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What is the cause of elevated ESR levels?

Q: Recently my wife strained her back while washing clothes. She had a severe backache. We consulted the doctor who asked for ESR test and an x-ray. The mentioned that the ESR should be within (0-10) but my wife's ESR levels were as high as 35 and x-ray shows some minor damage in spine. What should we do? The doctor gave us calcium & iron tablets.

A:Erythrocyte sedimentation rate (ESR) is a nonspecific screening test for various diseases. It is a simple and inexpensive test that measures the distance that red blood cells have fallen after one hour in a vertical column of anti coagulated blood under the influence of gravity. The amount of fibrinogen (a blood protein) in the blood directly correlates with the ESR. Although many studies have been done, an increased ESR remains a nonspecific finding. The use of the ESR as a screening test in asymptomatic persons is limited by its low sensitivity and specificity as it is affected by many variables. Women tend to have higher ESR values, as do the elderly. Obese people too tend to have raised ESR for some unknown reason though this is not thought to have any clinical significance. Any condition that increases fibrinogen levels (e.g., pregnancy, diabetes mellitus, end-stage renal failure, heart disease, collagen vascular diseases, malignancy, and chronic infection) may elevate the ESR. In anaemia the ESR rises as the speed of the upward flow of plasma is altered so that red blood cell aggregates fall faster. Macrocytic (larger) red cells with a smaller surface-to-volume ratio also settle more rapidly. No obvious cause is seen in fewer than 2 percent of patients with a markedly elevated ESR. An elevated ESR in the absence of other findings should not prompt an extensive laboratory or radiographic evaluation but a mild to moderately raised one without any obvious cause should be repeated after a few months rather than an expensive search for occult disease.

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