ESR 64 mm/hr means : is it normal, good, bad or dangerous?

In this article we discuss what an ESR of 64 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 64 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?

The measurement of Erythrocyte Sedimentation Rate (ESR) involves the collection of a small blood sample from the patient's arm, typically drawn from a vein. Before the blood draw, the area is meticulously cleaned with an antiseptic solution to maintain sterility. Following the collection, the blood is mixed with an anticoagulant to prevent clotting. Subsequently, the prepared blood sample is placed in a tall, thin tube, which is then positioned upright. This allows red blood cells to settle over a specified period, usually 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 commonly employed technique for ESR measurement, uses a specialized Westergren tube for blood collection. To prepare for the test, patients are generally advised to inform their healthcare provider about any medications they are taking, as certain drugs can impact the results. While fasting is not obligatory for ESR, maintaining adequate hydration is recommended to ensure a smooth blood draw and accurate results. ESR is a vital diagnostic tool, offering healthcare professionals valuable insights into inflammatory conditions within the body.

What is the normal range of ESR and how is an ESR of 64 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 64

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

Normal Range and Grading for Adult Women : ESR 64

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 64

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

What does an ESR of 64 mm/hr mean?

An ESR level of 64 is considered to be significantly elevated. A cause must be found for the elevated ESR, while ruling out normal or physiological causes. An ESR between 50 and 80, is definitely not normal and must be further investigated together with additional tests, that are listed in a subsequent section.

Is an ESR of 64 mm/hr good?

An ESR of 64 is not a good value. In adults, or children this value is above normal and needs investigating.

Is an ESR of 64 mm/hr bad?

An ESR of 64 is bad in all populations and should be further investigated.

Is an ESR of 64 mm/hr dangerous?

An ESR of 64 is elevated but not necessarily dangerous

Is an ESR of 64 mm/hr normal?

An ESR of 64 is not normal and is classified as elevated.

What are the causes of an ESR of 64 mm/hr?

An ESR of 64 can have various causing including the following

Aging

ESR tends to increase with age, and mild elevation may be normal in elderly individuals.

Autoimmune Disorders

Conditions like rheumatoid arthritis and systemic lupus erythematosus can cause inflammation and elevate ESR.

Sickle Cell Anemia

A genetic blood disorder affecting red blood cells.

Temporal Arteritis

An inflammatory condition affecting the blood vessels.

Rheumatoid Arthritis

A chronic inflammatory disorder affecting the joints.

Polymyalgia Rheumatica

An inflammatory disorder that commonly affects older adults.

Inflammatory Bowel Disease

Conditions like Crohn's disease and ulcerative colitis can cause elevated 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.

Thyroid Disorders

Both hyperthyroidism and hypothyroidism can influence ESR levels.

Bronchiectasis

A chronic lung condition characterized by damaged airways.

Myeloma

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

What are the causes for a falsely elevated ESR value of 64?

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

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.

Blood Donation

Recent blood donation can lead to a temporary decrease in the number of red blood cells, affecting blood viscosity. This change may contribute to a transient increase in ESR. Understanding the timing of blood donation is essential for accurate interpretation of ESR results.

Strenuous Exercise

Intense physical activity, especially when not part of the routine, can cause muscle and tissue damage, triggering an inflammatory response. This acute inflammation can lead to a temporary increase in ESR. Regular exercise, however, generally has a positive impact on overall health.

Menopause

The hormonal changes associated with menopause, including a decline in estrogen levels, can impact the inflammatory response in the body. These changes may contribute to alterations in ESR levels, reflecting the natural physiological transition of menopause.

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.

Sleep Patterns

Disruptions in sleep patterns, including irregular sleep duration and quality, can influence the body's inflammatory response. Sleep deprivation or poor sleep hygiene may contribute to elevated ESR levels. Prioritizing good sleep habits is essential for overall health.

Temperature Changes

Extreme temperatures, whether due to fever or exposure to cold, can affect the viscosity of blood. These temperature-related changes can influence ESR levels. Monitoring body temperature and addressing the underlying cause is important for accurate interpretation of ESR results.

Emotional Factors

Emotional stress and psychological factors can influence the body's inflammatory response, potentially leading to a temporary increase in ESR. The mind-body connection underscores the importance of mental health for overall well-being.

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.

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.

Dietary Factors

Nutritional status can influence ESR levels. Dietary factors such as certain vitamins, minerals, and antioxidants play a role in modulating the inflammatory response. A well-balanced and nutrient-rich diet is essential for maintaining overall health, including appropriate ESR levels.

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.

What does an ESR of 64 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 64 can be classified as below.
If you are in the first three months of pregnancy an ESR of 64 is elevated
If you are in the second trimester or months 3-6 of pregnancy an ESR of 64 is elevated
If you are in the third trimester or months 7-9 of pregnancy an ESR of 64 is normal

What are the symptoms of an ESR of 64 ?

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 64

Frequent Urination

Increased need to urinate.

Muscle Aches

Generalized or localized pain in muscles.

Fever

Elevated body temperature beyond normal range.

Dizziness

Feeling lightheaded or unsteady.

Neurological Symptoms

Tingling, numbness, or weakness.

Shortness of Breath

Difficulty breathing or breathlessness.

Loss of Appetite

Decreased desire to eat.

Unexplained Weight Loss

Losing weight without intentional changes in diet or exercise.

Headaches

Recurrent or persistent headaches.

Depression

Persistent feelings of sadness or hopelessness.

Cough

Persistent or chronic coughing.

Recurrent Infections

Frequent or persistent infections.

Mouth Ulcers

Sores in the mouth that may be painful.

Cognitive Impairment

Memory problems or difficulty concentrating.

Difficulty Sleeping

Insomnia or disrupted sleep patterns.

Abnormal Blood Counts

Changes in white blood cell count or other blood parameters.

Fatigue

Persistent tiredness and lack of energy.

Dry Eyes and Mouth

Symptoms of Sjögren's syndrome.

Vision Changes

Blurred vision or other visual disturbances.

Digestive Issues

Irregular bowel movements, diarrhea, or constipation.

Abdominal Pain

Discomfort or pain in the abdominal region.

Skin Rashes

Unexplained skin eruptions or changes.

Chest Pain

Pain or discomfort in the chest area.

Photosensitivity

Increased sensitivity to sunlight.

Irregular Menstrual Cycles

Changes in menstrual patterns for women.

Night Sweats

Excessive sweating during sleep.

Which foods can reduce an ESR of 64 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.

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.

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.

Legumes

Legumes, such as lentils and chickpeas, are high in phytochemicals. These compounds have anti-inflammatory effects, making legumes an essential part of the Mediterranean diet for promoting a healthier lifestyle.

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.

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.

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 64 mm/hr ?

For an ESR of 64, 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 64

What is my ESR:CRP ratio for an ESR of 64 mm/hr ?

ESR	CRP	Ratio	Means
64	1.0	64.0	More likely to be autoimmune disease flareup of SLE
64	1.5	42.666666666666664	More likely to be autoimmune disease flareup of SLE
64	2.0	32.0	More likely to be autoimmune disease flareup of SLE
64	2.5	25.6	More likely to be autoimmune disease flareup of SLE
64	3.0	21.333333333333332	More likely to be autoimmune disease flareup of SLE
64	3.5	18.285714285714285	More likely to be autoimmune disease flareup of SLE
64	4.0	16.0	More likely to be autoimmune disease flareup of SLE
64	4.5	14.222222222222221	Inconclusive
64	5.0	12.8	Inconclusive
64	5.5	11.636363636363637	Inconclusive
64	6.0	10.666666666666666	Inconclusive
64	6.5	9.846153846153847	Inconclusive
64	7.0	9.142857142857142	Inconclusive
64	7.5	8.533333333333333	Inconclusive
64	8.0	8.0	Inconclusive
64	8.5	7.529411764705882	Inconclusive
64	9.0	7.111111111111111	Inconclusive
64	9.5	6.7368421052631575	Inconclusive
64	10.0	6.4	Inconclusive
64	10.5	6.095238095238095	Inconclusive
64	11.0	5.818181818181818	Inconclusive
64	11.5	5.565217391304348	Inconclusive
64	12.0	5.333333333333333	Inconclusive
64	12.5	5.12	Inconclusive
64	13.0	4.923076923076923	Inconclusive
64	13.5	4.7407407407407405	Inconclusive
64	14.0	4.571428571428571	Inconclusive
64	14.5	4.413793103448276	Inconclusive
64	15.0	4.266666666666667	Inconclusive
64	15.5	4.129032258064516	Inconclusive
64	16.0	4.0	Inconclusive
64	16.5	3.878787878787879	Inconclusive
64	17.0	3.764705882352941	Inconclusive
64	17.5	3.657142857142857	Inconclusive
64	18.0	3.5555555555555554	Inconclusive
64	18.5	3.4594594594594597	Inconclusive
64	19.0	3.3684210526315788	Inconclusive
64	19.5	3.282051282051282	Inconclusive
64	20.0	3.2	Inconclusive
64	20.5	3.1219512195121952	Inconclusive
64	21.0	3.0476190476190474	Inconclusive
64	21.5	2.9767441860465116	Inconclusive
64	22.0	2.909090909090909	Inconclusive
64	22.5	2.8444444444444446	Inconclusive
64	23.0	2.782608695652174	Inconclusive
64	23.5	2.723404255319149	Inconclusive
64	24.0	2.6666666666666665	Inconclusive
64	24.5	2.6122448979591835	Inconclusive
64	25.0	2.56	Inconclusive
64	25.5	2.5098039215686274	Inconclusive
64	26.0	2.4615384615384617	Inconclusive
64	26.5	2.4150943396226414	Inconclusive
64	27.0	2.3703703703703702	Inconclusive
64	27.5	2.327272727272727	Inconclusive
64	28.0	2.2857142857142856	Inconclusive
64	28.5	2.245614035087719	Inconclusive
64	29.0	2.206896551724138	Inconclusive
64	29.5	2.169491525423729	Inconclusive

---