ESR 77 mm/hr means : is it normal, good, bad or dangerous?

In this article we discuss what an ESR of 77 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 77 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 77 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 77

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

Normal Range and Grading for Adult Women : ESR 77

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 77

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

What does an ESR of 77 mm/hr mean?

An ESR level of 77 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 77 mm/hr good?

An ESR of 77 is not a good value. In adults, or children this value is above normal and needs investigating.

Is an ESR of 77 mm/hr bad?

An ESR of 77 is bad in all populations and should be further investigated.

Is an ESR of 77 mm/hr dangerous?

An ESR of 77 is elevated but not necessarily dangerous

Is an ESR of 77 mm/hr normal?

An ESR of 77 is not normal and is classified as elevated.

What are the causes of an ESR of 77 mm/hr?

An ESR of 77 can have various causing including the following

Polymyalgia Rheumatica

An inflammatory disorder that commonly affects older adults.

Thyroid Disorders

Both hyperthyroidism and hypothyroidism can influence ESR levels.

Infection

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

Giant Cell Arteritis

An inflammatory disease affecting large blood vessels.

Heart Disease

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

HIV/AIDS

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

Dehydration

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

Tissue injury

Any injury or trauma to tissues can result in an elevated ESR.

Myeloma

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

Lymphoma

A type of cancer that originates in the lymphatic system.

Bronchiectasis

A chronic lung condition characterized by damaged airways.

Systemic Lupus Erythematosus

An autoimmune disease that can affect multiple organs.

What are the causes for a falsely elevated ESR value of 77?

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

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.

Pregnancy

During pregnancy, the body undergoes significant hormonal and physiological changes. The increased blood volume, hormonal fluctuations, and immune system adaptations can contribute to higher ESR levels. This elevation is often considered normal in pregnant individuals.

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.

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.

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.

Sleep Deprivation

Lack of sleep can be associated with changes in inflammatory markers, including ESR. Sleep deprivation disrupts the body's natural regulatory processes, affecting the immune system and potentially leading to an elevation in ESR. Prioritizing sufficient and quality sleep is crucial for overall health.

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.

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.

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.

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.

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.

What does an ESR of 77 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 77 can be classified as below.
If you are in the first three months of pregnancy an ESR of 77 is elevated
If you are in the second trimester or months 3-6 of pregnancy an ESR of 77 is elevated
If you are in the third trimester or months 7-9 of pregnancy an ESR of 77 is elevated

What are the symptoms of an ESR of 77 ?

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 77

Depression

Persistent feelings of sadness or hopelessness.

Abnormal Blood Counts

Changes in white blood cell count or other blood parameters.

Digestive Issues

Irregular bowel movements, diarrhea, or constipation.

Night Sweats

Excessive sweating during sleep.

Loss of Appetite

Decreased desire to eat.

Abdominal Pain

Discomfort or pain in the abdominal region.

Fever

Elevated body temperature beyond normal range.

Irregular Menstrual Cycles

Changes in menstrual patterns for women.

Swollen Lymph Nodes

Enlarged and tender lymph nodes.

Dry Eyes and Mouth

Symptoms of Sjögren's syndrome.

Difficulty Sleeping

Insomnia or disrupted sleep patterns.

Headaches

Recurrent or persistent headaches.

Dizziness

Feeling lightheaded or unsteady.

Cough

Persistent or chronic coughing.

Mouth Ulcers

Sores in the mouth that may be painful.

Shortness of Breath

Difficulty breathing or breathlessness.

Chest Pain

Pain or discomfort in the chest area.

Fatigue

Persistent tiredness and lack of energy.

Neurological Symptoms

Tingling, numbness, or weakness.

Recurrent Infections

Frequent or persistent infections.

Skin Rashes

Unexplained skin eruptions or changes.

Vision Changes

Blurred vision or other visual disturbances.

Photosensitivity

Increased sensitivity to sunlight.

Unexplained Weight Loss

Losing weight without intentional changes in diet or exercise.

Muscle Aches

Generalized or localized pain in muscles.

Cognitive Impairment

Memory problems or difficulty concentrating.

Which foods can reduce an ESR of 77 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.

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.

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.

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.

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.

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.

What other tests should be done with an ESR of 77 mm/hr ?

For an ESR of 77, 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 77

What is my ESR:CRP ratio for an ESR of 77 mm/hr ?

ESR	CRP	Ratio	Means
77	1.0	77.0	More likely to be autoimmune disease flareup of SLE
77	1.5	51.333333333333336	More likely to be autoimmune disease flareup of SLE
77	2.0	38.5	More likely to be autoimmune disease flareup of SLE
77	2.5	30.8	More likely to be autoimmune disease flareup of SLE
77	3.0	25.666666666666668	More likely to be autoimmune disease flareup of SLE
77	3.5	22.0	More likely to be autoimmune disease flareup of SLE
77	4.0	19.25	More likely to be autoimmune disease flareup of SLE
77	4.5	17.11111111111111	More likely to be autoimmune disease flareup of SLE
77	5.0	15.4	More likely to be autoimmune disease flareup of SLE
77	5.5	14.0	Inconclusive
77	6.0	12.833333333333334	Inconclusive
77	6.5	11.846153846153847	Inconclusive
77	7.0	11.0	Inconclusive
77	7.5	10.266666666666667	Inconclusive
77	8.0	9.625	Inconclusive
77	8.5	9.058823529411764	Inconclusive
77	9.0	8.555555555555555	Inconclusive
77	9.5	8.105263157894736	Inconclusive
77	10.0	7.7	Inconclusive
77	10.5	7.333333333333333	Inconclusive
77	11.0	7.0	Inconclusive
77	11.5	6.695652173913044	Inconclusive
77	12.0	6.416666666666667	Inconclusive
77	12.5	6.16	Inconclusive
77	13.0	5.923076923076923	Inconclusive
77	13.5	5.703703703703703	Inconclusive
77	14.0	5.5	Inconclusive
77	14.5	5.310344827586207	Inconclusive
77	15.0	5.133333333333334	Inconclusive
77	15.5	4.967741935483871	Inconclusive
77	16.0	4.8125	Inconclusive
77	16.5	4.666666666666667	Inconclusive
77	17.0	4.529411764705882	Inconclusive
77	17.5	4.4	Inconclusive
77	18.0	4.277777777777778	Inconclusive
77	18.5	4.162162162162162	Inconclusive
77	19.0	4.052631578947368	Inconclusive
77	19.5	3.948717948717949	Inconclusive
77	20.0	3.85	Inconclusive
77	20.5	3.7560975609756095	Inconclusive
77	21.0	3.6666666666666665	Inconclusive
77	21.5	3.5813953488372094	Inconclusive
77	22.0	3.5	Inconclusive
77	22.5	3.422222222222222	Inconclusive
77	23.0	3.347826086956522	Inconclusive
77	23.5	3.276595744680851	Inconclusive
77	24.0	3.2083333333333335	Inconclusive
77	24.5	3.142857142857143	Inconclusive
77	25.0	3.08	Inconclusive
77	25.5	3.019607843137255	Inconclusive
77	26.0	2.9615384615384617	Inconclusive
77	26.5	2.9056603773584904	Inconclusive
77	27.0	2.8518518518518516	Inconclusive
77	27.5	2.8	Inconclusive
77	28.0	2.75	Inconclusive
77	28.5	2.7017543859649122	Inconclusive
77	29.0	2.6551724137931036	Inconclusive
77	29.5	2.610169491525424	Inconclusive

---