Raised ESR

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Haemolytic anaemia
    • Any evidence of pancytopenia (Hb <100g/L, Neutrophils <1.0, PLT <50)
    • Abnormal blood film (circulating blasts, leucoerythroblastic or dysplastic changes)
    • Symptomatic Hypercalcaemia
    • Splenomegaly
    • Lymphadenopathy
    • Fevers/night sweats
    • Presence of a paraprotein or abnormal serum free light chain ratio
    • Cancer in a child or young person is uncommon but must be addressed as a matter of urgency. Advice should be sought from an on-call specialist and/or emergency department when a diagnosis of cancer is strongly suspected.
    • Refer to local HealthPathways or local guidelines
    • High ESR with headache or any visual disturbance should be referred urgently to Emergency as suspected temporal arteritis.
    • High ESR associated with a monoclonal paraproteinaemia should be urgently referred to Haematology.
    • ESR is a non-specific inflammatory marker. Asymptomatic patients who have isolated raised ESR and normal investigations should not be referred to Haematology.
    • Patients with raised ESR and positive autoimmune screen should be referred to Rheumatology.
    • Moderately raised ESR can be associated with:
      • Autoimmune disease
      • Chronic inflammation
      • Infections
      • Malignancy
      • Pregnancy
      • Menstruation
      • Normal aging
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Raised ESR with features stated below:
    • splenomegaly
    • symptomatic lymphadenopathy
    • raised LDH
    • bulky disease (>5 cm diameter of LN mass)
    • presence of fever, night sweats, weight loss or new onset pruritus
    • concurrent recent onset cytopenia (e.g. anaemia, thrombocytopenia)
    • extra nodal masses
    • clinical history of rapid growth
Category 2
(appointment within 90 calendar days)
  • No category 2 criteria
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • FBC
  • Serial ESR
  • E/LFTs
  • Serum light chains
  • Serum free light chains
  • Serum protein electrophoresis and B2 microglobulin
  • Immunoglobulins

3. Additional referral information Useful for processing the referral

  • CXR, Ultrasound and CT scans (if done)

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 2 June 2025

© State of Queensland (Queensland Health) 2023

Except as permitted under the Copyright Act 1968, no part of this work may be reproduced, communicated or adapted without permission from Queensland Health. To request permission email ip_officer@health.qld.gov.au1.