ICSH recommendations for modified and alternate methods measuring the erythrocyte sedimentation rate

Abstract

Introduction: The gold standard for the determination of the erythrocyte sedimenta-

Erythrocyte sedimentation rate measured using microhemagglutination is not elevated in monoclonal gammopathy compared with other diseases

“…Erythrocyte sedimentation rate is elevated in various infectious diseases, infarctions, malignancies, rheumatic disorders, autoimmune diseases, and mono‐ or polyclonal gammopathies . The common denominator is the increased production of plasma (monoclonal) proteins that stimulate RBC aggregation which, in turn, increase the ESR.…”

“…Highly increased ESR values are considered a surrogate marker for diagnosing clonal plasma cell disorder including MM. However, ESR value measured using alternate ESR methods in MG has never been comprehensively investigated, even though two‐thirds of laboratories worldwide use various alternate ESR methods …”

“…ESR refers to the distance (not the rate) that the red blood cells (RBCs) settle toward the bottom of a vertical tube of well‐mixed venous blood during a given time interval (normally 1 hour); it is expressed in mm/h . The ESR increases during inflammation owing to the accelerated sedimentation of RBCs following an increase in the plasma concentration of acute phase proteins of large molecular size . The Westergren method for measuring ESR is recommended by the International Council for Standardization in Haematology (ICSH), and modified Westergren method using EDTA‐anticoagulated blood is known to correlate well with the Westergren method …”

“…The ESR increases during inflammation owing to the accelerated sedimentation of RBCs following an increase in the plasma concentration of acute phase proteins of large molecular size . The Westergren method for measuring ESR is recommended by the International Council for Standardization in Haematology (ICSH), and modified Westergren method using EDTA‐anticoagulated blood is known to correlate well with the Westergren method …”

“…Some studies have shown that the ESR measured by the microhemagglutination method better reflects inflammation than that measured by the Westergren method in malignancies, autoimmune diseases, or infections . While the Westergren method measures the final length of sedimentation, some of the alternate methods do not measure all the ESR phases and may thus have different susceptibilities to known interferences, including paraproteinemia . However, whether the traditional concept of patients with MG typically exhibiting very high ESRs remains true when the ESR is measured using alternate methods have never been systematically evaluated.…”