The ESR can be falsely low in sicklers because they do not form rouleaux
no matter how many acute phase reactants are in the area because sickled
cells cant stack up. Without a stack of RBC's to fall faster the ESR
may not elevate so.. a high ESR in a sickler is great a normal
I think a bone marrow scan looking for infarct followed by a scan for
osteomyletis would be the workup. I would probably tap it though I
always worry that sticking a needle in the joint is going to alter my
bone scan findings.
David F. Soglin, M.D.
Chair, Pediatric Emergency Medicine
Cook County Children's Hospital
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