How to evaluate an elevated ESR

What is an approach to the evaluation of an elevated ESR

a. Complete history and physical examination and routine screening laboratories (complete blood count, chemistries, liver enzymes, urinalysis). Make sure that routine health care maintenance is up-to-date. Repeat ESR to ensure it is still elevated and there was no laboratory error.

b. If there is no clear association after step a, consider the following:

• Review medical record to compare with any previously obtained ESR data to determine how long the ESR may have been elevated.

• Check SPEP, fibrinogen, and CRP for evidence of acute-phase response as well as to rule out myeloma or polyclonal gammopathy.

c. If still no obvious explanation, recheck the ESR in 1–3 months. Up to 80% of patients will normalize. Follow patient for development of other symptoms or signs of disease if ESR remains elevated.


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