Clinical Laboratory & DiagnosticsAug 16, 2026·6 min read
Erythrocyte Sedimentation Rate (ESR): A Non-Specific Marker of Inflammation
Understand the principles of the Westergren ESR test. A classic, widely used laboratory method for detecting systemic inflammation, infections, and autoimmune diseases.
1. Abstract & Brief Introduction
The Erythrocyte Sedimentation Rate (ESR) is a simple, non-specific test that measures the rate at which red blood cells (RBCs) settle at the bottom of a vertical tube in one hour. It is a widely used clinical marker for detecting the presence of inflammation, infection, or autoimmune diseases in the body.
2. Test Objectives
Detect the presence of acute or chronic inflammation.
Monitor the course and response to therapy in inflammatory diseases (e.g., Rheumatoid Arthritis, Temporal Arteritis).
Screen for hidden infections (e.g., osteomyelitis) or malignancies (e.g., multiple myeloma).
Differentiate between inflammatory and non-inflammatory conditions.
3. Method Principle (Westergren Method)
The most widely accepted method is the Westergren Method. When anticoagulated blood is placed in a vertical tube, RBCs normally settle slowly because they repel each other (due to their negative zeta potential). During inflammation, the liver produces acute-phase proteins (like fibrinogen and CRP). These positively charged proteins bind to the RBCs, neutralizing their negative charge and causing them to stack together in columns called rouleaux. Rouleaux are heavier than individual cells, so they settle much faster, resulting in a higher ESR reading.
4. Laboratory Equipment
Westergren ESR rack (must be perfectly vertical and vibration-free)
Westergren pipettes/tubes (graduated from 0 to 200 mm)
Timer / Stopwatch
Optional: Automated ESR analyzer (e.g., using infrared sensors)
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The Erythrocyte Sedimentation Rate (ESR) is a simple, non-specific test that measures the rate at which red blood cells (RBCs) settle at the bottom of a vertical tube in one hour. It is a widely used clinical marker for detecting the presence of inflammation, infection, or autoimmune diseases in the body.
2. Test Objectives
Detect the presence of acute or chronic inflammation.
Monitor the course and response to therapy in inflammatory diseases (e.g., Rheumatoid Arthritis, Temporal Arteritis).
Screen for hidden infections (e.g., osteomyelitis) or malignancies (e.g., multiple myeloma).
Differentiate between inflammatory and non-inflammatory conditions.
3. Method Principle (Westergren Method)
The most widely accepted method is the Westergren Method. When anticoagulated blood is placed in a vertical tube, RBCs normally settle slowly because they repel each other (due to their negative zeta potential). During inflammation, the liver produces acute-phase proteins (like fibrinogen and CRP). These positively charged proteins bind to the RBCs, neutralizing their negative charge and causing them to stack together in columns called rouleaux. Rouleaux are heavier than individual cells, so they settle much faster, resulting in a higher ESR reading.
4. Laboratory Equipment
Westergren ESR rack (must be perfectly vertical and vibration-free)
Westergren pipettes/tubes (graduated from 0 to 200 mm)
Timer / Stopwatch
Optional: Automated ESR analyzer (e.g., using infrared sensors)
