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MARKEDLY RAISED ESR - REVISITED

OP Kapoor

Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

Dr. Sunil Parekh a leading Haematologist has suggested that the following conditions can cause markedly raised ESR:
1. Myeloma - Macroglobulinaemia

2. Metastatic cancer

3. HIV - AIDS

4. SLE - Auto Immune Diseases

5. AIHA- Auto Immune Diseases

6. Rheumatoid Arthritis - (RS +ve)

7. Aplastic Anaemia

8. Leukaemia - acute - or blastic crisis

9. Chronic infections -

Pus
Pyelonephritis
Tubo-ovarian mass
Pelvis sepsis

10. Myelofibrosis

11. Nephropathy

12. Fungus infection (disseminated)

13. Septicaemia

14. Bone tuberculosis (miliary TB)

15. Chronic/active malaria and kala-azar
I have written in the past that the following are the causes of markedly raised ESR:
1. Myeloma - Macroglobulinaemia

2. Metastatic cancer

3. HIV-AIDS

4. SLE - Auto Immune Diseases

5. AIHA - Auto Immune Diseases

6. Bone tuberculosis/miliary TB
Recently, I saw a patient of PUO with severe anaemia, enlarged spleen and markedly elevated ESR. Her ANA was found to be +ve in a leading five star hospital laboratory. When this patient was referred to another leading laboratory, the test was found to be negative and when the bone marrow biopsy was done as one of the investigations by Dr. Sunil Parekh, the diagnosis of myelofibrosis was made.

Since the rest of the conditions mentioned in the chart are becoming common in practice, I would suggest that all the practitioners should now remember all the 15 causes and conditions which raise ESR to more than 100.


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