High ESR is non-specific, usually due to large amount of immunoglobulin. Inflammatory conditions cause high polyclonal levels of immunoglobulins whereas in Myeloma there is a monoclonal paraprotein. Although ferritin is an acute phase protein and will rise in inflammatory states a ferritin of >100µg/L makes iron deficiency very unlikely. A low serum iron and transferrin is seen in anaemia of chronic disease whereas in iron deficiency the transferrin is normal or high. This is important to recognise to avoid unnecessary endoscopies. With these results a CT abdo / pelvis is much more likely to point to the diagnosis.
