ESR 46 mm/hr means : is it normal, good, bad or dangerous?

In this article we discuss what an ESR of 46 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 46 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 46 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 46

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

Normal Range and Grading for Adult Women : ESR 46

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 46

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

What does an ESR of 46 mm/hr mean?

An ESR level of 46 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 46 mm/hr good?

An ESR of 46 is not a good value. In adults, or children this value is above normal and needs investigating.

Is an ESR of 46 mm/hr bad?

An ESR of 46 is bad in all populations and should be further investigated.

Is an ESR of 46 mm/hr dangerous?

An ESR of 46 is elevated but not necessarily dangerous

Is an ESR of 46 mm/hr normal?

An ESR of 46 is not normal and is classified as elevated.

What are the causes of an ESR of 46 mm/hr?

An ESR of 46 can have various causing including the following

Liver Disease

Certain liver conditions can be associated with higher ESR.

Inflammatory Bowel Disease

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

Lymphoma

A type of cancer that originates in the lymphatic system.

Certain Cancers

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

HIV/AIDS

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

Behçet's Disease

A rare inflammatory disorder causing blood vessel inflammation.

Hepatitis

Inflammation of the liver, often caused by viral infections.

Aging

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

Infection

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

Myeloma

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

Sickle Cell Anemia

A genetic blood disorder affecting red blood cells.

Polymyalgia Rheumatica

An inflammatory disorder that commonly affects older adults.

What are the causes for a falsely elevated ESR value of 46?

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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 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.

What does an ESR of 46 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 46 can be classified as below.
If you are in the first three months of pregnancy an ESR of 46 is normal
If you are in the second trimester or months 3-6 of pregnancy an ESR of 46 is normal
If you are in the third trimester or months 7-9 of pregnancy an ESR of 46 is normal

What are the symptoms of an ESR of 46 ?

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 46

Irregular Menstrual Cycles

Changes in menstrual patterns for women.

Cough

Persistent or chronic coughing.

Loss of Appetite

Decreased desire to eat.

Vision Changes

Blurred vision or other visual disturbances.

Chest Pain

Pain or discomfort in the chest area.

Digestive Issues

Irregular bowel movements, diarrhea, or constipation.

Fever

Elevated body temperature beyond normal range.

Fatigue

Persistent tiredness and lack of energy.

Abnormal Blood Counts

Changes in white blood cell count or other blood parameters.

Recurrent Infections

Frequent or persistent infections.

Unexplained Weight Loss

Losing weight without intentional changes in diet or exercise.

Swollen Lymph Nodes

Enlarged and tender lymph nodes.

Dry Eyes and Mouth

Symptoms of Sjögren's syndrome.

Joint Pain

Discomfort, swelling, or stiffness in the joints.

Neurological Symptoms

Tingling, numbness, or weakness.

Frequent Urination

Increased need to urinate.

Headaches

Recurrent or persistent headaches.

Night Sweats

Excessive sweating during sleep.

Photosensitivity

Increased sensitivity to sunlight.

Depression

Persistent feelings of sadness or hopelessness.

Shortness of Breath

Difficulty breathing or breathlessness.

Skin Rashes

Unexplained skin eruptions or changes.

Dizziness

Feeling lightheaded or unsteady.

Mouth Ulcers

Sores in the mouth that may be painful.

Muscle Aches

Generalized or localized pain in muscles.

Abdominal Pain

Discomfort or pain in the abdominal region.

Which foods can reduce an ESR of 46 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.

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.

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.

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.

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 46 mm/hr ?

For an ESR of 46, 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 46

What is my ESR:CRP ratio for an ESR of 46 mm/hr ?

ESR	CRP	Ratio	Means
46	1.0	46.0	More likely to be autoimmune disease flareup of SLE
46	1.5	30.666666666666668	More likely to be autoimmune disease flareup of SLE
46	2.0	23.0	More likely to be autoimmune disease flareup of SLE
46	2.5	18.4	More likely to be autoimmune disease flareup of SLE
46	3.0	15.333333333333334	More likely to be autoimmune disease flareup of SLE
46	3.5	13.142857142857142	Inconclusive
46	4.0	11.5	Inconclusive
46	4.5	10.222222222222221	Inconclusive
46	5.0	9.2	Inconclusive
46	5.5	8.363636363636363	Inconclusive
46	6.0	7.666666666666667	Inconclusive
46	6.5	7.076923076923077	Inconclusive
46	7.0	6.571428571428571	Inconclusive
46	7.5	6.133333333333334	Inconclusive
46	8.0	5.75	Inconclusive
46	8.5	5.411764705882353	Inconclusive
46	9.0	5.111111111111111	Inconclusive
46	9.5	4.842105263157895	Inconclusive
46	10.0	4.6	Inconclusive
46	10.5	4.380952380952381	Inconclusive
46	11.0	4.181818181818182	Inconclusive
46	11.5	4.0	Inconclusive
46	12.0	3.8333333333333335	Inconclusive
46	12.5	3.68	Inconclusive
46	13.0	3.5384615384615383	Inconclusive
46	13.5	3.4074074074074074	Inconclusive
46	14.0	3.2857142857142856	Inconclusive
46	14.5	3.1724137931034484	Inconclusive
46	15.0	3.066666666666667	Inconclusive
46	15.5	2.967741935483871	Inconclusive
46	16.0	2.875	Inconclusive
46	16.5	2.787878787878788	Inconclusive
46	17.0	2.7058823529411766	Inconclusive
46	17.5	2.6285714285714286	Inconclusive
46	18.0	2.5555555555555554	Inconclusive
46	18.5	2.4864864864864864	Inconclusive
46	19.0	2.4210526315789473	Inconclusive
46	19.5	2.358974358974359	Inconclusive
46	20.0	2.3	Inconclusive
46	20.5	2.2439024390243905	Inconclusive
46	21.0	2.1904761904761907	Inconclusive
46	21.5	2.13953488372093	Inconclusive
46	22.0	2.090909090909091	Inconclusive
46	22.5	2.0444444444444443	Inconclusive
46	23.0	2.0	More likely to be infection
46	23.5	1.9574468085106382	More likely to be infection
46	24.0	1.9166666666666667	More likely to be infection
46	24.5	1.8775510204081634	More likely to be infection
46	25.0	1.84	More likely to be infection
46	25.5	1.803921568627451	More likely to be infection
46	26.0	1.7692307692307692	More likely to be infection
46	26.5	1.7358490566037736	More likely to be infection
46	27.0	1.7037037037037037	More likely to be infection
46	27.5	1.6727272727272726	More likely to be infection
46	28.0	1.6428571428571428	More likely to be infection
46	28.5	1.6140350877192982	More likely to be infection
46	29.0	1.5862068965517242	More likely to be infection
46	29.5	1.5593220338983051	More likely to be infection

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