ESR (high)

• Causes of a high ESR include:
  
  malignancy:
  • malignant lymphoma
  • carcinomas of colon and breast
    
    
• haematological:
  • multiple myeloma - a high ESR plus osteoporosis equals multiple myeloma until proved otherwise
  • anaemia of acute or chronic disease, alone or combined with iron deficiency anaemia - not Fe deficiency alone
    
    
• connective tissue disorders - especially:
  • systemic lupus erythematosus
  • rheumatoid arthritis (normal in 5% of patients)
  • polymyalgia rheumatica
  • temporal arteritis
  • systemic sclerosis
    
    
• infections:
  • tuberculosis
  • acute hepatitis
  • bacterial
    
    
• others:
  • sarcoidosis
  • renal disease
  • drug fever
  • hepatic cirrhosis
  • physiological increases in fibrinogen e.g. during pregnancy, also raise ESR levels

Reference:

1. Bray C et al. Erythrocyte Sedimentation Rate and C-reactive Protein Measurements and Their Relevance in Clinical Medicine. WMJ. 2016 Dec;115(6):317-21