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Raised inflammatory Markers - Draft

Checked: 10-01-2025 by Rob Adams Next Review: not set yet

Overview

ESR and PV

These are non-specific tests and results should be interpreted according to clinical context, The standard inflammatory marker should be the CRP. For mainly historical reasons, plasma viscosity was widely used in and around Bristol. This test is no longer offered routinely and, in the majority of indications, this would be replaced by a CRP.

Occasionally an additional inflammatory marker is useful, over and above the CRP. The ESR will be available for such cases. The main indications for an ESR are in suspected polymyalgia rheumatic/giant cell arteritis/temporal arteritis. Additionally, it may on occasion be useful in SLE, vasculitis, inflammatory bowel disease and exclusion of osteomyelitis in diabetic foot ulcers. We would advise against an ESR as a myeloma screen – rather immunoglobulins with serum protein electrophoresis to check for a paraprotein should be performed.

Plasma viscosity will no longer be routinely available. It will be available as a send-away test for the investigation and monitoring of hyperviscosity.

Common causes:

· Infection

· Inflammation (including autoimmune disease such as temporal arteritis)

· Cancers

· Smoking

· Obesity

Less common:

· Connective tissue disease

· Myeloma

· Waldenstrom’s macroglobulinaemia

· Lymphoma

Assessment in primary care:

History should specifically include constitutional symptoms (weight loss, sweats, fevers, itching), bone pain and the patient should be assessed for infective and inflammatory causes as above.

Investigations in primary care:

· FBC, CRP, Calcium, renal and liver function

· Immunoglobulins

· Serum protein electrophoresis

· Urine Bence Jones protein or Serum free light chains

Further tests should be done according to the symptoms and signs (e.g. autoimmune screen)

Haematology referral

Only refer to haematology if a paraprotein is present or lymphoma is suspected. In the absence of specific symptoms, signs or other abnormal blood results, a marginally raised plasma viscosity is usually of doubtful significance.

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