The erythrocyte sedimentation rate (ESR) remains one of the most widely used laboratory tests. Its clinical usefulness and interpretation are in the monitoring of inflammatory diseases, in particular rheumatoid arthritis, temporal arteritis and polymyalgia rheumatica. At present, the reference method for measuring the ESR proposed by the International Committee for Standardization in Haematology (ICSH) utilizes EDTA-anticoagulated-undiluted blood to perform the test using the method described by Westergren in 1921. Current interest in the methodology focuses on the development of an automated closed system that allows the determination of the sedimentation rate with selected working methods, using a single sample for more than one haematological test, improving the bio-hazardous aspects of the testing procedures. As a consequence, standardization becomes necessary. ESR results should be reliable, despite the increased number of different methods and testing variables. Control materials and External Quality Assurance Schemes are now available, and should be used. In conclusion, innovative techniques may improve the appropriateness and usefulness of ESR in clinical practice, but in addition, they need to guarantee the traceability of results in comparison to the reference method in order to ensure comparability of results among different clinical laboratories.
Biernacki EF. Samoistna sedymentacja krwi jako naukowa, praktyczno-kliniczna metoda badania. Gazeta Lekarska, 1897; 17: 962-96.
Fåhraeus R. The suspension-stability of the blood. Acta Med Scand 1921; 55: 1-228.
Westergren A. Studies of the suspension stability of the blood in pulmonary tuberculosis. Acta Med Scand 1921; 54: 247-82.
Koepke JA. Welcome Innovation in Erythrocyte Sedimentation Testing. Am J Clin Pathol 2002; 118: 11-2.
International Committee for Standards in Haematology. Recommendations for measurement of erythrocyte sedimentation rate. J Clin Pathol 1993; 46: 198-203.
NCCLS. Reference and selected procedures for the erythrocyte sedimentation rate (ESR) test; approved standard, 4th ed. H2-A4. Wayne, PA: NCCLS, 2000.
Pure and Applied Chemistry; Properties and units in general chemistry. IUPAC, 2000; 72: 945.
Plebani M, De Toni S, Sanzari MC, Bernardi D, Stokreiter E. The TEST 1 automated system: a new method for measuring the erythrocyte sedimentation rate. Am J Clin Pathol 1998; 110: 334-40.
Happe MR, Battafarano DF, Dooley DP, Rennie TA, Murphy FT, Casey TJ, et al. Validation of the Diesse Mini-Ves erythrocyte sedimentation rate (ESR) analyzer using the Westergren ESR method in patients with systemic inflammatory conditions. Am J Clin Pathol 2002; 118: 14-7.
Romero A, Munoz M, Ramirez G. Length of sedimentation reaction in blood: a comparison of the test1 ESR system with the ICSH reference method and the sedisystem 15. Clin Chem Lab Med 2003; 41: 232-7.
Ajubi NE, Bakker AJ, Van den Berg GA. Determination of the length of sedimentation reaction in blood using the TEST 1 system: comparison with the Sedimatic 100 method, turbidimetric fibrinogen levels, and the influence of M-proteins. Clin Chem Lab Med 2006; 44: 904-6.
Piva E, Sanzari MC, Servidio G, Plebani M. Length of sedimentation reaction in undiluted blood (erythrocyte sedimentation rate): variation with sex and age and reference limits. Clin Chem Lab Med 2001; 39: 451-4.
Piva E, Fassina P, Plebani M. Determination of the length of sedimentation reaction (erythrocyte sedi mentation rate) in non-anticoagulated blood with the Microtest 1. Clin Chem Lab Med 2002; 40: 713-7.
Bull BS. Quality assurance strategies. In: Koepke JA. Ed. Practical Laboratory Hematology. New York, NY: Churchill Livingstone; 1991.
Piva E, Pajola R, Temporin V, Plebani M. A new turbidimetric standard to improve the quality assurance of the erythrocyte sedimentation rate measurement. Clin Biochem 2007; 40: 491-5.
Plebani M, Piva E. Erythrocyte sedimentation rate: use of fresh blood for quality control. Am J Clin Pathol 2002 Apr; 117: 621-6.
Asher E, Parag Y, Zeller L, Yerushalmi R, Reuven H. Unconscious defensive medicine: the case of erythrocyte sedimentation rate. E J Int Med 2007; 18: 35-8.
Plebani M. Erythrocyte sedimentation rate: innovative techniques for an obsolete test? Clin Chem Lab Med 2003; 41: 115-16.
Hunder GG, Bloch DA, Michel BA. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 1990; 33: 1122-8.
Salvarani C, Cantini F, Boiardi L, Hunder GG. Polymyalgia reumatica and giant-cell arteritis. N Engl J Med 2002; 347: 261-71.
Salvarani C, Hunder GG. Giant cell arteritis with low erythrocyte sedimentation rate. Arthritis Care Res 2001; 45: 140-5.
Combe B, Dougados M, Goupille P, Cantagrel A, Eliaou JF, Sibilia J. Prognostic factors for radiographic damage in early rheumatoid arthritis: a multiparameter prospective study. Arthritis Rheum 2001; 44: 1736-43.
Andresdottir MB, Sigfusson N, Sigvaldason H, Gudnason V. Erythrocyte sedimentation rate, an independent predictor of coronary heart disease in men and women: the Reykjavik Study. Am J Epidemiol 2003; 158: 844-51.
Steinvil A, Shapira I, Arbel Y, Justo D, Berliner S, Rogowski O. Determinants of the erythrocyte sedimentation rate in the era of microinflammation excluding subjects with elevated C-reactive protein levels. Am J Clin Pathol 2008; 129: 486-91.