Elevated ESR in Women

Malignant Neoplasms (Fallopian Tube Cancer)

One of the most formidable conditions associated with an elevated ESR is primary fallopian tube cancer. Diagnosing this disease is extremely difficult: even during surgical intervention (laparoscopy or laparotomy), the correct diagnosis is established in only every second patient (in 50% of cases).

The probability of a malignant process increases significantly when a specific clinical and laboratory triad is identified:

• Enlargement of the uterine appendages.
• Decreased leukocyte count in the blood.
• Elevated ESR against the background of an absolutely normal body temperature.

Diagnostic and Clinical Features: To confirm the diagnosis, a cytologic examination of the aspirate from the cervical canal and uterine cavity is used. To increase accuracy, the discharge is collected using special caps or tampons, which are inserted into the vagina for several hours. The instrumental method of choice is ultrasound with color Doppler mapping (CDM). It allows the detection of the tumor and pathological blood flow within it even in obese patients. Maximum value is achieved by comparing ultrasound and cytology data.

In the early stages, the fallopian tube appears intact, and the tumor is easy to miss. In later stages, the tube deforms, acquiring a retort-like, pear-shaped, or sausage-like shape (resembling pyosalpinx externally). The ampullary section is most frequently affected, and on cross-section, the cavity is filled with cauliflower-like tumor masses.

Treatment requires a comprehensive approach: total hysterectomy with adnexectomy and omentectomy, postoperative radiation therapy, and platinum-based chemotherapy (indicated in all cases except the earliest stages). Adequate combined treatment reliably increases the recurrence-free interval. Overall 5-year survival is about 35% (about 70% for stage I, and 25–30% for stages II–III). Secondary cancer (metastases from the uterine corpus or ovaries) is treated based on the management tactics for the primary focus.

Infectious and Parasitic Pathologies

Accelerated ESR frequently accompanies severe infectious processes. A striking example is malaria. In clinical practice, there are cases where, against the background of a Plasmodium falciparum infestation, a complete blood count reveals an ESR of 36 mm/h, decreased hemoglobin (down to 95 g/L), and a normal or slightly elevated leukocyte count (10×10⁹/L). Additionally, the biochemical blood test may show hypoglycemia (glucose 3.2 µmol/L).

The course of malaria in women can be complicated by comorbid conditions. For example, infection with Plasmodium malariae (frequently imported from endemic regions such as West Africa) against the background of chronic glomerulonephritis can lead to a severe condition with persistent arterial hypertension (up to 170/100 mm Hg), pronounced edema (anasarca), and massive proteinuria (up to 2 g/day). Objectively, such female patients, as with other forms of malaria (including Plasmodium vivax, which causes fever attacks every other day), present with hepatomegaly and splenomegaly—enlargement of the liver and a firm spleen.

Anemic Syndrome and Red Blood Cell Changes

The ESR assessment is inextricably linked with the analysis of other red blood cell parameters, primarily hemoglobin (Hb). Anemia is a pathological condition whose main criterion is a decrease in the Hb concentration per unit volume of blood. It can be either an independent nosological entity or a syndrome in other diseases.

According to WHO data, anemias are detected in 20% of the world's population. Women of childbearing (fertility) age and children constitute the main risk group. Globally, the leading causes are alimentary factors (malnutrition) and isolated iron deficiency.

For an accurate diagnosis, anemias are classified according to several parameters:

1. By erythrocyte morphology: microcytic, normocytic, macrocytic.
2. By color index: hypochromic, normochromic, hyperchromic.
3. By bone marrow regenerative capacity (reticulocyte level): hyporegenerative, normoregenerative, hyperregenerative.
4. By the mechanism of development (etiopathogenesis): due to impaired erythropoiesis, increased erythrocyte destruction (hemolytic), or blood loss (posthemorrhagic).

When evaluating lab results, it is important to remember age-related norms. In newborns, the ESR is only 0–3 mm/h (with a high Hb of 170–220 g/L), and gradually increases to 8–10 mm/h by adolescence. The diagnostic threshold for anemia is considered to be Hb less than 110 g/L for children under 6 years old, and less than 120 g/L for those over 6.

Differential Diagnosis: Uterine Myoma

When detecting space-occupying pelvic masses in women and alterations in blood tests, it is necessary to perform a differential diagnosis with malignant processes. One of the most frequent findings is uterine myoma—a benign hormone-dependent myometrial tumor.

It occurs predominantly in women of reproductive age, with the peak incidence at 40 years. In the general structure of gynecological diseases, myoma accounts for up to 30%. Unlike fallopian tube cancer, uncomplicated myoma generally does not present with a specific triad of sharply elevated ESR and decreased leukocytes, which helps the physician make the correct diagnosis.

Class and exam questions

What else to study on this topic

• Ultrasound with Color Doppler Mapping (CDM) in Gynecology
• Surgical and Chemotherapeutic Treatment of Fallopian Tube Cancer
• Age Dynamics of Red Blood Cell Parameters in Children
• Complications of Malaria: Kidney Damage and Nephrotic Syndrome
• Uterine Myoma: Epidemiology and Clinical Significance

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.