Both the International Congress for Standardisation in Haematology (ICSH) and the Clinical Laboratory Standards Institute in the USA (CLSI) state that reference values for the ESR or Sed-rate should be established ‘locally’. This is because variations occur between different areas of the world depending on age, diet, state of general health, ethnic origins, etc. It should also be noted that the ICSH (2011) state that several other variables influence the ESR and may therefore affect physiological reference values, most notably haemoglobin concentration, medication, menstrual cycle, pregnancy and smoking. (1)
What this means for the individual laboratory must be determined by reference to the relevant documentation supplied by the country in which the testing site is established.
For example: in the USA testing sites should refer to the CLSI documentation, currently H02-A5. (2)
In the UK and most of Europe the ICSH guidance should be followed. In countries where no specific National Guidance or values are available the testing site should follow ICSH guidance (i.e. the ‘International’ guidance) or refer to standard textbooks such as Practical Haematology by Dacie and Lewis.
The table below is shown only as very general guidance and must only be taken in context with what has been written above. The information is based on the CLSI table published in document H02-A5, approved in May 2011. (2)
It should be further noted that in childhood and adolescence the ESR (Sed Rate) is the same as for normal men with no differences between boys and girls. (3)
Age in Years
18 - 30
31 - 40
41 - 50
51 - 60
61 - 70
Male (Upper Limit)
Female (Upper Limit)
1 Jou, J.M., Lewis, S.M., Briggs, C., et al. ICSH review of the measurement of the erythrocyte sedimentation rate: Int. J. Lab Haem, 2011: 33,125-132
2 Clinical and Laboratory Standards Institute (CLSI), Procedures for the Erythrocyte Sedimentation Rate Test; Approved Standard-Fifth Edition. H02-A5, May 2011. ISBN 1-56238-754-5.
3 Dacie & Lewis, Practical Haematology, 6th Edition 1984. Published by Churchill Livingstone. Page 421.