Extreme elevation of the erythrocyte sedimentation rate in children

BACKGROUND: Extreme elevation the of erythrocyte sedimentation rate (ESR≥100 mm/hour) is usually associated with significant diseases. This study was performed to assess its significance in pediatric patients seen in Aseer Central Hospital. METHODS: All ESRs performed for children between September 2001 and December 2002 were reviewed. The medical records of those with an ESR≥100 mm/hr (group 1) were reviewed for age, sex, diagnosis, ESR value, hemoglobin (Hgb) value and leukocyte counts. The diagnoses were divided into seven categories: malignancy, connective tissue diseases (CTDs), tropical infections, mild infections, severe infections, renal diseases and miscellaneous. One hundred forty-five patients with an ESR<100 mm/hr (group 2) were randomly selected for comparison. RESULTS: Of 2540 ESRs, 99 were ≥100 mm/hr (3.9%). There were 54 males and 45 females and the mean age was 72±48.2 months. Infection was the most common cause (49.5%), followed by CTDs (26.3%), malignancy (12.1%) and renal diseases (8.1%). Malignancy was associated with the lowest Hgb value (8.2 g/dL). A comparison between group 1 and group 2 considering each diagnostic category separately showed that group 1 patients with mild infections had significantly higher mean leukocyte counts and that group 1 patients with CTDs had significantly lower Hgb values than group 2 patients with the same diagnoses, but there were no significant differences between the other diagnostic categories. CONCLUSION: The most common cause of extreme elevation of ESR is infection. This extreme elevation may be used as a sickness index, but not as a screening tool for any disease.