ESR 67 mm/hr means : is it normal, good, bad or dangerous?

In this article we discuss what an ESR of 67 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 67 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?

ESR, or Erythrocyte Sedimentation Rate, is measured by collecting a small blood sample from the patient's arm, usually from a vein. Before the blood draw, the area is cleaned with an antiseptic solution to ensure a sterile collection. Once obtained, the blood is mixed with an anticoagulant to prevent clotting. The prepared blood sample is then placed in a tall, thin tube, which is positioned upright to allow red blood cells to settle over a specific period, often one hour. The distance the red blood cells travel in the tube during this time is carefully measured, and the settling rate is recorded. The Westergren method, a widely recognized technique for ESR measurement, involves the use of a specialized Westergren tube for blood collection. In preparation for the test, patients are usually advised to communicate any medications they are taking to their healthcare provider, as certain drugs can influence the results. Fasting is not mandatory for ESR, but maintaining hydration is recommended to facilitate an efficient blood draw and ensure accurate results. ESR is an essential diagnostic tool, providing healthcare professionals with valuable information to assess and monitor inflammatory conditions within the body.

What is the normal range of ESR and how is an ESR of 67 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 67

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

Normal Range and Grading for Adult Women : ESR 67

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 67

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

What does an ESR of 67 mm/hr mean?

An ESR level of 67 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 67 mm/hr good?

An ESR of 67 is not a good value. In adults, or children this value is above normal and needs investigating.

Is an ESR of 67 mm/hr bad?

An ESR of 67 is bad in all populations and should be further investigated.

Is an ESR of 67 mm/hr dangerous?

An ESR of 67 is elevated but not necessarily dangerous

Is an ESR of 67 mm/hr normal?

An ESR of 67 is not normal and is classified as elevated.

What are the causes of an ESR of 67 mm/hr?

An ESR of 67 can have various causing including the following

Pregnancy

ESR levels can be higher during pregnancy.

Rheumatoid Arthritis

A chronic inflammatory disorder affecting the joints.

Certain Medications

Some medications, such as corticosteroids, can influence ESR levels.

Bronchiectasis

A chronic lung condition characterized by damaged airways.

Lymphoma

A type of cancer that originates in the lymphatic system.

Heart Disease

Inflammatory changes in the cardiovascular system may contribute to an elevated ESR.

Chronic Obstructive Pulmonary Disease (COPD)

Inflammatory changes in the lungs can lead to an increased ESR.

Liver Disease

Certain liver conditions can be associated with higher ESR.

Infection

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

Certain Cancers

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

Vasculitis

Inflammation of blood vessels.

Giant Cell Arteritis

An inflammatory disease affecting large blood vessels.

What are the causes for a falsely elevated ESR value of 67?

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

Ovulation

The process of ovulation in the menstrual cycle involves hormonal changes that can affect ESR levels. Fluctuations in estrogen and progesterone during ovulation contribute to variations in the inflammatory response, leading to changes in ESR.

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.

Stress

Physiological stress triggers the release of stress hormones and inflammatory mediators, potentially leading to a temporary increase in ESR. Chronic stress can have negative effects on overall health, emphasizing the importance of stress management for well-being.

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.

Surgery

Postoperative recovery involves a complex interplay of physiological responses, including inflammation. Surgery can lead to a temporary increase in ESR as part of the body's natural healing process. Monitoring ESR levels post-surgery is a routine part of medical care.

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.

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.

Postpartum Period

In the postpartum period following childbirth, the body goes through a process of recovery and adaptation. Hormonal changes, including a decrease in pregnancy-related hormones, can contribute to temporary fluctuations in ESR levels.

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.

Iron Deficiency

Mild iron deficiency can affect the composition of blood, potentially leading to changes in ESR levels. Adequate iron levels are essential for overall health, and addressing iron deficiency is important for maintaining optimal blood parameters.

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.

Aging

ESR tends to increase with age, and a mild elevation may be a normal part of the aging process. The gradual wear and tear on the body's tissues can contribute to a low-level inflammatory state, leading to a slightly higher ESR in elderly individuals.

What does an ESR of 67 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 67 can be classified as below.
If you are in the first three months of pregnancy an ESR of 67 is elevated
If you are in the second trimester or months 3-6 of pregnancy an ESR of 67 is elevated
If you are in the third trimester or months 7-9 of pregnancy an ESR of 67 is normal

What are the symptoms of an ESR of 67 ?

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 67

Abnormal Blood Counts

Changes in white blood cell count or other blood parameters.

Dry Eyes and Mouth

Symptoms of Sjögren's syndrome.

Cognitive Impairment

Memory problems or difficulty concentrating.

Abdominal Pain

Discomfort or pain in the abdominal region.

Depression

Persistent feelings of sadness or hopelessness.

Irregular Menstrual Cycles

Changes in menstrual patterns for women.

Mouth Ulcers

Sores in the mouth that may be painful.

Vision Changes

Blurred vision or other visual disturbances.

Neurological Symptoms

Tingling, numbness, or weakness.

Headaches

Recurrent or persistent headaches.

Hair Loss

Unexplained loss of hair.

Dizziness

Feeling lightheaded or unsteady.

Photosensitivity

Increased sensitivity to sunlight.

Fatigue

Persistent tiredness and lack of energy.

Shortness of Breath

Difficulty breathing or breathlessness.

Difficulty Sleeping

Insomnia or disrupted sleep patterns.

Night Sweats

Excessive sweating during sleep.

Cough

Persistent or chronic coughing.

Chest Pain

Pain or discomfort in the chest area.

Frequent Urination

Increased need to urinate.

Fever

Elevated body temperature beyond normal range.

Muscle Aches

Generalized or localized pain in muscles.

Skin Rashes

Unexplained skin eruptions or changes.

Joint Pain

Discomfort, swelling, or stiffness in the joints.

Nausea and Vomiting

Feeling of sickness and vomiting.

Digestive Issues

Irregular bowel movements, diarrhea, or constipation.

Which foods can reduce an ESR of 67 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.

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.

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.

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.

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.

What other tests should be done with an ESR of 67 mm/hr ?

For an ESR of 67, 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 67

What is my ESR:CRP ratio for an ESR of 67 mm/hr ?

ESR	CRP	Ratio	Means
67	1.0	67.0	More likely to be autoimmune disease flareup of SLE
67	1.5	44.666666666666664	More likely to be autoimmune disease flareup of SLE
67	2.0	33.5	More likely to be autoimmune disease flareup of SLE
67	2.5	26.8	More likely to be autoimmune disease flareup of SLE
67	3.0	22.333333333333332	More likely to be autoimmune disease flareup of SLE
67	3.5	19.142857142857142	More likely to be autoimmune disease flareup of SLE
67	4.0	16.75	More likely to be autoimmune disease flareup of SLE
67	4.5	14.88888888888889	Inconclusive
67	5.0	13.4	Inconclusive
67	5.5	12.181818181818182	Inconclusive
67	6.0	11.166666666666666	Inconclusive
67	6.5	10.307692307692308	Inconclusive
67	7.0	9.571428571428571	Inconclusive
67	7.5	8.933333333333334	Inconclusive
67	8.0	8.375	Inconclusive
67	8.5	7.882352941176471	Inconclusive
67	9.0	7.444444444444445	Inconclusive
67	9.5	7.052631578947368	Inconclusive
67	10.0	6.7	Inconclusive
67	10.5	6.380952380952381	Inconclusive
67	11.0	6.090909090909091	Inconclusive
67	11.5	5.826086956521739	Inconclusive
67	12.0	5.583333333333333	Inconclusive
67	12.5	5.36	Inconclusive
67	13.0	5.153846153846154	Inconclusive
67	13.5	4.962962962962963	Inconclusive
67	14.0	4.785714285714286	Inconclusive
67	14.5	4.620689655172414	Inconclusive
67	15.0	4.466666666666667	Inconclusive
67	15.5	4.32258064516129	Inconclusive
67	16.0	4.1875	Inconclusive
67	16.5	4.0606060606060606	Inconclusive
67	17.0	3.9411764705882355	Inconclusive
67	17.5	3.8285714285714287	Inconclusive
67	18.0	3.7222222222222223	Inconclusive
67	18.5	3.6216216216216215	Inconclusive
67	19.0	3.526315789473684	Inconclusive
67	19.5	3.4358974358974357	Inconclusive
67	20.0	3.35	Inconclusive
67	20.5	3.268292682926829	Inconclusive
67	21.0	3.1904761904761907	Inconclusive
67	21.5	3.116279069767442	Inconclusive
67	22.0	3.0454545454545454	Inconclusive
67	22.5	2.977777777777778	Inconclusive
67	23.0	2.9130434782608696	Inconclusive
67	23.5	2.851063829787234	Inconclusive
67	24.0	2.7916666666666665	Inconclusive
67	24.5	2.7346938775510203	Inconclusive
67	25.0	2.68	Inconclusive
67	25.5	2.627450980392157	Inconclusive
67	26.0	2.576923076923077	Inconclusive
67	26.5	2.5283018867924527	Inconclusive
67	27.0	2.4814814814814814	Inconclusive
67	27.5	2.4363636363636365	Inconclusive
67	28.0	2.392857142857143	Inconclusive
67	28.5	2.3508771929824563	Inconclusive
67	29.0	2.310344827586207	Inconclusive
67	29.5	2.2711864406779663	Inconclusive

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