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Illnesses associated with extreme elevation of the erythrocyte sedimentation rate in children
Insights
Children with very high erythrocyte sedimentation rates (ESR) are often diagnosed with infectious diseases. These patients are typically younger and present with higher fever and white blood cell counts compared to other conditions.
Area of Science:
- Pediatrics
- Clinical Pathology
- Immunology
Background:
- Elevated erythrocyte sedimentation rates (ESR) are common indicators of inflammation.
- Understanding the underlying causes of extremely high ESR in children is crucial for diagnosis and management.
Purpose of the Study:
- To analyze the spectrum of diseases associated with erythrocyte sedimentation rates (ESR) ≥ 100 mm/hr in pediatric patients.
- To identify clinical and laboratory differences between patient groups with high ESR.
Main Methods:
- Retrospective review of laboratory and hospital records.
- Inclusion criteria: 156 children with ESR ≥ 100 mm/hr over a 31-month period.
- Categorization of patients based on underlying disease: infectious, collagen/renal, neoplasms, and miscellaneous.
Main Results:
- Infectious diseases were diagnosed in 55% of children with high ESR.
- Collagen or renal diseases accounted for 25%, neoplasms for 13%, and miscellaneous for 6%.
- Patients with infections were younger, more febrile, with higher leukocyte and band counts. Malignancy patients had lower hemoglobin and leukocyte counts.
Conclusions:
- Extremely elevated ESR in children strongly suggests an underlying infectious etiology.
- Distinct clinical and laboratory features differentiate infectious causes from other conditions like malignancy.
- While some patients may have severe underlying diseases, death did not occur during the hospitalization for ESR determination.
Abstract:
The laboratory and hospital records were reviewed for the 156 children seen at Milwaukee Children's Hospital over a thirty-one month period with erythrocyte sedimentation rates (ESR) greater than or equal to 100 mm/hr. Fifty-five per cent of the children had an underlying infectious disease, 25 per cent had a collagen or renal disease, 13 per cent had neoplasms, and 6 per cent had miscellaneous disease processes. Patients with infectious diseases and high ESRs were significantly younger, significantly more febrile, and had higher leukocyte and absolute band counts than did patients in the other groups. Patients with malignancy had significantly lower hemoglobin levels, leukocyite and absolute PMN counts. Some patients did die during the 30-month study period but not during the particular hospitalization in which the ESR was obtained.