Causes of High & Low Erythrocyte Sedimentation Rate

Causes of High & Low Erythrocyte Sedimentation Rate
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  • 0:00 Understanding Test Results
  • 0:31 Erythrocyte Sedimentation Rate
  • 1:38 Elevated ESR
  • 3:20 Low ESR
  • 4:48 Lesson Summary
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Lesson Transcript
Instructor: Alexandra Unfried

Alexandra earned her master's degree in nursing education and is currently a hospital supervisor/administrator.

An erythrocyte sedimentation rate is a blood test usually done in combination with other blood tests. This lesson will discuss the causes of high and low erythrocyte sedimentation rate.

Understanding Test Results

Barbara is 60 years old and is having an annual checkup with her doctor. A general set of blood tests are ordered to make sure the body is functioning normally. Barbara is a pretty healthy woman with her only complaint being minor joint pain, and is surprised when her erythrocyte sedimentation rate comes back moderately elevated. All of her other blood work are fairly normal. She asks her doctor what the results mean.

Erythrocyte Sedimentation Rate

An erythrocyte sedimentation rate (ESR) is a blood test that's done to test for inflammation. It can help detect infections, cancer, and autoimmune diseases. It's not a diagnostic test because it cannot tell why or what is causing the inflammation, but just tells if there is an inflammation present in the body. This is why an ESR is usually done with other blood and diagnostic tests. An ESR may be done when these symptoms are present:

  • Pain in the joints
  • Headache
  • Neck or shoulder pain
  • Digestion problems
  • Pelvic pain
  • Low red blood cell count
  • Unexplained weight loss
  • Decreased appetite

Barbara's indication for the ESR test was minor joint pain. The doctor also thought it was convenient to check it while Barbara was in for an annual visit where yearly blood work is completed. Her result of a moderately elevated ESR is not a large concern because other tests are normal. However, the doctor discusses reasons for an abnormal ESR with Barbara.

Elevated ESR

An increased ESR can be caused by inflammation in the body from diseases or infections, but can also be caused by other things, such as medications, pregnancy, menstruation, and older age.

Medications that may cause an elevated ESR include:

  • Oral contraceptives (birth control)
  • Vitamin A (antioxidant that helps the body function and remain healthy)
  • Dextran (restores blood plasma and blood volume)
  • Theophylline (taken for asthma, bronchitis, and various lung diseases)
  • Methyldopa (blood pressure medication)
  • Penicillamine procainamide (treats rheumatoid arthritis)

An elevated ESR may also be caused by autoimmune diseases, like:

  • Systemic lupus erythematosus (SLE) (inflammatory disease that attacks body tissue)
  • Rheumatoid arthritis (inflammatory disorder that causes joint pain)
  • Polymyalgia rheumatica (PMR) or giant cell arteritis (muscle pain and stiffness)
  • Necrotizing vasculitis (inflamed blood vessels that slows blood flow)
  • Hyperfibrinogenemia (increased fibrinogen in blood which increases cardiovascular disease)
  • Primary macroglobulinemia (type of cancer)

Additionally, infections can cause an elevated ESR, such as:

  • Heart or heart valve infection
  • Bone infection
  • Systemic infection
  • Rheumatic fever
  • Tuberculosis
  • Skin infection


A low ESR is usually not a concern unless accompanied by symptoms. It can be caused by medications or certain conditions.


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