What is the purpose of an ESR test. How is the erythrocyte sedimentation rate measured. What can high or low ESR results indicate. When might a doctor order an ESR test. How does ESR compare to other inflammation markers.

What is the Erythrocyte Sedimentation Rate (ESR) Test?

The erythrocyte sedimentation rate (ESR) test, also known as the sed rate test, is a simple blood test used to detect inflammation in the body. This test measures how quickly red blood cells (erythrocytes) settle at the bottom of a test tube over a period of one hour.

Why is this settling rate important? In the presence of inflammation, certain proteins in the blood cause red blood cells to clump together. These clumps are heavier than individual cells, causing them to fall faster in the test tube. Therefore, a faster sedimentation rate can indicate higher levels of inflammation in the body.

Key Points About the ESR Test:

• It’s a non-specific test, meaning it can detect inflammation but not its exact location or cause
• Results are reported in millimeters per hour (mm/hr)
• Normal ranges vary based on age and gender
• It’s often used in conjunction with other tests for diagnosis and monitoring of various conditions

Why Would a Doctor Order an ESR Test?

Doctors may order an ESR test for various reasons, primarily when they suspect an inflammatory condition or infection. Some common scenarios include:

• Investigating unexplained symptoms like fever, weight loss, or fatigue
• Monitoring the progression of inflammatory diseases
• Assessing the effectiveness of treatments for inflammatory conditions
• Screening for hidden infections or cancers in certain cases

Are there specific symptoms that might prompt an ESR test? Yes, some symptoms that could lead to an ESR test include:

• Persistent headaches
• Joint pain or stiffness
• Muscle pain, particularly in the shoulders, neck, or pelvis
• Unexplained loss of appetite or weight

How is the ESR Test Performed?

The ESR test is a relatively simple procedure that involves drawing a blood sample from a vein, typically in the arm. Here’s what you can expect during the test:

1. A healthcare professional will clean the area with an antiseptic
2. An elastic band may be tied around your upper arm to make the vein more visible
3. A needle is inserted into the vein to collect the blood sample
4. The blood is collected in a tube and sent to a laboratory for analysis
5. The whole process usually takes just a few minutes

Is any special preparation required for an ESR test? Generally, no specific preparation is needed. However, it’s important to inform your doctor about any medications or supplements you’re taking, as some can affect the results. Additionally, factors like pregnancy or menstruation should be mentioned as they can influence ESR levels.

Understanding ESR Test Results

ESR test results are typically available within a few hours. The results are reported in millimeters per hour (mm/hr), indicating how far the red blood cells have fallen in one hour. Normal ranges can vary based on age and gender:

• Men under 50: 0-15 mm/hr
• Men over 50: 0-20 mm/hr
• Women under 50: 0-20 mm/hr
• Women over 50: 0-30 mm/hr

What does a high ESR result mean? A higher than normal ESR suggests the presence of inflammation in the body. However, it doesn’t pinpoint the exact location or cause of the inflammation. Some conditions associated with elevated ESR include:

• Infections (including bone infections)
• Autoimmune diseases like lupus or rheumatoid arthritis
• Some types of cancer
• Arteritis (inflammation of blood vessels)
• Polymyalgia rheumatica

Can ESR be too low? While less common, a lower than normal ESR can occur in some conditions like polycythemia, sickle cell anemia, or leukocytosis. However, low ESR results are generally less clinically significant than high results.

Factors Affecting ESR Results

While the ESR test is valuable, several factors can influence the results, potentially leading to false positives or negatives. Understanding these factors is crucial for accurate interpretation:

Factors That Can Increase ESR:

• Pregnancy
• Menstruation
• Advanced age
• Obesity
• Anemia
• Certain medications (e.g., oral contraceptives, vitamin A)

Factors That Can Decrease ESR:

• Polycythemia (increased red blood cell count)
• Some medications (e.g., cortisone, aspirin in high doses)
• Conditions affecting red blood cell shape (e.g., sickle cell anemia)

How do these factors impact diagnosis? Given these potential influences, doctors typically consider ESR results in conjunction with other tests, clinical symptoms, and patient history to make accurate diagnoses.

ESR vs. Other Inflammation Markers

While the ESR test is a valuable tool for detecting inflammation, it’s not the only test available. Another commonly used inflammation marker is C-reactive protein (CRP). How do these tests compare?

ESR vs. CRP:

• ESR changes more slowly in response to inflammation
• CRP levels can rise and fall more rapidly
• CRP is considered more sensitive for detecting acute inflammation
• ESR can be useful for monitoring chronic conditions

Why might a doctor order both tests? Often, doctors will order both ESR and CRP tests to get a more comprehensive picture of inflammation in the body. This combination can provide insights into both acute and chronic inflammatory processes.

Conditions Commonly Diagnosed or Monitored with ESR

The ESR test plays a crucial role in diagnosing and monitoring various conditions. While it’s not specific to any particular disease, it can be especially useful in the context of:

Autoimmune Diseases:

• Rheumatoid Arthritis: ESR can help track disease activity and treatment response
• Systemic Lupus Erythematosus (SLE): Elevated ESR is common during disease flares
• Polymyalgia Rheumatica: Often presents with significantly elevated ESR

Infections:

• Osteomyelitis (bone infection): ESR is often markedly elevated
• Endocarditis: Can cause persistent elevation in ESR
• Tuberculosis: ESR may be used as part of the diagnostic workup

Inflammatory Conditions:

• Temporal Arteritis: Very high ESR is characteristic
• Inflammatory Bowel Disease: ESR can help monitor disease activity

Some Cancers:

• Multiple Myeloma: Often associated with very high ESR
• Lymphoma: Can cause elevated ESR, especially in advanced stages

How does ESR guide treatment decisions? In many of these conditions, ESR is used not just for initial diagnosis but also to monitor disease progression and response to treatment. A decreasing ESR often indicates that treatment is effective, while a rising ESR might suggest a need to adjust the treatment approach.

Limitations and Considerations of the ESR Test

While the ESR test is valuable, it’s important to understand its limitations:

• Non-specificity: ESR can’t pinpoint the exact cause or location of inflammation
• Slow response: ESR changes more slowly than some other inflammation markers
• Influenced by non-inflammatory factors: Age, gender, and certain conditions can affect results
• Not always correlated with disease severity: In some cases, ESR may not accurately reflect the intensity of inflammation

Given these limitations, how do doctors use ESR results effectively? Typically, ESR is interpreted in the context of:

• Patient’s clinical symptoms
• Other laboratory tests (e.g., CRP, complete blood count)
• Imaging studies when appropriate
• Patient’s medical history and risk factors

This comprehensive approach helps ensure that ESR results contribute to accurate diagnoses and effective treatment plans.

Future Perspectives and Research on ESR

While the ESR test has been in use for over a century, research continues to explore its applications and limitations:

Emerging Research Areas:

• Combining ESR with other biomarkers for improved diagnostic accuracy
• Exploring the role of ESR in predicting long-term outcomes in chronic diseases
• Investigating the utility of ESR in less common conditions
• Developing standardized interpretation guidelines across different patient populations

How might future developments impact the use of ESR? As our understanding of inflammation and its role in various diseases evolves, the interpretation and application of ESR results may become more nuanced. This could lead to more personalized approaches in diagnosing and monitoring inflammatory conditions.

Additionally, as new inflammation markers are discovered and validated, the role of ESR may shift. However, its simplicity and low cost are likely to keep it relevant in clinical practice for the foreseeable future.

In conclusion, the erythrocyte sedimentation rate test remains a valuable tool in modern medicine. While it has limitations, when used appropriately and interpreted in context, it provides important insights into inflammatory processes in the body. As research progresses, our understanding and application of ESR results will continue to evolve, potentially opening new avenues for improved patient care and disease management.

ESR Test Results High vs. Low

Written by WebMD Editorial Contributors

• Why You Might Get a Sed Rate
• Taking the Blood Sample
• The Results and What They Mean
• Other Tests You May Need

The sedimentation rate — or “sed rate,” for short — is a blood test that checks for inflammation in your body. It’s one clue for your doctor that you might have a disease linked to inflammation, like arthritis or cancer, or an infection.

The sed rate test measures how fast red blood cells fall to the bottom of a tube. Inflammation creates proteins that make red blood cells fall more quickly.

Another name for this test is erythrocyte sedimentation rate (ESR). Red blood cells are called erythrocytes. Sedimentation is the process by which they fall to the bottom of the tube.

Your doctor might order the sed rate test if you have symptoms like these:

• Headaches
• Stiff, swollen, or painful joints
• Pain in your shoulders, neck, or pelvis
• Appetite loss
• Weight loss without trying

The sed rate test can be part of the process of discovering if you have one of these conditions:

• Infection (including of the bones)
• Cancer
• Arteritis (inflammation of the blood vessels)
• Lupus (an autoimmune disease that damages the skin, joints, and other parts of your body)
• Polymyalgia rheumatica (causes stiff and painful muscles)
• Rheumatoid arthritis (autoimmune disease in which the immune system attacks your joints)
• Systematic vasculitis (inflammation in your blood vessels)

You might also get this test once you’ve started treatment for one of these conditions. The sed rate can help your doctor see how well your body is responding to treatment.

You don’t need to do anything special to prepare. It’s just a basic blood test.

Let your doctor know what medicines (and supplements) you take before you have the test. Certain drugs can affect the results. Also let your doctor know if you are pregnant or are having your period.

A nurse or other health care provider will take a sample of your blood, usually from a vein in your arm. They will first tie a band around the upper part of your arm to make your vein fill with blood and swell up. Then they’ll clean the area with an antiseptic, and place a needle into your vein. Your blood will collect into a vial or tube.

The process should only take a couple of minutes. Afterward, you’ll get a piece of gauze and a bandage over the area to stop the bleeding.

You may feel a slight sting as your blood is drawn. Afterward, you may have a small bruise. You might feel dizzy and sore, and there might be some bleeding.

Your sample will go to a lab. You should have the results in 1 or 2 hours.

A lab technician will place your red blood cells into a tall, thin tube and check how far they fall in 1 hour. When you have inflammation in your body, abnormal proteins in your blood make red blood cells form into clumps. These clumps are heavy, so they fall to the bottom of the tube more quickly than single blood cells.

The faster the blood cells sink, the more inflammation you have in your body.

The sed rate test reports in millimeters (mm) the distance between the clear liquid (plasma) at the top of the tube and your red blood cells after 1 hour. The normal range is:

• 0 to 15 mm/hour in men younger than 50
• 0 to 20 mm/hour in men older than 50
• 0 to 20 mm/hour in women younger than 50
• 0 to 30 mm/hour for women older than 50

A high sed rate is a sign you have a disease that causes inflammation in your body.

Some conditions and medicines can affect the speed at which red blood cells fall, and they may affect your test results. These include:

• Anemia
• Older age
• Kidney problems
• Thyroid disease
• Pregnancy or having your period
• Obesity
• Drugs like birth control pills, methyldopa (Aldomet), theophylline (Theo-24, Theolair, Elixophylline), vitamin A, cortisone, and quinine

The sed rate test can only tell your doctor that you have inflammation somewhere in your body. It can’t show where the inflammation is or what caused it. Your doctor may also test for your erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) to help make a diagnosis. Both are acute phase reactants or inflammatory markers which can help point to a diagnosis or help follow treatment in a diagnosis. You will still need imaging or even biopsyies to make a specific diagnosis.

Talk to your doctor about the results of your sed rate test, and any other tests you have. Make sure you understand what the results mean, and how they’ll affect your treatment.

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ESR Blood Test (Erythrocyte Sedimentation Rate)

Test Quick Guide

The erythrocyte sedimentation rate, also known as ESR, is based on how quickly red blood cells (RBCs) settle inside a test tube.

An ESR test is used to assess inflammation in the body. Many conditions can cause an abnormal ESR, so an ESR test is typically used with other tests to diagnose and monitor different diseases.

About the Test

Purpose of the test

The main purpose of an ESR test is to detect abnormal levels of inflammation in the body. Measuring ESR is primarily used for diagnosis and monitoring of different health conditions:

• Diagnosis is the process of finding the cause of a patient’s symptoms. Because many health problems can cause an ESR test to be abnormal, the test alone cannot diagnose conditions. However, when combined with other tests, an ESR test may help detect infections, autoimmune diseases, blood disorders, kidney disease, and many other health problems.
• Monitoring is the process of periodically assessing a patient’s health after a diagnosis. An ESR test may be used periodically to see how inflammatory health conditions change over time. It can also help assess a patient’s response to treatments for certain disorders.

It is important to talk with your health care provider for more details about the specific purpose of ESR testing in your situation.

What does the test measure?

An ESR test measures how fast RBCs, also known as erythrocytes, fall to the bottom of a test tube. The falling of these cells is called sedimentation, which is measured in millimeters per hour (mm/h).

When should I get an erythrocyte sedimentation test?

An ESR test may be appropriate if you have unexplained symptoms like a fever, muscle or joint pain, or other problems without a clear cause. In these situations, an ESR is usually combined with other tests, such as a complete blood count, comprehensive metabolic panel, and arthritis tests, to evaluate your overall health and look for signs of specific health problems.

Your doctor may also recommend an ESR test to help track your health if you have previously been diagnosed or received treatment for infections, autoimmune diseases, or other inflammatory health conditions.

Finding an Erythrocyte Sedimentation Rate Test

How can I get a test?

An ESR test requires a blood sample and is typically conducted at a doctor’s office, urgent care facility, or hospital. The test usually has to be ordered by a health care provider. The person conducting the test will either be a phlebotomist who is trained to draw blood or another health care professional.

You can also order an ESR test online with the blood draw and testing performed by a Clinical Laboratory Improvement Amendments (CLIA) approved lab.

Can I take the test at home?

An ESR test typically cannot be conducted at home. It has to be done by a trained medical professional in a medical setting where the blood can be quickly analyzed after it has been drawn. It is possible to use a mobile phlebotomy service, but there are no self-collection tests available

How much does the test cost?

The price of an ESR test varies based on where you have the test done and whether you have health insurance. The cost of the test may increase if you have other tests performed along with an ESR.

If you want to know more about the cost of the procedure and how much your insurance covers, contact your insurance company. If you do not have any kind of health insurance coverage, you can ask the testing facility about any available financial assistance programs for the uninsured.

Taking an Erythrocyte Sedimentation Test

The ESR test is performed with a sample of blood that is drawn from a vein in your arm. The blood draw process is typically carried out in a medical office, lab testing site, or hospital.

Before the test

There is no special test preparation required for an ESR test. Before the test, make sure to tell your doctor about any drugs or supplements that you take because some medications may affect your results.

During the test

The blood draw for an ESR test usually only takes a few minutes to perform.

The health professional taking your blood sample will start by using an alcohol wipe to clean a small area of your skin near a vein. A needle will then be inserted into the vein, and blood will be drawn into an attached tube. Once enough blood has been drawn, the needle is removed.

There may be some pain, such as a pinch or sting, when the needle pierces the skin and is removed from your arm.

After the test

Most people do not have any negative reactions to an ESR test, but you may have some bruising or tenderness around the puncture site. There are no activity restrictions after the test, but contact your doctor if you notice any signs of infection such as redness, swelling, or persistent pain.

Erythrocyte Sedimentation Rate Test Results

Receiving test results

An ESR test is usually performed within a couple of hours after your blood is drawn, and the RBCs in the test tube are monitored for one hour to determine the ESR.

Once the results are available, you may receive a test report by mail or electronically. Your doctor may also contact you to discuss your ESR test results.

If multiple tests are being performed along with the ESR test, your doctor may wait for all the results to be available before discussing the results with you. This allows them to interpret the test results together.

Interpreting test results

The ESR is reported in millimeters per hour (mm/h) and reflects how quickly the RBCs in your sample fall toward the bottom of a test tube.

There is no universal definition of a normal ESR. Age, sex, and other factors can influence ESR, so there is no reference range for this test that applies to all people.

Instead, the results of testing are interpreted based on an individual’s situation. This includes considering their symptoms and the results of any other tests that have been performed.

If an ESR is abnormally high, it means that the RBCs fell faster than expected. This usually happens when the RBCs have more protein within them, which causes them to stick together.

Many conditions can cause an ESR to become elevated. Most often, an elevated ESR is related to conditions that cause inflammation, but it can also be caused by other health problems. Examples of conditions that can cause an abnormally high ESR include:

• Infections
• Autoimmune conditions like lupus and rheumatoid arthritis
• Anemia
• Kidney or thyroid disease
• Some types of cancer
• Tissue injury or trauma

It is also possible for the ESR to be lower than expected. This may be caused by conditions such as:

• RBC disorders
• Heart failure
• Some liver and kidney problems

It is important to remember that an ESR test alone cannot diagnose any disease or medical condition. It must be used in conjunction with other tests to detect and monitor health problems. An ESR test should always be interpreted by a doctor who can explain its significance.

When going over your test results with the doctor, the following questions can be helpful:

• Did the test detect any abnormalities?
• If so, what kind of abnormal result was detected?
• What is the most likely explanation for my test result?
• What other tests were conducted along with the ESR?
• Do I need any follow-up testing?

• C Reactive Protein (CRP Blood Test)
  Learn More
• CBC Blood Test (Complete Blood Count)
  Learn More
• CMP Blood Test (Comprehensive Metabolic Panel)
  Learn More

Resources

• National Library of Medicine: Autoimmune Disorders
• National Library of Medicine: Blood Disorders
• National Library of Medicine: Immune Response

Sources

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Erythrocyte sedimentation rate (ESR)

Test that evaluates the rate of separation of blood into plasma and erythrocytes. The rate of separation is mainly determined by the degree of their aggregation, i.e., the ability to stick together with each other.

Russian synonyms

Erythrocyte sedimentation test, ROE, ESR.

Synonyms English

Erythrocyte sedimentation rate, Sed rate, Sedimentation rate.

Test method

Capillary photometry method.

Units

mm/h (millimeter per hour).

What biomaterial can be used for research?

Venous, capillary blood.

How to properly prepare for an examination?

• Eliminate alcohol from the diet for 24 hours prior to the study.
• Do not eat for 2-3 hours before the test (you can drink pure non-carbonated water).
• Stop taking medications 24 hours before the study (as agreed with the doctor).
• Exclude physical and emotional overexertion within 30 minutes prior to the study.
• Do not smoke for 30 minutes before the test.

General information about the study

Erythrocyte sedimentation rate (ESR) is an indirect method for detecting an inflammatory, autoimmune or oncological disease. It is performed on a sample of venous or capillary blood, which has been added to a substance that allows it not to clot (anticoagulant). When analyzing ESR by the Panchenkov method, blood is placed in a thin glass or plastic tube and monitored for an hour. At this time, erythrocytes (red blood cells), as having a large specific gravity, settle, leaving a column of transparent plasma above them. According to the distance from the upper border of the plasma to the erythrocytes, the ESR is calculated. Normally, red blood cells settle slowly, leaving very little pure plasma. For this method, a Panchenkov apparatus is used, consisting of a stand and capillary pipettes with a scale of 100 mm.

Capillary photometry (automatic analyzers ROLLER, TEST1) uses the “stopped jet” kinetic method. At the beginning of the ESR analysis, a programmed mixing of the sample takes place in order to disaggregate the erythrocytes. Ineffective disaggregation or the presence of microclots can affect the final result, since the analyzer actually measures the kinetics of erythrocyte aggregation. In this case, the measurement takes place in the range from 2 to 120 mm / h. The results of measuring ESR by this method have a high correlation with the Westergren method, which is the reference for determining ESR in the blood, and the same reference values.

The results obtained when using the method of capillary photometry, in the region of normal values, coincide with the results obtained when determining the ESR by the Panchenkov method. However, the capillary photometry method is more sensitive to an increase in ESR, and the results in the zone of elevated values ​​are higher than the results obtained by the Panchenkov method.

An increase in the level of pathological proteins found in the liquid part of the blood, as well as some other proteins (the so-called acute phase proteins that appear during inflammation) contributes to the “gluing” of erythrocytes. Because of this, they settle faster and ESR rises. It turns out that any acute or chronic inflammation can lead to an increase in ESR in the blood.

The fewer red blood cells, the faster they settle, so women have a higher ESR than men. The norm of ESR is different depending on gender and age.

What is research used for?

• For the diagnosis of diseases associated with acute or chronic inflammation, including infections, cancers and autoimmune diseases. The determination of ESR is sensitive, but one of the least specific laboratory tests, since an increase in ESR in the blood alone does not allow determining the source of inflammation, in addition, it can occur not only due to inflammation. That is why the ESR analysis is usually used in combination with other studies.

When is the test ordered?

• For diagnostics and monitoring:
  • inflammatory diseases,
  • infectious diseases,
  • oncological diseases,
  • autoimmune diseases.
• When conducting preventive examinations in conjunction with other studies (general blood count, leukocyte formula, etc.).

What do the results mean?

Reference values ​​

The results of this test must be interpreted in the light of clinical findings, medical history, and other tests.

Causes of increased ESR in the blood

• Infectious diseases (usually a bacterial cause). ESR can increase in both acute and chronic infectious diseases.
• Inflammatory diseases.
• Connective tissue diseases (rheumatoid arthritis, systemic lupus erythematosus, systemic scleroderma, vasculitis).
• Inflammatory bowel disease (Crohn’s disease, ulcerative colitis).

1. Oncological diseases:
   1. Myeloma. As a rule, it is accompanied by a very high level of ESR in the blood, because with it pathological proteins are synthesized in large quantities, which cause the formation of erythrocyte “coin columns”.
   2. Hodgkin’s disease is a malignant disease of the lymph nodes. The ESR indicator is usually used not to make a diagnosis, but to monitor the course and effectiveness of treatment of an already diagnosed disease.
   3. Cancer of various localizations, especially hemoblastoses. It is believed that an extremely high level of ESR in the blood indicates the spread of the tumor beyond the primary focus (i. e., metastases).

• Myocardial infarction. With it, damage to the heart muscle occurs, which causes a systemic inflammatory response and, accordingly, an increase in ESR. After a heart attack, ESR peaks about a week later.
• Anemia. A decrease in the number of erythrocytes can lead to an increase in their sedimentation rate.
• Burns, injuries.
• Amyloidosis is a disease associated with the accumulation of an abnormal protein in tissues.

Causes of reduced ESR in the blood

• Diseases accompanied by a change in the shape of red blood cells, such as sickle cell anemia or hereditary spherocytosis (they make it difficult for red blood cells to settle).
• Polycythemia (an increase in the number of red blood cells) and conditions that lead to it, such as, for example, chronic heart failure or lung disease.

What can influence the result?

1. ESR in women tends to increase during pregnancy and menstruation.
2. Oral contraceptives, theophylline, vitamin A supplementation may increase ESR.
3. The administration of corticosteroids and the administration of albumin can reduce the ESR in the blood.

Important notes

• ESR analysis is one of the least specific laboratory tests – an increase in ESR in the blood can be observed in many diseases, and this indicator alone cannot make a diagnosis.
• Sometimes high ESR can be observed in healthy people.
• Normal ESR does not rule out cancer or connective tissue disease.

Also recommended

• C-reactive protein (quantitative)
• Rheumatoid factor
• Complete blood count (without leukocyte formula and ESR)
• Leukocyte formula

Who orders the examination?

Therapist, oncologist, hematologist, infectious disease specialist.

What shows a high ESR in a blood test in women after 50 years, an increased ESR in a child

The abbreviation of ESR means “erythrocyte sedimentation rate”, measured in millimeters per hour. (In the old reference books, this analysis was called ROE). The study is based on a process caused by gravitational forces. Since red blood cells are heavier than other blood elements, they are the first to precipitate. Their counting in a vertically installed test tube in an hour is the basis of the analysis.

The rate at which erythrocytes sink to the bottom depends on many factors, both physiological and pathological. ESR values ​​differ depending on age, gender. Changes in indicators are possible due to the peculiarities of nutrition, the patient’s course of treatment with certain types of medications, corticosteroids, anti-inflammatory drugs.

Knowing what a high ESR shows is especially important, since exceeding the standards most often indicates in favor of the development of a particular disease. High ESR numbers may indicate the presence of oncopathology in the body, an inflammatory process, an infectious, rheumatological, anemia. The indicator will exceed the norm for myocardial infarction, trauma, allergies, pregnancy.

Despite the fact that ESR is a non-specific indicator, the diagnostic value of the study is enormous. It is due to its high sensitivity. A change in this indicator is noted already in the early stages of the development of the pathological process, when other analyzes are not yet informative, they remain normal. An elevated ESR in a blood test is a reason to continue the examination, to clarify the situation.

Why the value of the parameter rises

Reasons why the value of the ESR parameter rises in normal women:

• menstrual period;
• use of oral contraceptives;
• pregnancy;
• postpartum period.

In a woman after 50 years of age, the passion for ESR is associated with hormonal changes in the body when menopause approaches.

In a child, the value of the ESR index depends on his age. In a newborn, the maximum value is 2.8 mm / h, which is associated with a very low concentration of protein in the blood, which means that the erythrocytes do not have conditions for rapid sedimentation.