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Westergren pipet array on StaRRsed automated ESR analyzer sedimentation rate, Westergren ESR The erythrocyte sedimentation rate ( ESR or sed rate) is the rate at which sediment in a period of one hour. It is a common test, and is a non-specific measure of. To perform the test, anticoagulated is traditionally placed in an upright tube, known as a Westergren tube, and the rate at which the fall is measured and reported in mm at the end of one hour.

Since the introduction of into the clinical laboratory, the ESR test has been automatically performed. The ESR is governed by the balance between pro-sedimentation factors, mainly, and those factors resisting sedimentation, namely the negative charge of the erythrocytes (). When an inflammatory process is present, the high proportion of fibrinogen in the blood causes red blood cells to stick to each other. The red cells form stacks called ',' which settle faster, due to their increased density.

Rouleaux formation can also occur in association with some lymphoproliferative disorders in which one or more are secreted in high amounts. Rouleaux formation can, however, be a normal physiological finding in horses, cats, and pigs. The ESR is increased in inflammation,,, autoimmune disorders (such as and ), infections, some kidney diseases and some cancers (such as and ). The ESR is decreased in,,,, low plasma protein (due to liver or kidney disease).

Although increases in immunoglobulins usually increase the ESR, very high levels can reduce it again due to hyperviscosity of the plasma. This is especially likely with IgM-class paraproteins, and to a lesser extent, IgA-class. The basal ESR is slightly higher in females.

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