Erythrocyte sedimentation rate permanently elevated.
November 8, 2014 | 15,00 EUR | answered by Dr. med. Ralf Berg
Good evening dear doctor!
I have the following problem: I have had an elevated ESR for about 10 years. The value fluctuates between 30-70 in the first hour when a blood test is done. I don't know the exact second values. In any case, this is very noticeable. All other values from the blood test are okay except for a permanent minimal increase in liver values. My primary care physician does not take this seriously and I wouldn't be worried either if it hadn't been going on for so long. I don't feel really sick, but I am often tired and have various unspecific symptoms. I went to a rheumatologist on my own initiative and he said it could be a disease from the rheumatic spectrum, but he couldn't find anything else in the blood tests except the elevated ESR. CRP and rheumatoid factor are also normal.
Could there be a hidden autoimmune hepatitis or kidney inflammation behind this? Which doctor should I go to to further investigate this? How severe is the inflammation with a value of 70 (comparison)?
Thank you very much for your response.
Good evening,
I am happy to answer your questions. The BSG is a sensitive but very unspecific marker for an inflammatory reaction in the body. In simple terms, it has to do with the proteins dissolved in the blood. If these are present in a different composition, the values of the erythrocyte sedimentation rate increase. This not only happens with increased immunoglobulins in inflammation or rheumatism, but can also occur with completely harmless protein molecules that you may have and others do not.
Now to your questions:
1. Autoimmune hepatitis is unlikely, as it would have already caused severe damage within 10 years. Also, liver values would be more than just minimally elevated.
2. A kidney inflammation is also unlikely, as in most cases, the CRP should also be elevated.
3. The BSG is measured in cm/hour or cm/2 hours and is only a relative unit. The severity levels can be classified as follows: 0-20 normal, 20-50 slightly elevated, 50-100 moderately elevated, over 100 in the first hour = rapid drop = significantly elevated. However, if this does not correlate with the CRP value, there may not be any inflammation at all, but rather individual protein molecules that have no clinical significance and simply increase the sedimentation rate in an unspecific manner.
4. In this case, it is best not to see a doctor, as this finding is likely not further investigable. Your elevated BSG is less of a problem and more of a phenomenon that must be interpreted as an individual deviation from the norm without clinical significance.
It's like playing the lottery, you can invest a lot of time and money, and try to find something out, but in the end, nothing will come of it.
With best regards,
Dr. R. Berg
