ESR 90 mm/hr means : is it normal, good, bad or dangerous?

In this article we discuss what an ESR of 90 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 90 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 90 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 90

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

Normal Range and Grading for Adult Women : ESR 90

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
>80	Very High

Normal Range and Grading for Children : ESR 90

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

What does an ESR of 90 mm/hr mean?

An ESR level of 90 is considered to be dangerously or alarmingly elevated. You should get immediate medical attention, and a doctor must evaluate all your health parameters to arrive at a cause for this ESR level.Other tests will inevitably be prescribed and a detailed medical history will also need to be taken.

Is an ESR of 90 mm/hr good?

Is an ESR of 90 mm/hr bad?

Is an ESR of 90 mm/hr dangerous?

Is an ESR of 90 mm/hr normal?

What are the causes of an ESR of 90 mm/hr?

An ESR of 90 can have various causing including the following

Heart Disease

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

Inflammation

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

Obesity

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

Bronchiectasis

A chronic lung condition characterized by damaged airways.

Hepatitis

Inflammation of the liver, often caused by viral infections.

Chronic Kidney Disease

Impaired kidney function can lead to higher ESR levels.

Myeloma

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

Chronic Obstructive Pulmonary Disease (COPD)

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

Vasculitis

Inflammation of blood vessels.

Tissue injury

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

Anemia

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

Aging

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

What are the causes for a falsely elevated ESR value of 90?

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

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.

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.

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.

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.

Recent Vaccination

Vaccination stimulates the immune system, triggering an inflammatory response. This immune activity can lead to a temporary increase in ESR levels as part of the body's natural defense mechanism. The elevation is usually transient and not indicative of a pathological condition.

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.

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.

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.

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.

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.

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.

What does an ESR of 90 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 90 can be classified as below.
If you are in the first three months of pregnancy an ESR of 90 is elevated
If you are in the second trimester or months 3-6 of pregnancy an ESR of 90 is elevated
If you are in the third trimester or months 7-9 of pregnancy an ESR of 90 is elevated

What are the symptoms of an ESR of 90 ?

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 90

Dizziness

Feeling lightheaded or unsteady.

Vision Changes

Blurred vision or other visual disturbances.

Frequent Urination

Increased need to urinate.

Abdominal Pain

Discomfort or pain in the abdominal region.

Cognitive Impairment

Memory problems or difficulty concentrating.

Mouth Ulcers

Sores in the mouth that may be painful.

Muscle Aches

Generalized or localized pain in muscles.

Joint Pain

Discomfort, swelling, or stiffness in the joints.

Headaches

Recurrent or persistent headaches.

Cough

Persistent or chronic coughing.

Swollen Lymph Nodes

Enlarged and tender lymph nodes.

Nausea and Vomiting

Feeling of sickness and vomiting.

Loss of Appetite

Decreased desire to eat.

Hair Loss

Unexplained loss of hair.

Neurological Symptoms

Tingling, numbness, or weakness.

Night Sweats

Excessive sweating during sleep.

Dry Eyes and Mouth

Symptoms of Sjögren's syndrome.

Digestive Issues

Irregular bowel movements, diarrhea, or constipation.

Chest Pain

Pain or discomfort in the chest area.

Unexplained Weight Loss

Losing weight without intentional changes in diet or exercise.

Recurrent Infections

Frequent or persistent infections.

Difficulty Sleeping

Insomnia or disrupted sleep patterns.

Fever

Elevated body temperature beyond normal range.

Fatigue

Persistent tiredness and lack of energy.

Skin Rashes

Unexplained skin eruptions or changes.

Abnormal Blood Counts

Changes in white blood cell count or other blood parameters.

Which foods can reduce an ESR of 90 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.

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.

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.

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.

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 90 mm/hr ?

For an ESR of 90, 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 90

What is my ESR:CRP ratio for an ESR of 90 mm/hr ?

ESR	CRP	Ratio	Means
90	1.0	90.0	More likely to be autoimmune disease flareup of SLE
90	1.5	60.0	More likely to be autoimmune disease flareup of SLE
90	2.0	45.0	More likely to be autoimmune disease flareup of SLE
90	2.5	36.0	More likely to be autoimmune disease flareup of SLE
90	3.0	30.0	More likely to be autoimmune disease flareup of SLE
90	3.5	25.714285714285715	More likely to be autoimmune disease flareup of SLE
90	4.0	22.5	More likely to be autoimmune disease flareup of SLE
90	4.5	20.0	More likely to be autoimmune disease flareup of SLE
90	5.0	18.0	More likely to be autoimmune disease flareup of SLE
90	5.5	16.363636363636363	More likely to be autoimmune disease flareup of SLE
90	6.0	15.0	More likely to be autoimmune disease flareup of SLE
90	6.5	13.846153846153847	Inconclusive
90	7.0	12.857142857142858	Inconclusive
90	7.5	12.0	Inconclusive
90	8.0	11.25	Inconclusive
90	8.5	10.588235294117647	Inconclusive
90	9.0	10.0	Inconclusive
90	9.5	9.473684210526315	Inconclusive
90	10.0	9.0	Inconclusive
90	10.5	8.571428571428571	Inconclusive
90	11.0	8.181818181818182	Inconclusive
90	11.5	7.826086956521739	Inconclusive
90	12.0	7.5	Inconclusive
90	12.5	7.2	Inconclusive
90	13.0	6.923076923076923	Inconclusive
90	13.5	6.666666666666667	Inconclusive
90	14.0	6.428571428571429	Inconclusive
90	14.5	6.206896551724138	Inconclusive
90	15.0	6.0	Inconclusive
90	15.5	5.806451612903226	Inconclusive
90	16.0	5.625	Inconclusive
90	16.5	5.454545454545454	Inconclusive
90	17.0	5.294117647058823	Inconclusive
90	17.5	5.142857142857143	Inconclusive
90	18.0	5.0	Inconclusive
90	18.5	4.864864864864865	Inconclusive
90	19.0	4.7368421052631575	Inconclusive
90	19.5	4.615384615384615	Inconclusive
90	20.0	4.5	Inconclusive
90	20.5	4.390243902439025	Inconclusive
90	21.0	4.285714285714286	Inconclusive
90	21.5	4.186046511627907	Inconclusive
90	22.0	4.090909090909091	Inconclusive
90	22.5	4.0	Inconclusive
90	23.0	3.9130434782608696	Inconclusive
90	23.5	3.8297872340425534	Inconclusive
90	24.0	3.75	Inconclusive
90	24.5	3.673469387755102	Inconclusive
90	25.0	3.6	Inconclusive
90	25.5	3.5294117647058822	Inconclusive
90	26.0	3.4615384615384617	Inconclusive
90	26.5	3.3962264150943398	Inconclusive
90	27.0	3.3333333333333335	Inconclusive
90	27.5	3.272727272727273	Inconclusive
90	28.0	3.2142857142857144	Inconclusive
90	28.5	3.1578947368421053	Inconclusive
90	29.0	3.103448275862069	Inconclusive
90	29.5	3.0508474576271185	Inconclusive

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