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


The ESR does not measure an analyte but rather a physical phenomenon that depends on a large number of variables. In this regard, the Westergren method may be affected by sources of variability, such as dilution of blood with anticoagulants (eg, citrate), hematocrit values, the internal diameter and length of the column, column material, temperature, and the time from venipuncture.[6] Several new methods of measuring ESR have improved the technical, as well as the biohazardous, aspects of the testing procedure. These include automated and semiautomated instruments, which shorten testing time. Careful comparison of each new technique with the reference procedure is required to confirm the accuracy of any new method.

The TEST 1 has been extensively evaluated and has shown good correlation with ICSH-recommended methods.[5,6,8,10] For comparison, we selected blood samples with hematocrit values between 33% and 35% (0.33–0.35). We found that TEST 1 measurements of the ESR were significantly lower than those of the Westergren method. An earlier study, which reported a significant difference between these methods, found no significant bias in groups with clinically relevant ESR values.[8] Romero et al[6] reported that, in samples with an ESR of more than 60 mm/h, TEST 1 values were significantly lower than those obtained with the Westergren method and suggested that the Westergren method might overestimate the ESR in samples with low hematocrit values. In addition, the Fabry formula failed to correct the differences when applied to the Westergren ESR values obtained in the comparison study, indicating that, in addition to hematocrit values, other variables may be involved.[6]

Erythrocyte sedimentation remains an only partly understood phenomenon. Three phases—the lag or aggregation phase, decantation or precipitation phase, and packing phase—can be distinguished in the sedimentation process. The all-important process of erythrocyte rouleaux formation is dependent on the concentrations of acute phase proteins and, to a lesser degree, the globulins.[4] Fibrinogen is the most abundant acute phase protein with greatest impact on ESR,[10,11] appearing in the β2 region during capillary electrophoresis of plasma proteins.[11] We found that the β2-globulin fraction was increased in all samples and that this fraction of β2-globulin showed the highest correlation coefficient (r 2) with the ESR data from both methods.

We found that the TEST 1 ESR values correlated better with inflammatory plasma protein concentrations than d the Westergren ESR data. In all fractions showing a significant correlation with both methods, the TEST 1 method showed higher correlation coefficients (r 2) and lower P values than d the Westergren method. When we analyzed samples subdived according to patient diagnosis, we also found that the TEST 1 method showed higher correlation coefficients (r 2) than d the Westergren method. Although only Westergren data were significantly correlated with β1-globulin levels in samples from patients with malignancy and with CRP levels in patients with autoimmune diseases, the correlation coefficients (r 2) were not high (0.061 and 0.129, respectively). Only the TEST 1 method was significantly correlated with globulin and α2- and β1-globulin concentrations in samples from patients with autoimmune diseases and with α1-globulin levels in samples from patients with infection, and these correlation coefficients (r 2) were high (0.212, 0.446, 0.142, and 0.263, respectively).

We have shown that the correlations between TEST 1 ESR values and the level of each plasma protein that increases under inflammatoryconditions were better than those for Westergren ESR data. These findings indicate that TEST 1 ESR measurements better reflect the presence of inflammation than do Westergren data in patients with malignancy, autoimmune disease, or infection.


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