TAT – A big challenge in ESR

Infectious diseases are spreading all over the world and becoming a serious problem. For example, 10 million people developed tuberculosis (TB), which is one of the most serious infectious diseases, and TB caused an estimated 1.6 million deaths in 2017 according to data from the WHO.

Clinicians order an ESR (erythrocyte sedimentation rate) if patient has symptoms of a condition that causes inflammation. Symptoms will depend on the condition patient may have, but they may include: headaches/unexplained fever/weight loss/joint stiffness/neck or shoulder pain/loss of appetite/anemia.

ESR is measured using an automated analyzer or with manual methods. However, ESR values measured with the manual methods are sensitive to changes in temperature and vibrations. Therefore, it is essential to consider and maintain the two factors. Another way to measure it is to directly evaluate the levels of plasma proteins.

ESR is a measure of the rate of fall of RBCs at the bottom of a test tube when held upright in a fixed position for a specified time. Essentially, the ESR is a physical process that occurs in normal conditions but can increase in response to an altered blood suspension, caused by numerous conditions and pathologies.

The ESR test serves three purposes:

1. It rules out the possibility of any underlying pathology, mainly infection and hyperinflammatory conditions (osteoarthritis, rheumatoid arthritis).
2. It helps monitor disease course.
3. It is used as a screening parameter for a neoplastic pathology.

The two most common manual methods used by labs to obtain the ESR are the Westergren and Wintrobe methods. Both the methods are relatively similar. The Westergren method is conducted with a 200-mm long Westergren-Katz tube, whereas the Wintrobe method is conducted with a 100-mm long and shorter diameter Wintrobe tube.

Factor that increases Rouleaux formation raises the ESR
Increase in plasma fibrinogen levels and increase in immunoglobulin levels.

So what are the laboratory challenges in doing ESR?
Red cell aggregation by kinetic photometry. This method overcomes Westergren limitations.

Temperature variability. Difference of 4°C could cause an error reading of 92 percent by Westergren in different seasons. In the newly available technology has 37°C constant temperature no variation.

Haematocrit influence. Dependence of HCT, falsely elevated ESR in Westergren method. In the newly available technology ESR systems are independent of HCT effect.

Dilution problems. Incorrect dilution causes erroneous results by Westergren. Direct EDTA sample aspirated. No dilution required in the newly available technology.

Pipette verticality and material;

• The using of plastic pipettes creates an electrostatic interaction between the erythrocytes with consequent errors in the final result.
• Errors in the final results are due to inadequate tubes diameter.

A single capillary for all samples, no false results in the newly available technology.

ESR variations due to red cell size and number in Westergren;

• Microcytosis false low
• Macrocytosis false high
• Low red cell number false high. (anemia).

Elevated ESR is associated with increased mortality in patients with DM due to respiratory failure. Thus, monitoring ESR should be an integral part of the clinical care of DM patients.

What is required for a better clinical outcome?
Cell counter integrated rheometric excellence technology can provide ESR result, highly correlated with Westergren method, by using HCT value and MCV value from CBC measurement and also RBC aggregation phenomenon in shorter time as compared to traditional ESR methods.

In a newly advanced technology, a single EDTA tube can be used for both CBC and ESR measurement. With the help of this newly advanced technology.

• CBC results will be available on the screen in 1 minute.
• ESR result in 1.5 minutes, with a single aspiration without any extra cost.

Unlike the traditional methods for ESR testing, this newly advanced technology requires only 80 μL of blood sample for both CBC and ESR measurement. Small blood collection volume improves laboratory workflow with paediatric samples and improves the patient experience.

This leads to reducing the workload, avoiding the risk of infection and providing a quick report to the patient. No additional reagents are required for ESR measurement in such automated CBC analyzers.

Newer advanced technology offers accurate results, better patient care, shorter TAT, and efficient testing work-flow lab management.

For all such things Nihon Kohden haematology analyzer model “Celltac α+ MEK1305” is the solution for the market.