Extremely elevated erythrocyte sedimentation rate: patient diagnoses at a tertiary Indian hospital


  • Christol Blanch Moras
  • Ashima Nagesh Amin
  • Reshma Gopal Kini




Infection, pneumonia, renal diseases, malignancy


Introduction and Aim: Extremely elevated Erythrocyte Sedimentation Rate (EEESR) is the term commonly used for elevation of ESR more than or equal to 100mm in the first hour.  To the best of our knowledge, this is the first study in Indian population. Aim was to study the common etiologies of EEESR in Indian patients at a tertiary hospital.

Materials and Methods: A retrospective, cross- sectional and descriptive study was carried out and included all patients 18 years of age and above, and who had a raised ESR of 100 mm and above at the end of 1st hour at least one time between January 2018 to December 2018 and tested at our institute. The patient’s demographic details, ESR values and diagnoses were retrieved from electronic records and were divided into 7 categories like infections, malignancy, renal diseases, autoimmune diseases, mixed diagnoses, miscellaneous and unknown.

Results: During the study period, 607 patients had EEESR. There were 335 males and 272 females. The mean age was 55 years. Within the broad categories of diseases, infection was the most common cause (52%) followed in descending order by renal diseases (12.4%), malignancy (9.6%), miscellaneous (8.4%), mixed diagnoses (7.6%), autoimmune diseases (7%) and unknown (3%). In the infection category, pneumonia was the commonest.

Conclusion: This study on frequency of common etiologies of EEESR is the first study in Indian population. Our study reaffirms findings that most patients have an underlying cause for EEESR. The commonest etiology in Indian patients is infection with pneumonia being the frequent cause.


Author Biographies

Christol Blanch Moras

Assistant Professor,  Department of Pathology, Father Muller Medical College Mangalore, Karnataka, India

Ashima Nagesh Amin

Assistant Professor,  Department of Pathology, Father Muller Medical College Mangalore, Karnataka, India

Reshma Gopal Kini

Associate Professor, Department of Pathology, Father Muller Medical College Mangalore, Karnataka, India


Brigden, M. L. Clinical Utility of the Erythrocyte Sedimentation Rate. Am Fam Physician. 1999;60(5):1443-1450.

Haque, M. D. Z., Alam, S. M. Z., Noman, M., Siddique, M. A. N., Azhar, M. A. laboratory tests required to reach the diagnosis in patients with grossly elevated ESR. J Medicine. 2009; 10: 7-11.

Laboratory Haematology. Part 1 Wintrobe’s Clinical Haematology 13th edition. Pages 16-17.

Ohta, R., Kaneko, M., Hattori, S. Diseases with Extremely elevated ESR in secondary healthcare facility: Retrospective cohort study. Shimane journal of medical sciences. Jan 2017; 34:27-33.

Al-Homrany, M. The Significance of Extreme Elevation of the Erythrocyte Sedimentation Rate in Hemodialysis Patients. Saudi J Kidney Dis Transplant. 2002; 13(2): 141-145.

Yousuf, M., Akhter, J., Khairy, K. A., Al-Saadan, M.A., Salih Bin- Salih. Extremely Elevated Erythrocyte Sedimentation Rate etiology at a tertiary care center in Saudi Arabia. Saudi Med J. 2010; 31(1): 1227-1231.

Daniels, L. M., Tosh, P. K., Fiala, J. A., Schleck, C. D., Mandrekar, J. N., Beckman, T. J. Extremely Elevated Erythrocyte Sedimentation Rates: Associations with Patients’ Diagnoses, Demographic Characteristics, and Comorbidities. Mayo Clin Proc. 2017; 92(11): 1636-1643.

Levay, P. F., Retief, J. H. Causes of high erythrocyte sedimentation rates in an inpatient population. SAMJ. January 2005; 95(1): 45-46.

Fincher, R.M.E., Page, M. I. Clinical Significance of Extreme Elevation of the Erythrocyte Sedimentation Rate. Arch Intern Med. 1986; 146(8): 1581-1583.

Zacharski, L. R., Kyle, R. A. Significance of extreme elevation of ESR rate. The Journal of the American Medical Association. 1967; 202(4): 264-266.

Stein, C. M., Xavier, R. Extreme Elevation of the Erythrocyte Sedimentation Rate in Patients Admitted to a General Medical Ward in Harare, Zimbabwe. Jou Tro Med and Hyg. 1989; 92(4): 259-62.

Abdullah, B. B., Zoheb, M., Ashraf, S. M., Ali, S., Nausheen, N. A Study of Community-Acquired Pneumonias in Elderly Individuals in Bijapur, India International Scholarly Research Network ISRN Pulmonology. 2012, Article ID 936790.

Amouzeg, F.H.A., Amid, H. Pro-Calcitonin, Erythrocyte Sedimentation Rate and C - reactive Protein in Predicting Diabetic Foot Ulcer Characteristics; a Cross Sectional Study. Archives of Academic Emergency Medicine. 2019; 7 (1): e37.

Abbag, F. I., Qehtani, J. M. A. Extreme elevation of ESR in children. Ann Saudi Med. 2007; 27(3): 175-178.

Tas, F., Erturk. K. Elevated ESR is associated with metastatic disease and worse survival in patients with cutaneous malignant melanoma. Molecular and clinical oncology. 2017; 7: 1142-1146.

Watson, J., Salisbury, C., Banks, J., Whiting, P., Hamilton, W. Predictive value of inflammatory markers for cancer diagnosis in primary care: a prospective cohort study using electronic health records. British Journal of Cancer. 2019; 120: 1045–1051.

Koshiaris, C., Bruel, A.V.D., Oke, J. L., Nicholson, B. D., Shephard, E., Braddick, M., Hamilton, W. Early detection of multiple myeloma in primary care using blood tests: a case–control study in primary care. British Journal of General Practice, September. 2018; e586-e593.

Bien, E., Balcerska, A. Serum Soluble Interleukin-2 Receptor, Beta2-Microglobulin, Lactate Dehydrogenase and Erythrocyte Sedimentation Rate in Children with Hodgkin’s Lymphoma. Scandinavian Journal of Immunology. 2009; 70: 490–500.

Garnavos, C., Xirou, S. T., Nikolatos, A., Kanakaris, N., Tzortzi, P., Balbouzis, T., Papavasiliou, N. Alteration of Body Temperature, Erythrocyte Sedimentation Rate, and C-reactive Protein After Reamed Intramedullary Nailing A Prospective Study. J Orthop Trauma. 2005; 19: 323–328.

Patil, A. M., Arifulla, M. K., Yendigeri, S. M., Sajanar, B. B. Study of Alcoholic Liver Cirrhosis in Hospital Based Patients, Bijapur, Northern Karnataka, India. International Journal of Current Medical and Applied Sciences. June 2015; 7(1): 16-20.

Mukherjee, P. S., Vishnubhatla, S., Amarapurkar, D. N., Das, K., Sood, A., Chawla,Y. K., Eapen, C. E.,et al., Etiology and mode of presentation of chronic liver diseases in India: A multi centric study. PLoS ONE 12(10): e0187033.

Kremers, H. M., Nicola, P. J., Crowson, C. S., Ballman, K. V., Jacobsen, S. J., Roger, V. L., Gabriel, S. E. Raised erythrocyte sedimentation rate signals heart failure in patients with rheumatoid arthritis. Ann Rheum Dis 2007; 66: 76–80.

Firooz, N., Albert, D. A., Wallace, D. J., Ishimori, M., Berel, D., Weisman,M. H. High-sensitivity C-reactive protein and erythrocyte sedimentation rate in systemic lupus erythematosus. LUPUS. May 2011; 20(6): 588-597.




How to Cite

Moras CB, Amin AN, Kini RG. Extremely elevated erythrocyte sedimentation rate: patient diagnoses at a tertiary Indian hospital. Biomedicine [Internet]. 2021Jan.1 [cited 2021May14];40(4):507-11. Available from: https://biomedicineonline.org/index.php/home/article/view/330



Original Research Articles