ESR 37 mm/hr means : is it normal, good, bad or dangerous?

In this article we discuss what an ESR of 37 means, together with its causes, false elevations and whether it is good, bad or normal. We also delve into reasons for false elevation of ESR, and explain the significance of an ESR of 37 in pregnancy. We conclude with the ESR to CRP ratio that can help distinguish an infection from SLE.

What is ESR?

How is ESR measured?

To measure Erythrocyte Sedimentation Rate (ESR), a healthcare professional collects a small blood sample from the patient's arm, typically from a vein. Before the blood draw, the selected area is cleaned with an antiseptic solution to minimize the risk of infection. The collected blood is then mixed with an anticoagulant to prevent clotting. Subsequently, the blood is placed in a tall, thin tube and positioned upright to allow the red blood cells to settle over a specified period, often one hour. The distance the red blood cells travel in the tube during this time is measured, and the settling rate is recorded. The Westergren method, a common approach to ESR measurement, involves utilizing a specialized Westergren tube for blood collection. In preparation for the test, patients are typically advised to inform their healthcare provider about any medications they are taking, as certain drugs can affect the results. While fasting is not obligatory for ESR, maintaining hydration is recommended to facilitate a smoother blood draw and ensure accurate results. ESR serves as a valuable diagnostic tool, aiding healthcare professionals in evaluating inflammatory conditions within the body.

What is the normal range of ESR and how is an ESR of 37 graded?

Different sources mention slightly different normal ranges for ESR. The normal range also varies slightly based on the method of measurement. When measured by the Westergren method, the normal range for ESR is mentioned below for adult males, adult females and children.

Normal Range and Grading for Adult Males : ESR 37

Range	Classification	Comments
0 to 20	Normal
20-80	Elevated	You are here
>80	Very High

Normal Range and Grading for Adult Women : ESR 37

Range	Classification	Comments
0 to 20	Normal
20 to 30	Normal above 50 years of age, slightly elevated below 50 years of age
30-80	Elevated	You are here
>80	Very High

Normal Range and Grading for Children : ESR 37

Range	Classification	Comments
0 to 10	Normal
10-80	Elevated	You are here
>80	Very High

What does an ESR of 37 mm/hr mean?

An ESR level of 37 is considered to be above normal or elevated. Whilst, this may not be an immediate cause for worry, you should get a detailed physical and medical examination from a qualified medical practitioner. There are numerous reasons why the ESR may be above normal that are themselves normal, which are termed physiological causes, these are listed in a subsequent section.

Is an ESR of 37 mm/hr good?

An ESR of 37 is not a good value. In adults, or children this value is above normal and needs investigating.

Is an ESR of 37 mm/hr bad?

An ESR of 37 is bad in all populations and should be further investigated.

Is an ESR of 37 mm/hr dangerous?

An ESR of 37 is elevated but not necessarily dangerous

Is an ESR of 37 mm/hr normal?

An ESR of 37 is not normal and is classified as elevated.

What are the causes of an ESR of 37 mm/hr?

An ESR of 37 can have various causing including the following

Infection

Both acute and chronic infections can lead to an increased ESR.

HIV/AIDS

The human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) can lead to immune system dysfunction and inflammation.

Inflammation

Any inflammatory condition in the body can cause an elevation in ESR.

Certain Cancers

Some cancers, especially those associated with inflammation, can cause an increase in ESR.

Obesity

Higher body mass index (BMI) has been associated with increased ESR.

Dehydration

Though less common, dehydration can affect blood viscosity and ESR.

Chronic Kidney Disease

Impaired kidney function can lead to higher ESR levels.

Myeloma

A type of cancer that affects plasma cells in the bone marrow.

Pregnancy

ESR levels can be higher during pregnancy.

Bronchiectasis

A chronic lung condition characterized by damaged airways.

Systemic Lupus Erythematosus

An autoimmune disease that can affect multiple organs.

Sickle Cell Anemia

A genetic blood disorder affecting red blood cells.

What are the causes for a falsely elevated ESR value of 37?

There are certain normal or physiological conditions in which the ESR May be falsely elevated or elevated without any abnormality.

Smoking

Smoking has been associated with higher ESR levels in some individuals. The chemicals in tobacco smoke can induce inflammation and oxidative stress, contributing to an elevated ESR. Quitting smoking has numerous health benefits, including potential improvements in inflammatory markers.

Hormonal Fluctuations

Beyond the menstrual cycle, fluctuations in hormonal levels can occur due to various factors, including stress, medication changes, or natural hormonal variations. These hormonal shifts may influence the inflammatory response and contribute to variations in ESR levels.

Hormonal Contraceptives

The use of hormonal contraceptives can impact hormonal levels in the body, potentially affecting the inflammatory response. This can lead to variations in ESR levels in some individuals. It's important for healthcare providers to consider these factors when interpreting ESR results in individuals using hormonal contraceptives.

Obesity

Obesity is linked to chronic low-grade inflammation, and individuals with higher body mass indexes (BMIs) may experience elevated ESR levels. Adipose tissue releases inflammatory molecules, influencing the overall inflammatory status in the body. Maintaining a healthy weight is crucial for overall well-being.

Race/Ethnicity

ESR levels can exhibit variations among different racial and ethnic groups. Genetic and environmental factors specific to certain populations may contribute to these differences. However, individual health and lifestyle choices remain crucial factors influencing ESR levels.

Genetic Factors

Genetic variations can contribute to individual differences in baseline ESR levels. While genetics play a role, lifestyle factors and overall health also significantly influence ESR. Understanding genetic predispositions can provide insights into an individual's inflammatory response.

Menstrual Cycle

Throughout the menstrual cycle, hormonal fluctuations, especially variations in estrogen levels, can influence the inflammatory response in the body, leading to periodic changes in ESR. This is particularly noticeable during the menstrual period.

Dehydration

Dehydration can result in reduced plasma volume, affecting blood viscosity. This change in blood composition may lead to an elevation in ESR. It's essential to maintain proper hydration levels for overall health and accurate blood test results.

Circadian Rhythms

ESR levels can vary throughout the day due to natural circadian rhythms. The body's internal clock influences various physiological processes, including inflammation. Understanding these fluctuations helps in interpreting ESR results accurately.

Altitude Changes

Changes in altitude can impact oxygen levels in the blood, influencing the inflammatory response. These altitude-related changes may contribute to variations in ESR levels. Adjusting to altitude and maintaining proper hydration are important considerations.

Mild Infections

Low-grade or chronic infections may result in a subtle increase in ESR. The immune system responds to even minor infections by releasing inflammatory markers, influencing ESR levels. Monitoring for signs of infection and addressing underlying causes is crucial.

Lack of Physical Activity

A sedentary lifestyle or lack of physical activity can impact overall health, including inflammatory markers like ESR. Regular exercise has anti-inflammatory effects and is crucial for maintaining a healthy balance in the body's immune response.

What does an ESR of 37 in pregnancy mean?

The normal range of ESR during pregnancy is different in the different months or trimesters of pregnancy. This is because pregnancy causes a small rise in the ESR, which is considered normal. The following table lists the normal ranges.

Trimester	Lower Limit	Upper Limit
1st	4	57
2nd	7	47
3rd	13	70

Based on these criteria, your ESR of 37 can be classified as below.
If you are in the first three months of pregnancy an ESR of 37 is normal
If you are in the second trimester or months 3-6 of pregnancy an ESR of 37 is normal
If you are in the third trimester or months 7-9 of pregnancy an ESR of 37 is normal

What are the symptoms of an ESR of 37 ?

ESR itself does not cause any direct symptoms. The symptoms of ESR are due the underlying disease process. The following is a list of symptoms that may be associated with an ESR of 37

Vision Changes

Blurred vision or other visual disturbances.

Swollen Lymph Nodes

Enlarged and tender lymph nodes.

Cough

Persistent or chronic coughing.

Digestive Issues

Irregular bowel movements, diarrhea, or constipation.

Dizziness

Feeling lightheaded or unsteady.

Abnormal Blood Counts

Changes in white blood cell count or other blood parameters.

Skin Rashes

Unexplained skin eruptions or changes.

Nausea and Vomiting

Feeling of sickness and vomiting.

Difficulty Sleeping

Insomnia or disrupted sleep patterns.

Headaches

Recurrent or persistent headaches.

Loss of Appetite

Decreased desire to eat.

Photosensitivity

Increased sensitivity to sunlight.

Night Sweats

Excessive sweating during sleep.

Fever

Elevated body temperature beyond normal range.

Neurological Symptoms

Tingling, numbness, or weakness.

Muscle Aches

Generalized or localized pain in muscles.

Unexplained Weight Loss

Losing weight without intentional changes in diet or exercise.

Mouth Ulcers

Sores in the mouth that may be painful.

Frequent Urination

Increased need to urinate.

Fatigue

Persistent tiredness and lack of energy.

Abdominal Pain

Discomfort or pain in the abdominal region.

Joint Pain

Discomfort, swelling, or stiffness in the joints.

Cognitive Impairment

Memory problems or difficulty concentrating.

Shortness of Breath

Difficulty breathing or breathlessness.

Recurrent Infections

Frequent or persistent infections.

Hair Loss

Unexplained loss of hair.

Which foods can reduce an ESR of 37 mm/hr?

Based on a study by Hulander et al, eating foods that lower inflammation can lead to a lowered value of ESR. The following foods can be consumed to try to reduce inflammation.

Fruits

Various fruits, including citrus fruits and berries, are packed with vitamins, minerals, and antioxidants. Their consumption is associated with reduced inflammation, aligning with the Mediterranean diet's focus on whole, nutrient-dense foods.

Whole Grains

Whole grains are a key component of the Mediterranean diet, providing essential nutrients and fiber. They contribute to reducing inflammation and promoting overall health.

Vegetables

A diverse array of vegetables is a cornerstone of the Mediterranean diet. They provide essential nutrients and phytochemicals that contribute to reducing inflammation and supporting overall health.

Probiotics

Foods enriched with probiotics, like yogurt and fermented products, support a healthy gut microbiome. A balanced gut contributes to reduced inflammation and improved overall well-being, aligning with the principles of the Mediterranean diet.

Fatty Fish

Fatty fish, such as salmon and mackerel, are rich in omega-3 fatty acids. These acids have anti-inflammatory properties, making fatty fish an excellent choice in the Mediterranean diet to combat inflammation.

Nuts

Nuts, like almonds and walnuts, are rich in healthy fats and antioxidants. They contribute to the anti-inflammatory effects of the Mediterranean diet, supporting heart health and overall well-being.

What other tests should be done with an ESR of 37 mm/hr ?

For an ESR of 37, other tests can be done to further ascertain the immune status of the body, as well as rule out infections or malignancies if any.
The following table lists other tests that can be done.

Lab Tests Related to ESR

Test	Description
High Sensitivity CRP	High Sensitivity C-Reactive Protein (CRP) test measures inflammation in the body.
LDH	Lactate Dehydrogenase (LDH) test assesses tissue damage and disease and inflammation in the body
Ferritin	Ferritin test measures the levels of iron storage in the body, as well as the level of inflammation in the body.

What is the ESR to CRP ratio and why does it matter?

The ESR to CRP ratio is the ratio of the Erythryocyte Sedimentation Rate in mm/hr to the C-Reactive Protein Value. The ratio has value in patients with Systemic Lupus Erythematosus. If the value is below 2 it indicates that the patient has an infection in addition to the SLE. If the value is above 15 it is more likely to be a flare up of SLE. You can find the ratio calculated for various values of CRP given your ESR value of 37

What is my ESR:CRP ratio for an ESR of 37 mm/hr ?

ESR	CRP	Ratio	Means
37	1.0	37.0	More likely to be autoimmune disease flareup of SLE
37	1.5	24.666666666666668	More likely to be autoimmune disease flareup of SLE
37	2.0	18.5	More likely to be autoimmune disease flareup of SLE
37	2.5	14.8	Inconclusive
37	3.0	12.333333333333334	Inconclusive
37	3.5	10.571428571428571	Inconclusive
37	4.0	9.25	Inconclusive
37	4.5	8.222222222222221	Inconclusive
37	5.0	7.4	Inconclusive
37	5.5	6.7272727272727275	Inconclusive
37	6.0	6.166666666666667	Inconclusive
37	6.5	5.6923076923076925	Inconclusive
37	7.0	5.285714285714286	Inconclusive
37	7.5	4.933333333333334	Inconclusive
37	8.0	4.625	Inconclusive
37	8.5	4.352941176470588	Inconclusive
37	9.0	4.111111111111111	Inconclusive
37	9.5	3.8947368421052633	Inconclusive
37	10.0	3.7	Inconclusive
37	10.5	3.5238095238095237	Inconclusive
37	11.0	3.3636363636363638	Inconclusive
37	11.5	3.217391304347826	Inconclusive
37	12.0	3.0833333333333335	Inconclusive
37	12.5	2.96	Inconclusive
37	13.0	2.8461538461538463	Inconclusive
37	13.5	2.740740740740741	Inconclusive
37	14.0	2.642857142857143	Inconclusive
37	14.5	2.5517241379310347	Inconclusive
37	15.0	2.466666666666667	Inconclusive
37	15.5	2.3870967741935485	Inconclusive
37	16.0	2.3125	Inconclusive
37	16.5	2.242424242424242	Inconclusive
37	17.0	2.176470588235294	Inconclusive
37	17.5	2.1142857142857143	Inconclusive
37	18.0	2.0555555555555554	Inconclusive
37	18.5	2.0	More likely to be infection
37	19.0	1.9473684210526316	More likely to be infection
37	19.5	1.8974358974358974	More likely to be infection
37	20.0	1.85	More likely to be infection
37	20.5	1.8048780487804879	More likely to be infection
37	21.0	1.7619047619047619	More likely to be infection
37	21.5	1.7209302325581395	More likely to be infection
37	22.0	1.6818181818181819	More likely to be infection
37	22.5	1.6444444444444444	More likely to be infection
37	23.0	1.608695652173913	More likely to be infection
37	23.5	1.574468085106383	More likely to be infection
37	24.0	1.5416666666666667	More likely to be infection
37	24.5	1.510204081632653	More likely to be infection
37	25.0	1.48	More likely to be infection
37	25.5	1.4509803921568627	More likely to be infection
37	26.0	1.4230769230769231	More likely to be infection
37	26.5	1.3962264150943395	More likely to be infection
37	27.0	1.3703703703703705	More likely to be infection
37	27.5	1.3454545454545455	More likely to be infection
37	28.0	1.3214285714285714	More likely to be infection
37	28.5	1.2982456140350878	More likely to be infection
37	29.0	1.2758620689655173	More likely to be infection
37	29.5	1.2542372881355932	More likely to be infection

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