What is the significance of an elevated erythrocyte sedimentation rate (ESR) of 37 mm/hour in a 7-year-old female, where the normal range is 0-20 mm/hour?

From the Guidelines

The elevated erythrocyte sedimentation rate (ESR) of 37 mm/hr in this 7-year-old female requires further evaluation by her pediatrician to determine the underlying cause of this inflammatory marker, as it could be indicative of various conditions including infections, autoimmune disorders, or inflammatory conditions 1. This blood test measures how quickly red blood cells settle in a test tube, with higher values indicating potential inflammation in the body. While this result is above the normal range (0-20 mm/hr), it represents a mild elevation.

Possible Causes and Next Steps

• The child should be evaluated for clinical symptoms such as fever, joint pain, rash, or fatigue.
• Additional testing may be necessary, including a complete blood count, C-reactive protein, and possibly specific tests based on any symptoms present.
• The ESR alone is not diagnostic of any specific condition but serves as a non-specific marker of inflammation that helps guide further investigation.
• According to the American Heart Association, an elevated ESR can be seen in patients with Kawasaki disease, but a diagnosis of KD is unlikely if the ESR, C-reactive protein (CRP), and platelet count are normal after day 7 of illness 1.
• The American College of Radiology suggests that an elevated ESR can also be seen in patients with osteomyelitis or septic arthritis, and clinical suspicion of these conditions is of paramount importance in management 1. Parents should monitor for any developing symptoms and follow up with the pediatrician for a complete assessment to determine the underlying cause of this elevated inflammatory marker.

Key Considerations

• The child's clinical presentation and medical history should be taken into account when interpreting the ESR result.
• A thorough physical examination and additional diagnostic tests may be necessary to determine the underlying cause of the elevated ESR.
• The pediatrician should consider the possibility of infections, autoimmune disorders, or inflammatory conditions, and order further testing accordingly.

From the Research

Sedimentation Rate in a 7-Year-Old Female

• The sedimentation rate of 37 mm/HR is considered high for a child, as the normal range is typically between 0-20 mm/HR 2, 3, 4.
• Elevated sedimentation rates can indicate the presence of inflammation or infection in the body 2, 3, 4.
• Studies have shown that sedimentation rates can be used to assess the severity of infections, such as bacteraemia, in children 2, 5.
• However, it is essential to note that sedimentation rates can be influenced by various factors, including age, sex, and underlying medical conditions 3, 4.

Relationship Between Sedimentation Rate and Infections

• Research has demonstrated that elevated sedimentation rates are associated with an increased risk of invasive bacterial infections (IBIs) in febrile children 4.
• A study published in the American Journal of Emergency Medicine found that none of the children with a normal sedimentation rate had an IBI, suggesting that sedimentation rates can be used to exclude IBIs in febrile children 4.
• Another study published in the Journal of Clinical Pathology found that leucocyte antisedimentation rate (LAR) was significantly higher in bacteraemic patients than in non-bacteraemic patients, indicating that LAR can be used to predict blood culture results in critical care patients 5.

Clinical Implications

• The high sedimentation rate in this 7-year-old female may indicate the presence of an underlying infection or inflammatory condition 2, 3, 4.
• Further testing, such as blood cultures and C-reactive protein (CRP) levels, may be necessary to determine the cause of the elevated sedimentation rate 2, 3, 4.
• It is crucial to obtain blood cultures before administering antibiotic therapy to increase the likelihood of detecting pathogens 6.