PT - JOURNAL ARTICLE AU - Muhammad Yousuf AU - Javed Akhter AU - Khalid Al-Khairy AU - Mohammed A. Al-Saadan AU - Salih Bin-Salih TI - Extremely elevated erythrocyte sedimentation rate. Etiology at a tertiary care center in Saudi Arabia DP - 2010 Nov 01 TA - Saudi Medical Journal PG - 1227--1231 VI - 31 IP - 11 4099 - http://smj.org.sa/content/31/11/1227.short 4100 - http://smj.org.sa/content/31/11/1227.full SO - Saudi Med J2010 Nov 01; 31 AB - OBJECTIVE: To evaluate the etiology of extremely elevated erythrocyte sedimentation rate (ESR) in adolescents and adults at a tertiary care center.METHODS: This retrospective, cross-sectional, observational study was carried out at King Abdulaziz Medical City, Riyadh, Saudi Arabia using the Westergren method of determining ESR in adolescents and adults aged >/=12 years. The patients included inpatients and outpatients with medical, surgical, and gynecological problems. During a period from June 2007 to October 2008, consecutive, non-repetitive patients with ESR >/=100 mm/hour were evaluated for possible etiology by checking the electronic and paper data file of each patient.RESULTS: During the study period, out of the 44,366 ESR tests carried out at this center, 1864 (4.2%) had an ESR >/=100 mm/hour belonging to 567 patients. Out of 508 patients fulfilling the study criteria, the main associated causes included: infections (38.6%), autoimmune diseases (15.9%), malignancy (15.4%), miscellaneous causes (10.2%), ischemic tissue injury or trauma (8.7%), and renal diseases (8.4%). Ten common individual causes included: rheumatoid arthritis (7.3%), osteomyelitis (6.9%), tuberculosis (5.5%), trauma (5.3%), lymphoma and sepsis of unknown origin (5.1%) each, urinary tract infection (4.7%), septic arthritis (3.1%), abscesses (2.8%), and pregnancy (2.2%). Fourteen (2.4%) patients had no known cause.CONCLUSION: Most of the patients with extreme ESR elevation have an underlying cause and a focused evaluation of such patients needs to be carried out to reach a diagnosis.