Erythrocyte Sedimentation Rate Measurements by TEST 1 Better Reflect Inflammation Than Do Those by the Westergren Method in Patients With Malignancy, Autoimmune Disease, or Infection

Choong-Hwan Cha, MD; Chan-Jeoung Park, MD, Young Joo Cha, MD; Hyun Kyung Kim, MD; Duck Hee Kim; Honghoon; Jae Hoon Bae; Jae-Seol Jung; Seongsoo Jang, MD; Hyun-Sook Chi, MD; Dong Soon Lee, MD; Han-Ik Cho, MD


Am J Clin Pathol. 2009;131(2):189-194. 

In This Article

Abstract and Introduction


We compared the TEST 1 (Alifax, Padova, Italy) and Westergren methods of measuring the erythrocyte sedimentation rate (ESR) to assess inflammation. The ESR was measured by both methods in 154 blood samples from patients with malignancy (n = 69), autoimmune disease (n = 44), or infection (n = 41). Total protein, albumin, and C-reactive protein (CRP) levels were measured in each plasma sample, and albumin and α1-, α2-, β1-, β2-, and γ-globulin fractions were measured by capillary electrophoresis. TEST 1 ESR values were significantly lower than the Westergren values, by 10.9 mm/h. We found that the correlations of TEST 1 ESR values with inflammatory protein levels (total protein, globulin, CRP, and α1-, α2-, β2-, and γ-globulin) were better than those obtained using the Westergren method. These findings indicate that ESR measurements by TEST 1 reflect inflammation better than do those by the Westergren method in patients with malignancy, autoimmune disease, or infection.


The erythrocyte sedimentation rate (ESR) is widely used as a screening or monitoring test for patients with acute or chronic inflammatory diseases.[1] The International Council for Standardization in Haematology (ICSH) selected the Westergren method as the reference technique for measuring ESR.[1] This method, however, takes 60 minutes and results in difficulty in quality control.[2,3] There are many variables in the Westergren method: specimen collection, time and temperature of specimen storage, sedimentation equipment, and methodological variables.[1,4] The ICSH and Clinical and Laboratory Standards Institute describe procedures for preventing errors in the ICSH reference method.[1,4]

Recently, an automated ESR measurement instrument, TEST 1 (Alifax, Padova, Italy) has been marketed. This system measures the ESR in small volumes (150 µL) of blood using a microagglutination method that assesses the interaction of RBCs with inflammatory plasma proteins and requires only 20 seconds.[5,6] To confirm system accuracy, carefully performed comparisons of this technique against the reference procedure are required.[1,4] Tests should be performed in parallel on at least 100 samples from patients with a wide variety of diseases and with ESR results distributed evenly in a wide range.

In response to stressful or inflammatory states that occur during infection, injury, surgery, trauma, and other causes of tissue necrosis, the levels of certain proteins, called acute phase reactant proteins, are elevated. These include α1-antitrypsin, α1-acid glycoprotein, haptoglobin, cerulo-plasmin, complement proteins, fibrinogen, C-reactive protein (CRP), and immunoglobulins.[7] The important process of erythrocyte rouleaux formation is dependent on the concentration of acute phase proteins.[4] We evaluated the capability of TEST 1 to reflect inflammation by determining correlations between plasma proteins that increase during inflammatory conditions and TEST 1 ESR values.


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