ESR 91 mm/hr means : is it normal, good, bad or dangerous?

In this article we discuss what an ESR of 91 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 91 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 91 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 91

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

Normal Range and Grading for Adult Women : ESR 91

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 91

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

What does an ESR of 91 mm/hr mean?

An ESR level of 91 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 91 mm/hr good?

Is an ESR of 91 mm/hr bad?

Is an ESR of 91 mm/hr dangerous?

Is an ESR of 91 mm/hr normal?

What are the causes of an ESR of 91 mm/hr?

An ESR of 91 can have various causing including the following

Systemic Lupus Erythematosus

An autoimmune disease that can affect multiple organs.

Autoimmune Disorders

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

Infection

Both acute and chronic infections 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.

Dehydration

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

Sickle Cell Anemia

A genetic blood disorder affecting red blood cells.

Lymphoma

A type of cancer that originates in the lymphatic system.

Certain Medications

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

Pregnancy

ESR levels can be higher during pregnancy.

Temporal Arteritis

An inflammatory condition affecting the blood vessels.

Bronchiectasis

A chronic lung condition characterized by damaged airways.

What are the causes for a falsely elevated ESR value of 91?

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

Genetic Factors

Genetic variations can contribute to individual differences in baseline ESR levels. While genetics play a role, lifestyle factors and overall health also significantly influence ESR. Understanding genetic predispositions can provide insights into an individual's inflammatory 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

What does an ESR of 91 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 91 can be classified as below.
If you are in the first three months of pregnancy an ESR of 91 is elevated
If you are in the second trimester or months 3-6 of pregnancy an ESR of 91 is elevated
If you are in the third trimester or months 7-9 of pregnancy an ESR of 91 is elevated

What are the symptoms of an ESR of 91 ?

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 91

Nausea and Vomiting

Feeling of sickness and vomiting.

Headaches

Recurrent or persistent headaches.

Difficulty Sleeping

Insomnia or disrupted sleep patterns.

Depression

Persistent feelings of sadness or hopelessness.

Swollen Lymph Nodes

Enlarged and tender lymph nodes.

Vision Changes

Blurred vision or other visual disturbances.

Skin Rashes

Unexplained skin eruptions or changes.

Abdominal Pain

Discomfort or pain in the abdominal region.

Night Sweats

Excessive sweating during sleep.

Chest Pain

Pain or discomfort in the chest area.

Unexplained Weight Loss

Losing weight without intentional changes in diet or exercise.

Dizziness

Feeling lightheaded or unsteady.

Muscle Aches

Generalized or localized pain in muscles.

Fatigue

Persistent tiredness and lack of energy.

Mouth Ulcers

Sores in the mouth that may be painful.

Loss of Appetite

Decreased desire to eat.

Frequent Urination

Increased need to urinate.

Neurological Symptoms

Tingling, numbness, or weakness.

Recurrent Infections

Frequent or persistent infections.

Digestive Issues

Irregular bowel movements, diarrhea, or constipation.

Irregular Menstrual Cycles

Changes in menstrual patterns for women.

Cough

Persistent or chronic coughing.

Abnormal Blood Counts

Changes in white blood cell count or other blood parameters.

Dry Eyes and Mouth

Symptoms of Sjögren's syndrome.

Joint Pain

Discomfort, swelling, or stiffness in the joints.

Shortness of Breath

Difficulty breathing or breathlessness.

Which foods can reduce an ESR of 91 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.

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.

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.

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.

What other tests should be done with an ESR of 91 mm/hr ?

For an ESR of 91, 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 91

What is my ESR:CRP ratio for an ESR of 91 mm/hr ?

ESR	CRP	Ratio	Means
91	1.0	91.0	More likely to be autoimmune disease flareup of SLE
91	1.5	60.666666666666664	More likely to be autoimmune disease flareup of SLE
91	2.0	45.5	More likely to be autoimmune disease flareup of SLE
91	2.5	36.4	More likely to be autoimmune disease flareup of SLE
91	3.0	30.333333333333332	More likely to be autoimmune disease flareup of SLE
91	3.5	26.0	More likely to be autoimmune disease flareup of SLE
91	4.0	22.75	More likely to be autoimmune disease flareup of SLE
91	4.5	20.22222222222222	More likely to be autoimmune disease flareup of SLE
91	5.0	18.2	More likely to be autoimmune disease flareup of SLE
91	5.5	16.545454545454547	More likely to be autoimmune disease flareup of SLE
91	6.0	15.166666666666666	More likely to be autoimmune disease flareup of SLE
91	6.5	14.0	Inconclusive
91	7.0	13.0	Inconclusive
91	7.5	12.133333333333333	Inconclusive
91	8.0	11.375	Inconclusive
91	8.5	10.705882352941176	Inconclusive
91	9.0	10.11111111111111	Inconclusive
91	9.5	9.578947368421053	Inconclusive
91	10.0	9.1	Inconclusive
91	10.5	8.666666666666666	Inconclusive
91	11.0	8.272727272727273	Inconclusive
91	11.5	7.913043478260869	Inconclusive
91	12.0	7.583333333333333	Inconclusive
91	12.5	7.28	Inconclusive
91	13.0	7.0	Inconclusive
91	13.5	6.7407407407407405	Inconclusive
91	14.0	6.5	Inconclusive
91	14.5	6.275862068965517	Inconclusive
91	15.0	6.066666666666666	Inconclusive
91	15.5	5.870967741935484	Inconclusive
91	16.0	5.6875	Inconclusive
91	16.5	5.515151515151516	Inconclusive
91	17.0	5.352941176470588	Inconclusive
91	17.5	5.2	Inconclusive
91	18.0	5.055555555555555	Inconclusive
91	18.5	4.918918918918919	Inconclusive
91	19.0	4.7894736842105265	Inconclusive
91	19.5	4.666666666666667	Inconclusive
91	20.0	4.55	Inconclusive
91	20.5	4.439024390243903	Inconclusive
91	21.0	4.333333333333333	Inconclusive
91	21.5	4.232558139534884	Inconclusive
91	22.0	4.136363636363637	Inconclusive
91	22.5	4.044444444444444	Inconclusive
91	23.0	3.9565217391304346	Inconclusive
91	23.5	3.872340425531915	Inconclusive
91	24.0	3.7916666666666665	Inconclusive
91	24.5	3.7142857142857144	Inconclusive
91	25.0	3.64	Inconclusive
91	25.5	3.5686274509803924	Inconclusive
91	26.0	3.5	Inconclusive
91	26.5	3.4339622641509435	Inconclusive
91	27.0	3.3703703703703702	Inconclusive
91	27.5	3.309090909090909	Inconclusive
91	28.0	3.25	Inconclusive
91	28.5	3.192982456140351	Inconclusive
91	29.0	3.1379310344827585	Inconclusive
91	29.5	3.0847457627118646	Inconclusive

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