Q: My mother has been diagnosed with kidney failure three weeks back. At that time her platelet count was normal 1.44 lakh/cmm. She has a AV fistula operation done, which was repeated since the first fistula did not function and later acquired infection. She was given claribid for the infection. The swelling and pain has reduced to a great extent. However, now her platelet count has reduced to 0.85 lakh/cmm and ESR 1st hour has been raised to 59 mm. We had not tested for her ESR earlier. Can we suspect autoimmune disorder (lupus)? Can the high ESR count be because of the infection of the non-functional fistula?

A:Erythrocyte sedimentation rate (ESR) is a nonspecific screening test for various diseases. 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. The normal value for women over 50 years is less than 30 mm. Any condition that increases fibrinogen levels (a type of blood protein) like pregnancy, diabetes mellitus, end-stage renal failure, heart disease, collagen vascular diseases, malignancy etc. may raise the ESR. In anaemia too the ESR rises. Earlier, this test was commonly used as an index of disease activity in patients who had certain disorders but with the development of more specific methods, it is no longer so. In your mother’s case, it could be high due to the renal disease, anaemia, surgery or infection. Her low platelets could also be due to the AV fistula and the surgery.