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Elevated ESR (very high)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Causes of a high ESR include:

  • malignancy:
    • malignant lymphoma
    • carcinomas of colon and breast

  • haematologic:
    • 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
    • macrocytosis elevates ESR (1)

  • connective tissue disorders - especially:
    • systemic lupus erythematosus } normal in 5% of
    • rheumatoid arthritis } patients
    • polymyalgia rheumatica
    • temporal arteritis
    • systemic sclerosis

  • infections:
    • tuberculosis
    • acute hepatitis
    • bacterial

  • others:
    • sarcoidosis
    • renal diseases - especially with azotemia
    • drug fever
    • hepatic cirrhosis
    • physiological increases in fibrinogen e.g. during pregnancy, also raise ESR levels


  1. Pulse (2004), 64 (14), 100.

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