Erythrocyte Sedimentation Rate

Effective Date: December 15, 2006
Revised Date: April 1, 2007

Recommendations and Topics


This guideline applies to the clinical use of the erythrocyte sedimentation rate (ESR), fee item 90515, as an investigative test in adults (19 years of age and over).



The ESR may be used to evaluate patients with unexplained symptoms or a deterioration of health status when:

  1. an inflammatory, neoplastic, or infectious disease is suspected; and
  2. a specific diagnosis is not made effectively by other means.



The ESR may be used to monitor the activity of temporal arteritis, polymyalgia rheumatica, inflammatory arthritis and some infections.



There is no evidence to support the use of the ESR in asymptomatic individuals and this test should not be appended to routine investigations.



The ESR will only be performed if a written indication is provided on the requisition.



The erythrocyte sedimentation rate (ESR) is a relatively nonspecific test that is frequently ordered during the diagnosis and monitoring of disease. A variety of factors influence the sedimentation rate. Disease-related factors that may affect the ESR include the plasma immunoglobulin and fibrinogen concentrations, and the presence and degree of anemia. Factors unrelated to disease process that may affect ESR values include age, sex, and drug therapy.

There is no evidence to support the use of the ESR in asymptomatic individuals. Elevated ESR values are found in a variety of pathological states. If the clinical history and physical findings are suggestive of specific disease processes, other investigations are usually more appropriate.

For instance, while individuals with a sedimentation rate greater than 100 mm/h are likely to be suffering from serious systemic disease, the presence of such diseases (malignancy, infection, cirrhosis, collagen disease, etc.) is generally detectable by clinical examination and history. However, the ESR may provide useful information when:1,2,3,4,5

  • used as a diagnostic criterion for temporal arteritis and polymyalgia rheumatica
  • monitoring response to therapy in temporal arteritis and polymyalgia rheumatica
  • used as a component of some clinical indices of rheumatoid arthritis6
  • following the course of patients with rheumatoid arthritis or other connective tissue disorders
  • screening for tissue infection in specific situations,7 e.g., after orthopaedic surgery or suspected pelvic inflammatory disease
  • assessing response of Hodgkin's Disease to therapy
  • monitoring certain infections such as tuberculosis or osteomyelitis
  • assessing elderly persons with vague complaints in whom there is a moderate to strong possibility of one of the above underlying diseases, but no definite findings following history and physical examination8



  1. Brigden M. The erythrocyte sedimentation rate. Still a helpful test when used judiciously. Postgrad Med 1998;103(5):257-274.
  2. Ontario Association of Medical Laboratories. Guideline for the ordering of erythrocyte Sedimentation Rate (ESR). Revised 2001. [Guidelines for clinical laboratory practice]. Retrieved June 26, 2006 from OAML web site at (PDF, 19KB)
  3. Olshaker JS, Jerrard DA. The erythrocyte sedimentation rate. J Emerg Med 1997;15(6):869-874.
  4. Smellie WS, Forth JO, McNulty CAM, et al. Best practice in primary care pathology: review 2. J Clin Pathol 2006;59(2):113-120.
  5. WRHA Laboratory Medicine Program. Guidelines for ordering erythrocyte sedimentation rate (ESR). Effective Date 2004. [Clinical Guideline]. Retrieved June 26, 2006, from Diagnostic Services of Manitoba Inc. at
  6. Lane SK, Gravel JW Jr. Clinical utility of common serum rheumatologic tests. Am Fam Physician 2002;65(6):1073-1080.
  7. An HS, Seldomridge JA. Spinal Infections. Diagnostic tests and imaging studies. Clin Orthop Relat Res 2006;444:27-33.
  8. Smith EM, Samadian S. Use of the erythrocyte sedimentation rate in the elderly. Br J Hosp Med 1994;51(8):394‑397.



This guideline, revised by the Guidelines and Protocols Advisory Committee, supersedes the Erythrocyte Sedimentation Rate guideline revised in 2003. This revision is approved by the British Columbia Medical Association and adopted by the Medical Services Commission.

This guideline is based on scientific evidence current as of the effective date.

The principles of the Guidelines and Protocols Advisory Committee are to:

  • encourage appropriate responses to common medical situations
  • recommend actions that are sufficient and efficient, neither excessive nor deficient
  • permit exceptions when justified by clinical circumstances.
Contact Information
Guidelines and Protocols Advisory Committee
Victoria BC V8W 9P1
Web site:
Clinical Practice Guidelines


Disclaimer The Clinical Practice Guidelines (the "Guidelines") have been developed by the Guidelines and Protocols Advisory Committee on behalf of the Medical Services Commission. The Guidelines are intended to give an understanding of a clinical problem and outline one or more preferred approaches to the investigation and management of the problem. The Guidelines are not intended as a substitute for the advice or professional judgment of a health care professional, nor are they intended to be the only approach to the management of clinical problems.  We cannot respond to patients or patient advocates requesting advice on issues related to medical conditions. If you need medical advice, please contact a health care professional.