Testing: Erythrocyte Sedimentation Rate (ESR)

The Erythrocyte Sedimentation Rate (ESR - sometimes called sed rate or sedimentation rate) is a nonspecific screening test for various inflammatory diseases. The test measures the distance (in millimeters) that red blood cells settle in unclotted blood toward the bottom of a specially marked test tube in 1 hour. It is often used to assess and follow patients with Hodgkin’s Lymphoma (Disease) and sometimes Non-Hodgkin’s Lymphoma although the test is performed in others to detect and monitor other inflammatory diseases including arthritis and tuberculosis. The test is relatively easy and noninvasive. It is also cost-effective, often costing less than $20.

How is the test performed?

In adults and children blood is drawn from a vein, usually from the inside of the elbow or the back of the hand. The puncture site is cleaned with antiseptic, and an elastic band or blood pressure cuff is placed around the upper arm to apply pressure and restrict blood flow through the vein. This causes veins below the pressure to distend (fill with blood). A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. During the procedure, the constricting band is removed to restore circulation. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.

With infants and young children the area is cleansed with antiseptic and punctured with a sharp needle or a lancet. The blood may be collected in a pipette (small glass tube), on a slide, onto a test strip, or into a small container. Cotton or a bandage may be applied to the puncture site if there is any continued bleeding.

Before the Test

There are no food or fluid restrictions. If a child is highly adverse to needle sticks ask the doctor or medical team about EMLA cream which may be able to numb the area beforehand. Ice or heat may also be used to numb the area and/or bring veins to the surface.

During the Test

The test takes about 5 minutes on average. Some people feel moderate pain when the needle is inserted to draw blood, while others feel only a prick or stinging sensation. Veins and arteries vary in size from one person to another and from one side of the body to the other - obtaining a blood sample from some people may be more difficult than from others - chemotherapy and radiotherapy may make veins harder to access. After the test there may be some throbbing.


There can be a slight risk of the following: multiple punctures to locate veins, excessive bleeding, bruising (hematoma), fainting, lightheadedness, and very slight risk of infection (since the skin is broken).


Once the blood is drawn it is tested by the medical staff or a laboratory. There are several different testing methods (Westergren, Landau, Wintrobe, Cutler, Smith) each which might give a bit different values. Typical values using the Westergren method are as follows:

Adults: (mm/hr = millimeters per hour)

  • Men under 50 years old: less than 15 mm/hr.
  • Men over 50 years old: less than 20 mm/hr.
  • Women under 50 years old: less than 20 mm/hr.
  • Women over 50 years old: less than 30 mm/hr.


  • Newborn: 0 to 2 mm/hr.
  • Neonatal to puberty: 3 to 13 mm/hr.

False-positive results may occur in healthy people.

ESR detects infection or inflammation but not its cause - it cannot confirm a specific diagnosis. A higher than normal value may indicate occurrence or reoccurrence of Hodgkin's Lymphoma or possibly Non-Hodgkin's Lymphoma. Additional tests would have to be performed to get an accurate diagnosis.

Related Articles

Adult Hodgkin's Lymphoma: Diagnosis

Adult Hodgkin's Lymphoma: Treatment

Adult Hodgkin's Lymphoma: Introduction

Childhood Hodgkin's Lymphoma: Diagnosis

Childhood Hodgkin's Lymphoma: Treatment

Childhood Hodgkin's Lymphoma: Introduction

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