ESR (high)

Last reviewed 07/2021

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

Reference:

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