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Causes of raised ESR

Pregnancy

Increases in pregnancy; maximal in 3rd trimester

Infections

Acute and chronic infections, including TB Note: 4 ESR also occurs in HIV infection

Collagen disorders

Rheumatoid, SLE, polymyalgia rheumatica, vasculitides etc. (including temporal arteritis); ESR useful as non-specific monitor of disease activity

Other inflammatory processes

Inflammatory bowel disease, sarcoidosis, post-MI

Neoplastic conditions

Carcinomatosis, NHL, Hodgkin's disease and paraproteinaemias (benign & malignant)

Investigations

Given the wide range of situations in which a raised ESR can arise, further investigation depends on a carefully conducted history and examination. In the absence of likely causes from these, simple initial laboratory and radiology assessments to include urinalysis, full blood count and film examination, urea, electrolytes, plasma protein electrophoresis, an autoimmune profile and CXR should represent a practical and pragmatic primary diagnostic screen.

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