the cause, which could be related to infection, autoimmune disorders, or other medical conditions. If you are wondering how to reduce ESR, here are some tips that can help reduce ESR levels: 

• Eat a healthy diet: Focusing on antioxidant-rich foods like fruits, vegetables, and whole grains can help reduce inflammation in the body and support healthy ESR levels¹⁸.  
• Consume foods rich in Omega-3 fatty acids: Consuming foods rich in this, such as walnuts, flaxseeds, and fish, can help reduce inflammation and lower ESR levels¹⁹. 
• Consume Vitamin D supplements: Consuming Vitamin D supplements can help reduce inflammation and lower ESR levels²⁰. 
• Exercise regularly: Getting active, especially with more intense exercise, can help lower ESR by reducing inflammation in the body²¹. 
• Maintain a healthy weight: Being overweight or having metabolic issues like high blood sugar can increase ESR, so keeping your weight in check is important²¹. 
• Avoid smoking: Smoking can raise ESR levels, so quitting or not smoking helps lower it²¹.
• Avoid drinking alcohol: Drinking too much alcohol can raise ESR levels, so avoiding or minimizing intake helps lower it²¹.
• Understand how age and gender affect ESR: ESR naturally increases with age, and women generally have higher ESR levels than men. It’s important to consider these factors when looking at ESR results²¹.
• Take medications as prescribed: Anti-inflammatory drugs²² or steroids²³ may be recommended by your doctor to address the underlying cause and help lower ESR levels. 

It’s important to talk to your doctor before making lifestyle changes to understand how to reduce high ESR and inflammation in your body. 

Conclusion

High ESR is an indicator of underlying inflammation in the body. It is linked to conditions like infections, autoimmune diseases, and certain cancers. While ESR is a non-specific tool that cannot be used for diagnosis on its own, it helps doctors detect inflammatory and certain non-inflammatory conditions in the body, as well as monitor the response to ongoing treatments. You can manage your ESR levels through a healthy diet, regular exercise, and lifestyle changes such as quitting smoking and limiting alcohol intake. But remember, if your results show abnormal levels of ESR, it is important to contact your doctor for a proper diagnosis and management plan.  

Frequently Asked Questions (FAQs)

References

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