ESR 78 mm/hr means : is it normal, good, bad or dangerous?

In this article we discuss what an ESR of 78 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 78 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 78 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 78

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

Normal Range and Grading for Adult Women : ESR 78

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 78

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

What does an ESR of 78 mm/hr mean?

An ESR level of 78 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 78 mm/hr good?

An ESR of 78 is not a good value. In adults, or children this value is above normal and needs investigating.

Is an ESR of 78 mm/hr bad?

An ESR of 78 is bad in all populations and should be further investigated.

Is an ESR of 78 mm/hr dangerous?

An ESR of 78 is elevated but not necessarily dangerous

Is an ESR of 78 mm/hr normal?

An ESR of 78 is not normal and is classified as elevated.

What are the causes of an ESR of 78 mm/hr?

An ESR of 78 can have various causing including the following

Chronic Obstructive Pulmonary Disease (COPD)

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

Inflammation

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

Behçet's Disease

A rare inflammatory disorder causing blood vessel inflammation.

Heart Disease

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

Thyroid Disorders

Both hyperthyroidism and hypothyroidism can influence ESR levels.

Obesity

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

Inflammatory Bowel Disease

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

Aging

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

Temporal Arteritis

An inflammatory condition affecting the blood vessels.

Certain Medications

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

Anemia

Certain types of anemia, such as sickle cell anemia, can be associated with an elevated ESR.

Pregnancy

ESR levels can be higher during pregnancy.

What are the causes for a falsely elevated ESR value of 78?

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

What does an ESR of 78 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 78 can be classified as below.
If you are in the first three months of pregnancy an ESR of 78 is elevated
If you are in the second trimester or months 3-6 of pregnancy an ESR of 78 is elevated
If you are in the third trimester or months 7-9 of pregnancy an ESR of 78 is elevated

What are the symptoms of an ESR of 78 ?

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 78

Vision Changes

Blurred vision or other visual disturbances.

Fever

Elevated body temperature beyond normal range.

Unexplained Weight Loss

Losing weight without intentional changes in diet or exercise.

Digestive Issues

Irregular bowel movements, diarrhea, or constipation.

Joint Pain

Discomfort, swelling, or stiffness in the joints.

Irregular Menstrual Cycles

Changes in menstrual patterns for women.

Abdominal Pain

Discomfort or pain in the abdominal region.

Abnormal Blood Counts

Changes in white blood cell count or other blood parameters.

Chest Pain

Pain or discomfort in the chest area.

Cognitive Impairment

Memory problems or difficulty concentrating.

Headaches

Recurrent or persistent headaches.

Shortness of Breath

Difficulty breathing or breathlessness.

Photosensitivity

Increased sensitivity to sunlight.

Recurrent Infections

Frequent or persistent infections.

Depression

Persistent feelings of sadness or hopelessness.

Skin Rashes

Unexplained skin eruptions or changes.

Swollen Lymph Nodes

Enlarged and tender lymph nodes.

Dizziness

Feeling lightheaded or unsteady.

Muscle Aches

Generalized or localized pain in muscles.

Cough

Persistent or chronic coughing.

Nausea and Vomiting

Feeling of sickness and vomiting.

Frequent Urination

Increased need to urinate.

Mouth Ulcers

Sores in the mouth that may be painful.

Hair Loss

Unexplained loss of hair.

Fatigue

Persistent tiredness and lack of energy.

Loss of Appetite

Decreased desire to eat.

Which foods can reduce an ESR of 78 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.

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.

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.

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.

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 78 mm/hr ?

For an ESR of 78, 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 78

What is my ESR:CRP ratio for an ESR of 78 mm/hr ?

ESR	CRP	Ratio	Means
78	1.0	78.0	More likely to be autoimmune disease flareup of SLE
78	1.5	52.0	More likely to be autoimmune disease flareup of SLE
78	2.0	39.0	More likely to be autoimmune disease flareup of SLE
78	2.5	31.2	More likely to be autoimmune disease flareup of SLE
78	3.0	26.0	More likely to be autoimmune disease flareup of SLE
78	3.5	22.285714285714285	More likely to be autoimmune disease flareup of SLE
78	4.0	19.5	More likely to be autoimmune disease flareup of SLE
78	4.5	17.333333333333332	More likely to be autoimmune disease flareup of SLE
78	5.0	15.6	More likely to be autoimmune disease flareup of SLE
78	5.5	14.181818181818182	Inconclusive
78	6.0	13.0	Inconclusive
78	6.5	12.0	Inconclusive
78	7.0	11.142857142857142	Inconclusive
78	7.5	10.4	Inconclusive
78	8.0	9.75	Inconclusive
78	8.5	9.176470588235293	Inconclusive
78	9.0	8.666666666666666	Inconclusive
78	9.5	8.210526315789474	Inconclusive
78	10.0	7.8	Inconclusive
78	10.5	7.428571428571429	Inconclusive
78	11.0	7.090909090909091	Inconclusive
78	11.5	6.782608695652174	Inconclusive
78	12.0	6.5	Inconclusive
78	12.5	6.24	Inconclusive
78	13.0	6.0	Inconclusive
78	13.5	5.777777777777778	Inconclusive
78	14.0	5.571428571428571	Inconclusive
78	14.5	5.379310344827586	Inconclusive
78	15.0	5.2	Inconclusive
78	15.5	5.032258064516129	Inconclusive
78	16.0	4.875	Inconclusive
78	16.5	4.7272727272727275	Inconclusive
78	17.0	4.588235294117647	Inconclusive
78	17.5	4.457142857142857	Inconclusive
78	18.0	4.333333333333333	Inconclusive
78	18.5	4.216216216216216	Inconclusive
78	19.0	4.105263157894737	Inconclusive
78	19.5	4.0	Inconclusive
78	20.0	3.9	Inconclusive
78	20.5	3.8048780487804876	Inconclusive
78	21.0	3.7142857142857144	Inconclusive
78	21.5	3.627906976744186	Inconclusive
78	22.0	3.5454545454545454	Inconclusive
78	22.5	3.466666666666667	Inconclusive
78	23.0	3.391304347826087	Inconclusive
78	23.5	3.3191489361702127	Inconclusive
78	24.0	3.25	Inconclusive
78	24.5	3.183673469387755	Inconclusive
78	25.0	3.12	Inconclusive
78	25.5	3.0588235294117645	Inconclusive
78	26.0	3.0	Inconclusive
78	26.5	2.943396226415094	Inconclusive
78	27.0	2.888888888888889	Inconclusive
78	27.5	2.8363636363636364	Inconclusive
78	28.0	2.7857142857142856	Inconclusive
78	28.5	2.736842105263158	Inconclusive
78	29.0	2.689655172413793	Inconclusive
78	29.5	2.6440677966101696	Inconclusive

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