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What causes elevated ESR levels?

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Posted on Sat, 8 Nov 2014
Question: Hi,
On Monday (October 14th) my step-mom (aged 61), went for a general health checkup. They took blood test and she got the results today, in which, it has been marked that ESR count is very high and so is Alkaline Phosphate. I am really concerned regarding this. Let me know what might be the issue. I have attached her recent blood test report (BloodTest_New.jpg).

Btw, my step-mom is a vegetarian and she has osteopenia and is already on medication for the same for nearly 2 years. On 26th July this year (nearly 3 months back) she took blood test, bone density test and her doctor prescribed her medicines. I have attached the blood test report taken on 26th july (BloodTest_Old.jpg), her bone density report (Bone Density Report_Old.jpg) and the medication she is taking (Medicine Prescribed_Old.jpg).

Therefore, my questions are:
1. Why is she having high ESR count and high alkaline phosphate? Is there any serious problems like cancer or kidney/liver issues?
2. Is this high count because of arthritis (ostopenia) or because of medication?
3. What action should I take, on her behalf?
Please advise.
doctor
Answered by Dr. Hardik Sanghvi (20 minutes later)
Brief Answer:
Please provide your reports.

Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern. But there are no any attachments with this. Please send me your reports so that I can help you further.
Thanks for using health care magic. Wish you a very good health.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Hardik Sanghvi (4 minutes later)
I have four attachments and I am trying to add it using your website. As specified by me in "Medications Tried:", it keeps giving me internal server error. I paid for premium service and this is not fair. Please provide me an alternate method to send the reports across.
doctor
Answered by Dr. Hardik Sanghvi (10 minutes later)
Brief Answer:
Don't worry dear. You will get answer.

Detailed Answer:
Hi, dear.
You may have some problems in uploading your reports. Don't worry you will get answer of your question. You can email the reports directly to YYYY@YYYY and specify they are to be attached to query ID 142632. If you need more help, they will guide you.

I will wait for your reports.
Thanks for using health care magic.
Wish you a very good health.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Hardik Sanghvi (2 hours later)
Hi, I have provided some attachments. Please review them.
doctor
Answered by Dr. Hardik Sanghvi (7 hours later)
Brief Answer:
I got your reports. I will explain you in detail.

Detailed Answer:
Hi dear,

I have gone through your question and all your reports. Your ESR is very high. There are many causes of such high ESR. Tuberculosis, paraprotienemia and malignancy are the most common cause for such a high ESR. Your alkaline phosphatase level is only slightly increased. Many time this can be seen as normal variation or it may be increased in liver disease, bone disease or intestinal disease.

Now you have osteopenia since two year. Your high ESR count is not due to osteopenia or medication. Your medication for osteopenia is perfect. You should continue with that.

However some paraprotienemia or metastatic bone disease can leads to high ESR with osteopenia.
You should search for the cause. No chance of kidney disease. You should investigate for paraprotienemia, liver disease and bone disease.

Go for protein electrophoresis, bone scan and complete liver function test.
This will clear the picture.
Then you should take treatment accordingly.

Hope I have answered your question, if you have doubt then I will be happy to answer.
Thanks for using health care magic.
Wish you a very good health.
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Hardik Sanghvi (42 minutes later)
I am attaching an Xray (xray.jpg) taken for the left leg on Monday.
Please let me know, if this helps with further diagnosis. What do you suggest after seeing this xray?
doctor
Answered by Dr. Hardik Sanghvi (1 hour later)
Brief Answer:
Your x ray doesn't suggest any major abnormality.

Detailed Answer:
Hi dear,

I have gone through the X - ray.

Your x ray doesn't suggest any major abnormality. So it will not help us to reach the diagnosis. You should go for further investigation as I told you earlier. Then take treatment accordingly.

Hope I have answered your question, if you have doubt then I will be happy to answer.

Thanks for using health care magic.

Wish you a very good health.
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Hardik Sanghvi (29 hours later)
I took another blood test yesterday at a reputed hospital to confirm the ESR. I have attached the Blood test report (NewBloodTest.jpg), I received today. The ESR is 75 and alkaline phosphate level is also normal. Should I be concerned that, the ESR is above normal? Could you please suggest the next steps that I should take?
doctor
Answered by Dr. Hardik Sanghvi (20 minutes later)
Brief Answer:
You should investigate for the causes of high ESR.

Detailed Answer:
Hi, dear
I have gone through your new blood test report. Your ESR is still high but good thing is that your alkaline phosphatase is normal.
So, now you should investigate for the causes of high ESR.
Autoimmune disease or Paraproteinemia may be the cause of your high ESR.
You should go for protein electrophoresis and complete ANA profile.

Then you should take treatment accordingly.
Hope I have answered your question, if you have still any doubts then feel free to ask me again. I will be happy to answer.
Thanks for using health care magic.
Wish you a very good health.
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Hardik Sanghvi (31 minutes later)
Shouldn't ESR be > 100, to be considered for Paraproteinemia? I was under the impression that, since I have ostopenia (arthritis), my ESR level is 75. Please advise.
doctor
Answered by Dr. Hardik Sanghvi (13 minutes later)
Brief Answer:
Yes it should me more than 100 in most of the case

Detailed Answer:
Hi, dear
In paraproteinemia ESR level is mostly more than 100.
Your previous report suggest your ESR is 150 after 30 minutes only. So we should rule out possibilities of some paraproteinemias also.
You are right about arthritis. It can lead to high ESR. I already advised complete ANA profile. Most of the arthritis are manifestation of some autoimmune disease.
So you have high chance of autoimmune disorder. SO we should investigate for the both.
Go for the investigation and take treatment accordingly.
Hope I have cleared your all doubts. If you still have any doubts then feel free to ask me. I will be happy to answer you again.
Thanks for using health care magic.
Wish you a very good health.
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
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Dr. Hardik Sanghvi

Hematologist

Practicing since :2008

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What causes elevated ESR levels?

Brief Answer: Please provide your reports. Detailed Answer: Hi, dear I have gone through your question. I can understand your concern. But there are no any attachments with this. Please send me your reports so that I can help you further. Thanks for using health care magic. Wish you a very good health.