ESR 36 mm/hr means : is it normal, good, bad or dangerous?

In this article we discuss what an ESR of 36 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 36 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 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 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 36 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 36

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

Normal Range and Grading for Adult Women : ESR 36

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 36

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

What does an ESR of 36 mm/hr mean?

An ESR level of 36 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 36 mm/hr good?

An ESR of 36 is not a good value. In adults, or children this value is above normal and needs investigating.

Is an ESR of 36 mm/hr bad?

An ESR of 36 is bad in all populations and should be further investigated.

Is an ESR of 36 mm/hr dangerous?

An ESR of 36 is elevated but not necessarily dangerous

Is an ESR of 36 mm/hr normal?

An ESR of 36 is not normal and is classified as elevated.

What are the causes of an ESR of 36 mm/hr?

An ESR of 36 can have various causing including the following

Rheumatoid Arthritis

A chronic inflammatory disorder affecting the joints.

HIV/AIDS

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

Liver Disease

Certain liver conditions can be associated with higher ESR.

Temporal Arteritis

An inflammatory condition affecting the blood vessels.

Giant Cell Arteritis

An inflammatory disease affecting large blood vessels.

Autoimmune Disorders

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

Inflammation

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

Infection

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

Sickle Cell Anemia

A genetic blood disorder affecting red blood cells.

Myeloma

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

Dehydration

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

Obesity

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

What are the causes for a falsely elevated ESR value of 36?

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

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.

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.

Sun Exposure

Exposure to sunlight influences vitamin D levels in the body, which in turn can affect the immune system and inflammatory response. Changes in ESR levels related to sun exposure highlight the interconnectedness of environmental factors and inflammation.

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.

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.

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.

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.

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.

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.

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.

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.

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 36 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 36 can be classified as below.
If you are in the first three months of pregnancy an ESR of 36 is normal
If you are in the second trimester or months 3-6 of pregnancy an ESR of 36 is normal
If you are in the third trimester or months 7-9 of pregnancy an ESR of 36 is normal

What are the symptoms of an ESR of 36 ?

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 36

Digestive Issues

Irregular bowel movements, diarrhea, or constipation.

Hair Loss

Unexplained loss of hair.

Skin Rashes

Unexplained skin eruptions or changes.

Loss of Appetite

Decreased desire to eat.

Unexplained Weight Loss

Losing weight without intentional changes in diet or exercise.

Night Sweats

Excessive sweating during sleep.

Dry Eyes and Mouth

Symptoms of Sjögren's syndrome.

Dizziness

Feeling lightheaded or unsteady.

Cognitive Impairment

Memory problems or difficulty concentrating.

Depression

Persistent feelings of sadness or hopelessness.

Abdominal Pain

Discomfort or pain in the abdominal region.

Cough

Persistent or chronic coughing.

Swollen Lymph Nodes

Enlarged and tender lymph nodes.

Vision Changes

Blurred vision or other visual disturbances.

Joint Pain

Discomfort, swelling, or stiffness in the joints.

Neurological Symptoms

Tingling, numbness, or weakness.

Muscle Aches

Generalized or localized pain in muscles.

Abnormal Blood Counts

Changes in white blood cell count or other blood parameters.

Photosensitivity

Increased sensitivity to sunlight.

Chest Pain

Pain or discomfort in the chest area.

Fatigue

Persistent tiredness and lack of energy.

Frequent Urination

Increased need to urinate.

Shortness of Breath

Difficulty breathing or breathlessness.

Irregular Menstrual Cycles

Changes in menstrual patterns for women.

Mouth Ulcers

Sores in the mouth that may be painful.

Fever

Elevated body temperature beyond normal range.

Which foods can reduce an ESR of 36 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.

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.

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.

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.

What other tests should be done with an ESR of 36 mm/hr ?

For an ESR of 36, 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 36

What is my ESR:CRP ratio for an ESR of 36 mm/hr ?

ESR	CRP	Ratio	Means
36	1.0	36.0	More likely to be autoimmune disease flareup of SLE
36	1.5	24.0	More likely to be autoimmune disease flareup of SLE
36	2.0	18.0	More likely to be autoimmune disease flareup of SLE
36	2.5	14.4	Inconclusive
36	3.0	12.0	Inconclusive
36	3.5	10.285714285714286	Inconclusive
36	4.0	9.0	Inconclusive
36	4.5	8.0	Inconclusive
36	5.0	7.2	Inconclusive
36	5.5	6.545454545454546	Inconclusive
36	6.0	6.0	Inconclusive
36	6.5	5.538461538461538	Inconclusive
36	7.0	5.142857142857143	Inconclusive
36	7.5	4.8	Inconclusive
36	8.0	4.5	Inconclusive
36	8.5	4.235294117647059	Inconclusive
36	9.0	4.0	Inconclusive
36	9.5	3.789473684210526	Inconclusive
36	10.0	3.6	Inconclusive
36	10.5	3.4285714285714284	Inconclusive
36	11.0	3.272727272727273	Inconclusive
36	11.5	3.130434782608696	Inconclusive
36	12.0	3.0	Inconclusive
36	12.5	2.88	Inconclusive
36	13.0	2.769230769230769	Inconclusive
36	13.5	2.6666666666666665	Inconclusive
36	14.0	2.5714285714285716	Inconclusive
36	14.5	2.4827586206896552	Inconclusive
36	15.0	2.4	Inconclusive
36	15.5	2.3225806451612905	Inconclusive
36	16.0	2.25	Inconclusive
36	16.5	2.1818181818181817	Inconclusive
36	17.0	2.1176470588235294	Inconclusive
36	17.5	2.057142857142857	Inconclusive
36	18.0	2.0	More likely to be infection
36	18.5	1.945945945945946	More likely to be infection
36	19.0	1.894736842105263	More likely to be infection
36	19.5	1.8461538461538463	More likely to be infection
36	20.0	1.8	More likely to be infection
36	20.5	1.7560975609756098	More likely to be infection
36	21.0	1.7142857142857142	More likely to be infection
36	21.5	1.6744186046511629	More likely to be infection
36	22.0	1.6363636363636365	More likely to be infection
36	22.5	1.6	More likely to be infection
36	23.0	1.565217391304348	More likely to be infection
36	23.5	1.5319148936170213	More likely to be infection
36	24.0	1.5	More likely to be infection
36	24.5	1.469387755102041	More likely to be infection
36	25.0	1.44	More likely to be infection
36	25.5	1.411764705882353	More likely to be infection
36	26.0	1.3846153846153846	More likely to be infection
36	26.5	1.3584905660377358	More likely to be infection
36	27.0	1.3333333333333333	More likely to be infection
36	27.5	1.309090909090909	More likely to be infection
36	28.0	1.2857142857142858	More likely to be infection
36	28.5	1.263157894736842	More likely to be infection
36	29.0	1.2413793103448276	More likely to be infection
36	29.5	1.2203389830508475	More likely to be infection

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