Esr Increase : Causes, Symptoms, Diagnosis & Treatment

Last Updated: 28/09/2022

An increase in ESR is an excess of the erythrocyte sedimentation rate in the blood of more than 10 mm / h in men and 15 mm / h in women. Acceleration of ESR is a non-specific laboratory marker, it can be caused by infectious, inflammatory, autoimmune and oncological diseases. Very often occurs together with leukocytosis and fever. The main clinical picture is determined by the pathology, against which there was an increase in ESR. The ESR indicator is examined manually or automatically in venous or capillary blood, usually in the morning before meals and medications. To correct the indicator, the treatment of the disease that caused the increase in ESR is carried out.


There are no clear digital gradations for separating the increase in ESR by degrees. Conditionally distinguished moderate and high degree. According to the mechanism of occurrence, they distinguish:

  • True increase in ESR . The cause is various inflammations, infectious, oncological pathologies. It develops due to dysproteinemias that increase erythrocyte aggregation.
  • False increase in ESR . False acceleration of ESR is observed with anemia, azotemia, alkalosis, high cholesterol levels in the blood. The reason for this phenomenon is various pathological processes, in which ESR increases due to changes in the number or shape of red blood cells, the protein-lipid composition of plasma, a shift in blood pH, and the presence of other chemical compounds.

Reasons for an increase in ESR

Physiological states

An increase in ESR does not always indicate a pathological process. Some physiological conditions also cause an increase in ESR. For example, the cause of such an increase in ESR can be food intake, insufficient fluid intake, intense physical activity. An increase in ESR also occurs during pregnancy. With each trimester, the indicator increases, reaching a maximum by childbirth. In the course of numerous studies, it was noted that ESR gradually increases with age (every 5 years by 0.8 mm / h). Therefore, in almost all elderly people, ESR up to 40-5 mm / h is observed in the blood. Approximately 10-15% of absolutely healthy people have an increase in ESR.


Infectious diseases are recognized as the most common cause of an increase in ESR in the blood. The pathogenetic mechanism is that the resulting inflammatory proteins (fibrinogen, C-reactive protein) and immunoglobulins (antibodies) to foreign microorganisms that have a positive charge are adsorbed on the surface of red blood cells, reducing their negative charge. This weakens the force of mutual repulsion of red blood cells, which leads to their agglutination, aggregation (“gluing”), the formation of “coin columns”, due to which they settle faster than normal.

  • Acute infections . An increase in ESR occurs somewhat later than the onset of clinical symptoms of pathology, the appearance of leukocytosis in the blood and fever, and correlates with the severity of the infection. With bacterial, fungal infections (tonsillitis, salmonellosis, candidiasis), ESR is much higher than with viral ones (flu, measles, rubella). It reaches a maximum after the reverse development of pathological processes, persists for some time after recovery, then gradually decreases.
  • chronic infections . Chronic infections of the urinary system and oral cavity are recognized as a common cause of persistently increased ESR. Quite often, an increase in ESR may be the only manifestation of such sluggish infectious inflammatory processes as tuberculosis, helminthic invasions, and chronic viral hepatitis C.

Aseptic inflammation

The cause of high ESR is also pathological conditions, accompanied by tissue damage and decay. These are heart attacks of various organs (myocardium, lung, kidneys), surgical interventions, non-infectious inflammation of the gastrointestinal tract (pancreatitis, cholecystitis). Under the influence of tissue decay products, proteins of the acute phase of inflammation are produced, mainly fibrinogen, which binds to the erythrocyte membrane, which causes their aggregation. An increase in ESR does not occur immediately, but for about 2-3 days, it increases intensively at the end of the 1st week, when the level of leukocytes in the blood begins to decrease. This phenomenon is especially typical of myocardial infarction and is called the "crossover symptom".

immune inflammation

The change in the negative charge of erythrocytes in nosologies characterized by immunopathological reactions is due to the deposition of immune complexes and gamma globulins on the membrane of red blood cells. An increase in ESR develops gradually, reflects the activity of the inflammatory process, and normalizes during remission. ESR serves as an indicator of the effectiveness of pathogenetic treatment. It is noteworthy that its increase occurs much earlier than the onset of symptoms of these diseases (joint pain, skin rashes, etc.).

Of this group of diseases, the most common causes of increased ESR in children are acute rheumatic fever, in adults - rheumatoid arthritis, in the elderly - polymyalgia rheumatica.

  • Joint diseases : ankylosing spondylitis (Bekhterev's disease), reactive arthritis.
  • Diffuse connective tissue diseases (collagenoses) : systemic lupus erythematosus, Sjögren's syndrome, systemic scleroderma, dermatomyositis.
  • Systemic vasculitis: giant cell arteritis, granulomatosis with polyangiitis, polyarteritis nodosa.
  • Inflammatory bowel disease: Crohn's disease, ulcerative colitis.
  • Other autoimmune pathologies : glomerulonephritis, autoimmune hepatitis, thyroiditis.



The reason for the pronounced increase in ESR (up to 10 mm/hour and above) are tumors of the B-lymphocyte system (paraproteinemic hemoblastoses). These include multiple myeloma, Waldenström's macroglobulinemia, heavy chain disease. These pathologies are characterized by the secretion of a large number of paraproteins (abnormal proteins) that cause blood hyperviscosity and change the membrane potential of erythrocytes. Moreover, an increase in ESR often develops several years before the onset of the first symptoms (skin itching, ossalgia, bleeding). An increase in ESR, although less sharp, occurs in patients with other oncohematological pathologies (leukemia, lymphoma).

Oncological diseases

Sometimes solid (non-hematopoietic) tumors become the cause of an increase in ESR in the blood. The increase in ESR is explained by two mechanisms: an increase in the level of fibrinogen, tumor markers, and the decay of a malignant formation. The degree of increase in ESR is determined not by the histological structure of the tumor, but by its size and damage to surrounding tissues. Often, the appearance of elevated ESR in the blood is ahead of clinical symptoms.

Rare Causes

  • Metabolic disorders : amyloidosis, familial hypercholesterolemia, generalized xanthomatosis.
  • Endocrine pathologies : thyrotoxicosis, hypothyroidism.
  • Heavy metal poisoning : arsenic, lead intoxication.
  • Use of drugs : dextrans, estrogen-containing products (oral contraceptives).


Any, even an asymptomatic increase in ESR, requires a visit to a doctor to find out the cause. The doctor asks the patient in detail whether there was an increase in body temperature, whether the patient experienced pain in the joints, muscles, whether fatigue appeared, etc. This can help in the diagnostic search. An additional examination is prescribed, depending on which nosology is suspected:

  • Blood tests . The concentration of hemoglobin, blood cells (erythrocytes, platelets, leukocytes) is measured. Very often, an increase in the level of fibrinogen, C-reactive protein, is detected. The blood is checked for the presence of auto-aggressive antibodies (aCCP, anti-neutrophil cytoplasmic antibodies, antibodies to double-stranded DNA). In severe bacterial infections, high presepsin and procalcitonin are observed in the blood.
  • Identification of the infectious agent . Antibodies to antigens of viruses, bacteria, parasites are determined using ELISA methods and serological tests. PCR detects DNA and RNA of microorganisms. Conducted microscopy, bacteriological culture of urine, sputum, blood. The feces are analyzed for worm eggs.
  • Radiography . With tuberculosis, an x-ray of the lungs shows an increase in mediastinal lymph nodes, infiltration in the upper lobes of the lungs. In case of paraproteinemic hemoblastoses, numerous foci of bone tissue destruction are found on the x-ray of the bones. Multiple myeloma is characterized by a “punch sign” on a skull x-ray.
  • ultrasound . On the echography of the abdominal cavity with cholecystitis, a thickening of the walls of the gallbladder is detected, with pancreatitis - an increase and diffuse changes in the pancreatic parenchyma, with hemoblastoses - an increase in the liver and spleen.
  • Angiography. In case of infarcts of various organs caused by thrombosis, a filling defect at the site of vessel occlusion is determined on radiography or computed tomography with contrast. With systemic vasculitis (Horton's arteritis, Takayasu), areas of vascular stenosis are visible.
  • Histological studies . If the cause of elevated ESR is an oncological pathology, a biopsy is mandatory. A common symptom is the detection of a large number of atypical cells. In patients with malignant blood diseases, a predominance of blast cells is noted in the bone marrow punctate, and atypical lymphoid proliferation is observed in the lymph node biopsy.



Conservative therapy

A transient increase in ESR after exercise, food intake or medication does not require correction. Elderly people with high ESR without other clinical and laboratory signs of any pathology also do not need any intervention. To normalize the pathological increase in ESR, it is necessary to treat the nosology that caused its development.

  • Fight against infection . For bacterial infections, antibiotics are prescribed according to sensitivity. In a serious condition of the patient requiring immediate treatment, broad-spectrum antibiotics (penicillins, cephalosporins, fluoroquinolones) are used. For influenza, oseltamivir is used, for other acute viral infections, symptomatic therapy is used. Combinations of peligated interferon with ribavirin and entecavir are effective for the treatment of chronic viral hepatitis.
  • Anti-inflammatory therapy . In diseases accompanied by immune inflammation, anti-inflammatory drugs are needed - glucocorticoids (prednisolone), cytostatics (azathioprine, methotrexate), 5-aminosalicylic acid derivatives (sulfasalazine). If they are ineffective, tumor necrosis factor inhibitors - monoclonal antibodies (infliximab) are used.
  • Blood thinning . If the cause of the heart attack is thrombosis or embolism, antiplatelet agents (clopidogrel, acetylsalicylic acid), anticoagulants (heparin, warfarin, dabigatran) are prescribed. Thrombolytics (streptokinase) are used to dissolve the thrombus.
  • Chemotherapy. Anticancer drugs (alkylating agents, antimetabolites) are used to treat oncological diseases. Malignant blood diseases require a combination of several chemotherapy drugs.


In acute abdominal pathology (cholecystitis, pancreatitis), it is necessary to perform a surgical (sometimes emergency) operation - pancreas resection, laparoscopic cholecystectomy. To remove the thrombus, endovascular thrombectomy is performed. With myocardial infarction, percutaneous coronary intervention (stent placement) is performed. Unsuccessful conservative therapy of oncohematological diseases is considered an indication for bone marrow transplantation.


The physiological increase in ESR is absolutely benign and quickly passes on its own. With a prolonged increase in ESR, it is necessary to examine and treat the disease that caused it. The prognosis is determined by the underlying pathology. It is favorable for some viral infections, timely treatment of autoimmune diseases. A high probability of death is observed in patients with extensive heart attacks, malignant neoplasms.

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