Library
/
Inflammation
/
Erythrocyte Sedimentation Rate (ESR) Testing

Erythrocyte Sedimentation Rate (ESR) Testing

January 21, 2026
Subscribe for updates
By clicking “Subscribe” you agree to our Terms and Privacy Policy.
Your content is on its way!
By clicking “Subscribe” you agree to our TOS and Privacy Policy.
Oops! Something went wrong while submitting the form.

Do I need an Erythrocyte Sedimentation Rate (ESR) test?

Experiencing unexplained fatigue, joint pain, or persistent inflammation that won't go away? Could hidden inflammation be affecting your body, and might an ESR test reveal what's happening beneath the surface?

ESR measures how quickly red blood cells settle in a test tube, which increases when inflammation is present in your body. It helps detect conditions like autoimmune disorders, infections, and chronic inflammatory diseases that might be causing your symptoms.

Testing your ESR gives you a valuable snapshot of inflammation levels in your body, empowering you to address the root causes of your pain and fatigue. Getting tested is your first step toward a personalized health plan that targets what's really going on.

Book your test now
With Superpower, you have access to a comprehensive range of biomarker tests
Book a Erythrocyte Sedimentation Rate (ESR) Testing Test
Physician reviewed
CLIA-certified labs
HIPAA compliant

Get tested with Superpower

If you’ve been postponing blood testing for years or feel frustrated by doctor appointments and limited lab panels, you are not alone. Standard healthcare is often reactive, focusing on testing only after symptoms appear or leaving patients in the dark.

Superpower flips that approach. We give you full insight into your body with over 100 biomarkers, personalized action plans, long-term tracking, and answers to your questions, so you can stay ahead of any health issues.

With physician-reviewed results, CLIA-certified labs, and the option for at-home blood draws, Superpower is designed for people who want clarity, convenience, and real accountability - all in one place.

Key benefits of Erythrocyte Sedimentation Rate (ESR) testing

  • Flags inflammation anywhere in your body before symptoms become severe.
  • Spots autoimmune conditions like rheumatoid arthritis or lupus early in their course.
  • Tracks how well treatment is working for inflammatory or rheumatic diseases.
  • Clarifies unexplained fever, joint pain, or fatigue with objective inflammatory evidence.
  • Guides diagnosis of temporal arteritis to protect vision and prevent stroke.
  • Monitors disease flares in chronic conditions like inflammatory bowel disease.
  • Best interpreted alongside CRP, complete blood count, and your clinical symptoms.

What is Erythrocyte Sedimentation Rate (ESR)?

A simple test that reveals how fast red blood cells settle

Erythrocyte sedimentation rate measures how quickly red blood cells (erythrocytes) fall to the bottom of a vertical tube of blood over one hour. This isn't a direct measurement of a molecule or cell count. Instead, it reflects how much your red blood cells clump together and sink under gravity.

Why red blood cells clump tells a bigger story

When inflammation is present anywhere in your body, the liver releases proteins like fibrinogen into your bloodstream. These proteins coat red blood cells and cause them to stick together in stacks, like coins. Stacked cells are heavier and fall faster than individual cells.

A decades-old window into hidden inflammation

ESR serves as a general marker of inflammation, infection, or tissue injury. It doesn't pinpoint a specific disease, but an elevated rate signals that something is activating your immune system. Doctors use it to detect and monitor inflammatory conditions, from infections to autoimmune diseases, making it one of the oldest and most widely used screening tests in medicine.

Why is Erythrocyte Sedimentation Rate (ESR) important?

ESR measures how quickly red blood cells settle in a test tube over one hour. It reflects the presence and intensity of inflammation anywhere in the body. When tissues are injured or inflamed, the liver releases proteins that cause red cells to clump and fall faster, making ESR a sensitive but nonspecific marker of systemic inflammatory activity.

When inflammation is quiet

Normal ESR values typically range from 0–15 mm/hr in men and 0–20 mm/hr in women, with optimal levels at the lower end. Low or normal readings suggest minimal systemic inflammation and healthy immune regulation. They indicate that no widespread tissue injury, infection, or autoimmune process is driving protein changes in the blood.

When the body is responding to injury or disease

Elevated ESR signals active inflammation, whether from infection, autoimmune disease, malignancy, or tissue damage. Values above 100 mm/hr often point to serious conditions like giant cell arteritis, severe infection, or advanced cancer. Moderate elevations appear in rheumatoid arthritis, inflammatory bowel disease, and chronic kidney disease. Symptoms vary widely but may include fatigue, fever, weight loss, or organ-specific pain.

Women naturally have slightly higher ESR due to hormonal effects on plasma proteins, and levels rise further during pregnancy. Older adults also trend higher as baseline inflammation increases with age.

The bigger inflammatory picture

ESR connects to cardiovascular risk, immune function, and metabolic health. Chronic elevation accelerates vascular aging and correlates with frailty and mortality. Tracking ESR over time helps assess disease activity and treatment response across multiple organ systems.

What do my Erythrocyte Sedimentation Rate (ESR) results mean?

Low ESR values

Low values usually reflect normal or reduced inflammatory activity in the body. ESR measures how quickly red blood cells settle in a test tube, which slows when inflammation is absent or when red blood cells are small, numerous, or shaped in ways that resist clumping. Very low values can occur with polycythemia (too many red cells), certain anemias affecting cell shape, or conditions that alter blood proteins. In most cases, a low ESR is reassuring and suggests minimal systemic inflammation.

Optimal ESR values

Being in range suggests balanced inflammatory signaling and normal blood protein composition. Many labs define normal as under 15 mm/hr for men and under 20 mm/hr for women, with values rising slightly with age. Optimal values typically sit at the lower end of the reference range, reflecting quiet background immune activity without acute or chronic inflammatory stress.

High ESR values

High values usually reflect active inflammation, infection, tissue injury, or conditions that increase certain blood proteins like fibrinogen and immunoglobulins. These proteins cause red cells to stack and settle faster. Common causes include autoimmune diseases, chronic infections, malignancies, and kidney disease. ESR rises more in women and older adults and can be markedly elevated during pregnancy.

Notes on interpreting ESR

ESR is a nonspecific marker that rises with many conditions and changes slowly over days to weeks. It is often paired with C-reactive protein for better context and should be interpreted alongside clinical symptoms and other lab findings.

Method: FDA-cleared clinical laboratory assay performed in CLIA-certified, CAP-accredited laboratories. Used to aid clinician-directed evaluation and monitoring. Not a stand-alone diagnosis.

Subscribe for updates
By clicking “Subscribe” you agree to our Terms and Privacy Policy.
Your content is on its way!
By clicking “Subscribe” you agree to our TOS and Privacy Policy.
Oops! Something went wrong while submitting the form.

Similar biomarker tests from Superpower

See more biomarkers

Frequently Asked Questions

Read more
How it works
What should I expect during a blood draw?
  • A trained phlebotomist will guide you through the process.
  • A tourniquet is placed on your arm, the site is cleaned, and a small needle is used to collect blood into one or more tubes.
  • Results are usually ready in about a week.
  • Most people feel only a quick pinch.
  • The needle is removed, gentle pressure is applied, and a bandage is placed.
How do I prepare for a blood draw?
  • Drink plenty of water beforehand — hydration makes veins easier to find.
  • Wear loose sleeves so your arm is easy to access.
  • Follow any fasting instructions you’ve been given.
  • Let us know if you’re on medications, have fainted before, or have needle anxiety.
What should I do after my blood draw?
  • Press gently on the site for a few minutes.
  • Keep the bandage on for 4-6 hours.
  • Skip heavy lifting or strenuous exercise for the rest of the day.
  • Drink extra water to rehydrate.
  • Monitor the site for redness, swelling, or pain.
How do I book a blood draw with Superpower?

Your membership includes:

  • An annual full body test and report across 100+ biomarkers
  • A personalized action plan to optimize your biomarkers and reach your health goals
  • A dashboard to centralize your health data and track changes across a lifetime
  • Access to a health concierge for questions on your plan and help scheduling
  • Plus a marketplace of curated health products and services cheaper than amazon

Many concierge clinics charge $10k – $100k for their services, we’ve built technology to make the world’s best healthcare as accessible as possible via an all-in-one membership.

Where can I take my blood test?

Superpower is currently available in the following US states:

  • Alabama
  • Arizona
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Idaho
  • Illinois
  • Indiana
  • Kansas
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • South Carolina
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
Our testing
Does Superpower replace my primary care provider?

Superpower specializes in prevention-based testing and treatments and is not intended for emergency or immediate health issues.

While you will have a Superpower care team, your annual membership is designed to complement a primary care doctor if you have one, not replace them.

We are happy to help you share any test results with an outside provider to ensure you receive well-rounded medical care.

How fast are blood test results and how do I read them?

Your annual lab test panel takes about a week to process. We will text you as soon as they become available in your dashboard. Other types of tests may have different testing windows. The Superpower concierge is your own health assistant who helps answer your questions on your results, ensure smooth scheduling, coordination of any office-based tests, specialist referrals as needed, and navigating you to interface with your care team.

Does Superpower accept health insurance?

Superpower membership and products are all eligible for HSA/FSA funding.

We see Superpower like a gym membership for those committed to prevention and performance. Superpower is a bridge between wellness and healthcare. Health insurance traditionally focuses on reactive care whereas, at Superpower, we believe it’s never too early to start looking out for your long-term health.

What if I want more than 1 blood test per year?

Absolutely — you're not limited to just one. Your membership includes one comprehensive 100+ biomarker blood test each year, but if you'd like to track your progress more closely, you can add extra tests at any time. Each additional full-panel test costs $179. You can order as many as you'd like throughout the year.

“Best health check of my entire life.”

Vinay Hiremath, Founder of Loom

“Life changing”

Jordi Hayes, Founder of Capital.xyz

Frequently Asked Questions about Erythrocyte Sedimentation Rate (ESR) Testing

What is the erythrocyte sedimentation rate (ESR) blood test and what does it measure?

The erythrocyte sedimentation rate (ESR) test measures how quickly red blood cells (erythrocytes) settle to the bottom of a tall tube in one hour. ESR is not a substance in your blood - it’s a measurement of settling speed. Faster settling generally reflects higher levels of inflammation-related proteins in plasma, which cause red cells to clump and sink more quickly. It’s a long-used, nonspecific marker of inflammation.

How does ESR show inflammation in the body, and why do red blood cells settle faster?

ESR increases when inflammation, infection, or tissue injury raises blood proteins such as fibrinogen and immunoglobulins. These proteins promote red blood cell clumping (rouleaux formation), making the cells heavier so they fall faster in the test tube. A higher ESR suggests there is systemic inflammation somewhere in the body, but it does not identify the exact cause or location of the inflammatory process.

What are the key benefits of ESR testing for hidden inflammation and chronic disease monitoring?

ESR testing can flag hidden inflammation before symptoms worsen, help explain unexplained fever, joint pain, or persistent fatigue, and support diagnosis of autoimmune diseases like rheumatoid arthritis or lupus. It’s also helpful for tracking whether treatment for inflammatory disease is working over time and for spotting flare-ups in chronic conditions such as inflammatory bowel disease. ESR is best interpreted alongside symptoms and other labs.

What is a normal ESR range by age and sex, and what does a normal result usually mean?

Typical ESR values range from under 10 to around 20 mm/hr, depending on age and sex. Many labs list normal as under 15–20 mm/hr for men and under 20–30 mm/hr for women, with higher reference ranges in older adults. A normal ESR usually suggests minimal systemic inflammation and a “quiet” immune environment, meaning there’s no strong signal of infection, autoimmune flare, or tissue damage.

What does a high ESR result mean, and what conditions can cause it to be elevated?

A high ESR usually signals active inflammation, infection, or tissue injury and can be seen in autoimmune conditions (rheumatoid arthritis, lupus), infections (including pneumonia or tuberculosis), cancers (lymphoma, multiple myeloma), kidney disease, and thyroid disorders. ESR can also rise with anemia and pregnancy independent of disease. Because ESR is nonspecific, an elevated result typically prompts further evaluation rather than a single diagnosis.

Can a low ESR be a problem, and what might cause very low ESR values?

Low ESR values usually reflect minimal inflammation and normal blood protein balance, and isolated low ESR rarely signals disease. Very low readings can occur when red blood cell count is higher than normal (polycythemia), when red blood cell shape changes reduce settling, or when proteins that promote clumping are reduced. In most cases, a low ESR indicates a calm inflammatory state rather than an illness.

Why do pregnancy and anemia increase ESR even without an infection or autoimmune flare?

Pregnancy and anemia can elevate ESR because they change blood composition in ways that affect settling. ESR is strongly influenced by plasma proteins and how easily red blood cells clump. In anemia, fewer red cells and altered blood viscosity can make cells settle faster. In pregnancy, physiologic shifts in plasma proteins can also raise ESR. These increases may not reflect disease and should be interpreted clinically.

How is ESR different from C-reactive protein (CRP), and when are they used together?

ESR and C-reactive protein (CRP) are both inflammation markers, but they behave differently. ESR tends to rise and fall more slowly, which can make it useful for tracking chronic inflammatory conditions over time. CRP is often more sensitive to acute changes. The context notes ESR is best interpreted alongside CRP, a complete blood count (CBC), and your clinical symptoms to better map inflammation and guide diagnosis.

What symptoms or situations should prompt an ESR test for unexplained fever, fatigue, or joint pain?

ESR is often ordered when symptoms suggest inflammation but the cause is unclear - such as unexplained fever, persistent fatigue, joint stiffness or pain, malaise, weight loss, or suspected infection severity. It can also help evaluate autoimmune disease activity (like rheumatoid arthritis or lupus) and monitor chronic inflammatory conditions for flare-ups. An elevated ESR supports the need for deeper investigation rather than providing a final answer.

What should I do if my ESR is persistently high, and why does long-term elevation matter?

Persistently high ESR suggests ongoing systemic inflammation that may be “smoldering” even when symptoms are mild. The context notes chronic elevation can contribute to cardiovascular disease risk, anemia of chronic disease, and organ damage over time. Because ESR does not pinpoint the source, ongoing elevation typically warrants medical evaluation and follow-up testing (often including CRP and a complete blood count) to identify and treat underlying causes and track response to therapy.

Finally, healthcare that looks at the whole you