Dr. Bateman answers IOM questions from the community: Part 2
Clark Ellis brings us Part 2 of an interview with Dr. Lucinda Bateman, where she answered questions posed by the patient community …
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ESR - always low in ME??

Discussion in 'Diagnostic Guidelines and Laboratory Testing' started by mobyjoby, Aug 31, 2012.

  1. SOC

    SOC Senior Member

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    Ah, that probably explains it. Thanks, Rich.
     
  2. jimells

    jimells Senior Member

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    ESR seems to be a common test where I live.

    Looking through my notebook, I found three tests in the last two years. In 2010 it was zero, last year it was 4, now it's up to 5. Meanwhile other inflammation markers are also showing up as I continue to get sicker. Two years ago the ANA screen was negative. Now it's slightly elevated. Also a recent 'single stranded DNA' test was elevated, which is supposed to be yet another non-specific marker of inflammation.

    In spite of my symptoms and inflammation markers, the rheumy concluded, "There are no signs of autoimmune disorder. We can't help you, and we don't know who can." :mad:
     
  3. Valentijn

    Valentijn Activity Level: 3

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    As of today, my ESR is still high, now at 25.
     
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  4. drob31

    drob31 Senior Member

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    RIP to Rich. I just wanted to bump this up because it matches exactly what is going on with me.

    APA can manifest a 100 different ways. It would make allot of sense if some cases of CFS are caused by APA.
     
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  5. Thinktank

    Thinktank Senior Member

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    My ESR and HsCRP have always been low.
    ESR 0 to 2 and HsCRP < 0.01
    Even though i've been diagnosed with every illness that ends with "-itis", also my cytokines and chemokines are extremely elevated.
     
  6. daisybell

    daisybell Senior Member

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    Bumping this thread....

    Are there any updates/new pieces of research into ESR in ME?
    My last reading was 2mm/hr.
     
  7. charles shepherd

    charles shepherd Senior Member

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    This is a Q and A from the next issue of the MEA magazine on the subject of the CRP (C-reactive protein) test - which is used instead of, or in parallel, with the ESR test:

    QUESTION: CRP blood test


    I've been feeling generally more unwell for several months – so my GP has done some blood tests. They were all reported to be normal - apart from a slightly raised level of one test called a CRP. This is now going to be repeated. What is this test? Is it something that can be raised in ME/CFS? And what happens if it remains raised?


    ANSWER


    The CRP (C-Reactive Protein) blood test is a very useful but non -specific marker for infection or inflammation in the body. So if the CRP level is raised, it suggests that there is some form of infection or inflammation occurring somewhere in the body - even though there may not be any obvious symptoms or signs that would help to demonstrate where in the body this is occurring.


    The CRP test is not therefore diagnostic of any particular infection or inflammation - as there are many possible explanations for a raised level. These can range from specific infections through to inflammatory bowel disease, arthritis, and autoimmune diseases such as lupus/SLE. The level can also be raised in the later stages of pregnancy, when taking the contraceptive pill or HRT, and with obesity.


    The CRP test, or a similar one called the ESR (erythrocyte sedimentation rate), should always form part of the raft of blood tests that are checked, and reported to be within normal limits, when a diagnosis of ME/CFS is being made or considered. When something is wrong, the CRP test usually rises and falls faster than the ESR test.


    In the case of ME/CFS, both the CRP and ESR test results should be within normal limits - but there are some circumstances (e.g a recent infection) where they might be raised.


    If the level is slightly raised, the test will probably be repeated. If the level remains raised, or is significantly raised, this should lead to a thorough re-evaluation of your clinical symptoms and some further investigations to try and find the cause. I assume from what you are saying that consideration has been given to conditions that are sometimes misdiagnosed as ME/CFS, and which do cause an elevation of the CRP level - lupus/SLE for example.


    Where the CRP level remains persistently raised, and the GP cannot find an explanation, referral to a hospital specialist will probably be necessary.


    · The use of ESR and CRP tests in ME/CFS are described in the Investigation section of the MEA purple booklet


    · More detailed information on the CRP test:


    http://labtestsonline.org.uk/understanding/analytes/crp/tab/test/
     
  8. knackers323

    knackers323 Senior Member

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    @charles shepherd and others. Can a person have an infection or inflammation but not have a high crp or ESR? Or is it highly unlikely.

    Do Lyme's and those with lform bacteria and chronic ebv always have high levels of these?
     
  9. halcyon

    halcyon Senior Member

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    My ESR was 1 while still in the throes of my triggering infection.
     
  10. Kyla

    Kyla ᴀɴɴɪᴇ ɢꜱᴀᴍᴩᴇʟ

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    Maybe subgroups?
    Or co-morbidities?

    If ESR is always low in ME I have been extremely misdiagnosed.
    Mine was at triple the reference range early in illness - 70

    I have definitely seen others on here saying they had high esr
     
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  11. drob31

    drob31 Senior Member

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    Was yours a virus like coxackie B?
     
  12. drob31

    drob31 Senior Member

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    I've read low ESR could be associated with sticky blood conditions. Mine is always 2.
     
  13. halcyon

    halcyon Senior Member

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    Yes, echovirus 30.
     
  14. drob31

    drob31 Senior Member

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    Igg/Igm? Have you made any progress with it? Equillibrant?
     
  15. halcyon

    halcyon Senior Member

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    The tests available in the US can't differentiate between IgM and IgG; they essentially measure both. Yes, Equilibrant and lamivudine. I've had mild progress symptom wise but my antibody titer hasn't budged in over a year.
     
  16. Hutan

    Hutan Senior Member

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    I don't think it is a subgroup thing.

    My son and I got ME at the same time and have had essentially the same symptoms.
    He has had low ESRs (4, 4 and 2) but normal CRP (with one slightly high value).
    My ESR has been normal (with the one high spike) but my CRP is consistently slightly elevated (10-20).

    It's possible we have different, complicating infections as well as ME or that different genes are having an impact.
     
  17. knackers323

    knackers323 Senior Member

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    Hutan. very interesting. how did your illnesses start?

    what is the ref range for those low ESRs?

    it seems like a lot of these tests are only a vague indication at best, and can even steer you down the wrong path.

    thanks
     
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  18. Hutan

    Hutan Senior Member

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    @knackers323
    Our illnesses started with severe gastro pain/flu. My daughter also got sick at teh same time and was hospitalised for three days with suspected appendicitis but that was later ruled out. We all remained unwell, going through periods where certain symptoms were prevalent eg joint pain, gastro issues, numbness. My daughter essentially recovered after 2 years. My son and I are much better than we were in the first year but not able to do much in the way of work/school.

    The ref range for ESR that I have is <15. The labs here don't seem to see low ESRs as a problem worth highlighting.

    Yes, I certainly wouldn't be trying to make ME subgroups based on ESR and CRP values.
     
  19. CantThink

    CantThink Senior Member

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    Mine has always been high. If a high ESR negated M.E., then I've been misdiagnosed for nearly a quarter of a century! I find it a bit weird that a doctor (think it was Cheney) would rule out M.E. if the ESR is not low. I'd love to know what is wrong and with me, if it is not that.
     
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  20. halcyon

    halcyon Senior Member

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    It seems to be a common enough finding to be noteworthy but it would never rule out ME. It's possible to have ME and something else wrong with you that would drive up the ESR.
     

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