Erythrocyte Sedimentation Rate Results Research Articles

Erythrocyte sedimentation rate and red blood cell indices association in pediatrics patients with fever and cough: A cross-sectional study.

The erythrocyte sedimentation rate (ESR) is an essential inflammatory marker in treating some patients, particularly children. The level of ESR can be affected by red blood cell (RBC) indices, and not considering this can complicate the interpretation of ESR and the treatment and follow-up of patients. The study aimed to assess the association between ESR and RBC indices in children hospitalized with fever and cough in the pediatric ward of Imam Khomeini Hospital, Jiroft, in 2023. A cross-sectional study was conducted to measure the association between ESR and RBC indices in children hospitalized with fever and cough in the pediatric ward of Imam Khomeini Hospital, Jiroft, in 2023. A total of 156 patients participated in the study. SPSS software was used for statistical analysis. The mean age of participants was 27.26 ± 3.14 months. The results showed that there is a significant negative correlation between ESR and RBC, r = -0.282 (p < 0.001), and ESR and hematocrit (HCT), r = -0.215 (p = 0.007). Also, the results demonstrated that there is a significant positive correlation between ESR and mean corpuscular volume (MCV), r = 0.159 (p = 0.048), ESR and mean corpuscular hemoglobin (MCH), r = 0.214 (p = 0.007), and ESR and mean cell hemoglobin concentration (MCHC), r = 0.209 (p = 0.009). There was a negative correlation between ESR and hemoglobin (Hb), r = -0.98 (p = 0.225), but this correlation was insignificant. This study showed an association between ESR and RBC indices in hospitalized children with complaints of fever and cough. So, it is necessary that physicians and treatment staff pay attention to the RBC indices while interpreting and following up the results of ESR to complete the treatment process of patients.

Overview of erythrocyte sedimentation rate examination results of farmers aged 30-40 years in Manunggal Karya Village Sub-district of Randangan District of Pohuwato

This research aimed to give an overview of the erythrocyte sedimentation rate (ESR) examination results of farmers aged 30-40 years in Manunggal Karya Village, sub-district of Randangan, Pohuwato.&#x0D; This research method used a quantitative research approach with the type of research being descriptive research. Samples in this study were 29 samples using the simple random sampling technique as well as conducting interview and examination of erythrocyte sedimentation rate of the farmers.&#x0D; The results of this study concerning the erythrocyte sedimentation rate examination of farmers aged 30-40 years in Manunggal Karya Village, sub-district of Randangan showed that the percentage of normal ESR results was 62.1% and the percentage of abnormal ESR results was 37.9%. Based on the risk factors that affect the ESR value, by the medical history of the farmers, the percentage of normal ESR results by 62.1% and the percentage of abnormal ESR results was 37.9%; by the length of work, farmers with a working period of &gt;10 years had normal ESR results of 62.1% and the abnormal ESR results of 37.9%.&#x0D;

Correlation of MLR with CRP and MPVPCR with LED in Traumatic Brain Injury

BACKGROUND: Traumatic brain injury (TBI) contributes greatly to high rates of death and disability globally. It may be divided into primary and secondary injuries. Primary head injuries occur at the moment of impact which causes mechanical loads and accelerations both linearly and rotationally, causing injury to the brain. After the primary brain injury, further biochemical and cellular processes occur that lead to secondary injury. Secondary insult in TBI may lead to several neuroinflammation processes that are reflected on laboratory markers. The monocyte-lymphocyte ratio and mean platelet volume-platelet count ratio (MPVPCR) theoretically have the potential to be used as neuroinflammation markers in TBI. AIM: This study was conducted to assess the relationship between monocyte-lymphocyte ratio (MLR), MPVPCR with both C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) regarded as inflammation markers in relation to secondary brain injury. METHODS: This study was a cross-sectional prospective analytic observational study conducted at the Sanglah hospital emergency department from February to May 2022. Patients diagnosed with TBI aged 18 years and over that were willing to be included in the study by consecutive sampling. Patients with a history of autoimmune disease, history of taking immunosuppressant drugs, and fractures of &gt; 2 long bones were excluded and the presence of infection characterized by fever was excluded from the study. History taking and physical examination were done to obtain data regarding age, gender, mechanism of injury, Glasgow Coma Scale, fainting duration, and memory loss. The blood sample was taken at 24 h after trauma to obtain MLR, MPVPCR, CRP, and ESR results. Pearson correlation test was done to determine the correlation between MLR and MPVPCR with CRP and LED. RESULTS: There are a total of 85 patients included in this study with the mean of age which is 36 ± 2.5 years old. Most of them are men (71.3%) with the mean of GCS on admission which is 12. Mean ± (SD) of the monocyte, lymphocyte, and platelet was 1.12 ± 0.82 × 103/μL, 1.83 ± 1.69 × 103/μL, and 259.34 ± 85.79 × 103/μL consecutively. MLR with CRP had a weak positive correlation and was statistically significant (r = 0.215; p = 0.045), as well as MPVPCR with ESR also had a weak positive correlation and was statistically significant (r = 0.276; p = 0.010). While both MLR with ESR and MPVPCR with CRP had no correlation. CONCLUSION: MLR can be an option representing CRP in predicting the magnitude of inflammation in head injury and MPVPCR can be considered to be used as a predictor of thrombotic phenomena in TBI.

Temporal Artery Biopsy Debate: Positive TAB Result Prolongs Steroid Use in Giant Cell Arteritis.

A retrospective chart review garnered patient demographics, symptoms, comorbidities, and steroid treatment duration in patients undergoing TAB at a single center. Steroid treatment was compared between TAB+ and TAB - patients. One hundred seven patients undergoing TAB were included. Patients were predominantly women (70.1%) with a median age of 74 years (46 -91). Of 107 TAB results, 74 (69.2%) were negative, 23 (21.5%) were positive, and 10 (9.3%) were found to be indeterminate. In TAB+ patients, the mean erythrocyte sedimentation rate was not significantly different than TAB - patients (60.2 versus 43.7, P = 0.45), nor was the median C-reactive protein (38.8 versus 18.1, P = 0.17). Regarding steroid use, both TAB+ and TAB - patients had a similarly high rate of prebiopsy steroid initiation (82.6% versus 70.3%, P = 0.32). More TAB+ patients remained on steroids at 6 weeks (95.0% versus 57.4%, P = 0.004), 6 months (95% versus 37.7%, P < 0.001), 1 year (65.0% versus 31.1%, P = 0.024), and 18 months (50.0% versus 19.7%, P = 0.045). By 2 years, the difference no longer met significance (35.0% versus 14.8%, P = 0.12). P = 0.12). TAB positivity does seem to influence maintenance of steroids up to 18 months after biopsy.

Contribution of Erythrocyte Sedimentation Rate to Predict Disease Severity and Outcome in COVID-19 Patients.

Aim The use of erythrocyte sedimentation rate (ESR) in coronavirus disease 2019 (COVID-19) to determine disease severity and prognosis is limited. This study aimed to interrogate the diagnostic and prognostic role of ESR compared to other acute-phase reactants. Method This retrospective cross-sectional study included 493 confirmed and hospitalized adult COVID-19 patients. Pneumonia, radiological severity, oxygen, intensive care requirements, mortality, ESR, and other acute-phase reactant values were recorded. Logistic regression and ROC analysis identified the effect of ESR on mortality and the sensitivity and specificity of the optimal cutoff values of ESR for the prediction of pneumonia, intensive care needs, and mortality and compared these with values for CRP. Results Of patients, 346 (70.2%) had pneumonia, 98 (19.9%) required intensive care, 183 (37.1%) required oxygen support, and 62 (12.6%) died. ESR data were obtained for 278 patients. Among patients, 80.2% had ESR above 20 mm/h, with a median value of 53 (interquartile range: 49). ESR was higher among those with pneumonia (p < 0.001), requiring oxygen (p < 0.001), and requiring intensive care (p=0.003) compared to those without these, and in exitus patients (p=0.043) compared to survivors. Logistic regression analysis identified that ESR did not impact mortality. ROC analysis found the AUC, cutoff, sensitivity, and specificity results of ESR for pneumonia were 0.827, 37 mm/h, 77%, and 78%; for intensive care were 0.625, 50 mm/h, 74%, and 52; and for mortality were 0.606, 51 mm/h, 71%, and 49%, respectively. However, ROC analysis values for CRP were superior to ESR for all these categories. Conclusion ESR increased in COVID-19 patients in the presence of pneumonia and severe disease; however, it was not prognostic. Sensitivity and specificity values for pneumonia, intensive care requirements, and mortality were lower than those for CRP.

Comparing Interleukin-6, C-Reactive Protein, Erythrocyte Sedimentation Rate, and White Blood Cell Count for the Early Diagnosis of Acute Pyelonephritis in Children

Background: Urinary tract infection (UTI) is common in children. Differentiating lower UTI from acute pyelonephritis (APN) is of great importance in children since early diagnosis and timely management can prevent kidney scarring and associated complications. Objectives: We aimed to compare the diagnostic performance of serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count with interleukin-6 (IL-6) for the diagnosis of APN in children. Methods: This cross-sectional study included 38 children with APN (based on clinical findings and positive urine culture) aged 1 month to 15 years admitted to Bandar Abbas Pediatric Hospital, Bandar Abbas, Iran, during 2019-2020. Serum CRP, WBC, IL-6, and WBC count were measured in all children. Age and sex of the participants were also recorded. Results: The mean ± SD age of the children was 65.82±46.67 months, of whom 23 (60.5%) were girls. The sensitivity of WBC, ESR, CRP, and IL-6 for the early diagnosis of APN was 39.5%, 71.1%, 60.5%, and 71.1%, respectively. Taking the results of ESR, CRP, and WBC into account as the basis of diagnosis, altogether 9.98 pg/mL was the best cut-off of serum IL-6 for the diagnosis of APN with 70%-80% sensitivity and 56.5%-73.7% specificity. A significant correlation was found between serum IL-6 and CRP, ESR, and WBC with the strongest correlation between IL-6 and CRP (r=0.451, P=0.004). Age and sex did not affect these correlations. The sensitivity of serum IL-6 at the 5 pg/mL cut-off for the diagnosis of APN was higher in boys and children younger than 6 years. Conclusion: IL-6 can diagnose APN in children aged 1 month to 15 years with 71.1% sensitivity. Its sensitivity is superior to CRP and WBC and comparable with ESR in this regard.

Evaluation of Erythrocyte Sedimentation Rate, C Reactive Protein and Ante-Streptolysin O Titer Regarding Tonsillectomy Indication and their Postoperative Changes

Objective: To evaluate the serum erythrocyte sedimentation rate, C reactive protein and antistreptolysin O titer as indicators for tonsillectomy with assessment of their postoperative changes.Patients and Methods: Our prospective comparative study was carried out on 150 patients divided into two groups. Group I included 75 patients clinically diagnosed as chronic tonsillitis by symptoms and signs and group II included 75 patients with previous tonsillectomy as a control group. Both groups were compared regarding the levels of the three laboratory markers. Also, the preoperative values of these markers were compared with postoperative values at 1, 3 and 6 months.Results: The values of the three markers in group I were higher than values in group II but statistically insignificant (p = 0.13, 0.11 and 0.78 respectively). There was a highly significant decrease in postoperative results of erythrocyte sedimentation rate, C reactive protein in group I at 1, 3 and 6 months after tonsillectomy (p value < 0.0001 for all). There was a significant decrease in postoperative results of antistreptolysin O titer in group I at 1, 3 and 6 months after tonsillectomy (p= 0.008, 0.019, 0.001 respectively).Conclusion: Erythrocyte Sedimentation Rate, C Reactive Protein and antistreptolysin O Titer should not be considered as indicators for tonsillectomy in chronic tonsillitis patients by having a non-significant difference when compared with post tonsillectomy patients. Being inflammatory markers, the values of these markers showed a significant decrease after tonsillectomy due to removal of the septic focus of chronic tonsillitis

Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio Correlations with C-reactive Protein and Erythrocyte Sedimentation Rate in Traumatic Brain Injury

BACKGROUND: Immune system and inflammatory response play an essential role in the development of secondary brain injury (SBI) after traumatic brain injury (TBI). An inflammatory biomarker that can reflect the SBI severity is needed to increase the effectivity of TBI management and prevent morbidity and mortality post-TBI. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), which are more affordable than C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), theoretically have the potential to be used as a marker of the SBI severity. However, NLR and PLR in daily medical practice are not yet fully utilized.&#x0D; AIM: The aim of the study was to correlate NLR and PLR with CRP and ESR as a marker of SBI severity post-TBI.&#x0D; METHODS: This cross-sectional study was conducted at Sanglah Hospital Denpasar from January to April 2020. Patients diagnosed with TBI were included in this study by consecutive sampling. The blood samples were taken at 24-h post-TBI to obtain the NLR, PLR, CRP, and ESR results. Spearman’s correlation test was conducted to determine the correlation between NLR and PLR with CRP and ESR.&#x0D; RESULTS: Eighty-five patients were included in data analysis. Median ± (interquartile range) of the NLR, PLR, CRP, and ESR were 7.60 ± (6.83), 145.58 ± (76.95), 60.83 ± (66.3), and 12.50 ± (13.85) consecutively. NLR and PLR had a significant positive correlation with CRP (r = 0.472, **p &lt; 0.01; r = 0.283, **p &lt; 0.01 consecutively). But, NLR and PLR were not correlated with ESR.&#x0D; CONCLUSION: NLR and PLR can become a useful and more affordable marker for reflecting the SBI severity in acute TBI.

The Predictive Effectiveness of Blood Biochemical Indexes for the Severity of COVID-19.

Objective We aimed to explore the predictive effectiveness of blood biochemical indexes for COVID-19 severity. Method We retrospectively analyzed the clinical data of COVID-19 patients who were cured and discharged from the Public Health Treatment Center of Changsha from January 30, 2020, to February 19, 2020. According to the clinical classification of the disease, the patients were divided into severe and nonsevere groups. General clinical data and underlying medical conditions were recorded through the electronic medical record (EMR) system. Laboratory examination results of the patients during their hospitalization were collected, including the first results for erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), peripheral blood lymphocyte ratio and count, and peripheral blood white blood cell (WBC) count. Univariate and multivariate logistic regression models were used to analyze the predictive effectiveness of blood biochemical indexes and other related factors for COVID-19 severity. Result In all, 108 COVID-19 patients (median age: 43.9 years (range: 1–75); male patients: 56 (51.85%)) were enrolled, of whom 24 (22.22%) showed severe disease and 84 (77.78%) showed nonsevere disease, and two in 24 patients with severe disease developed into a critically severe type and died. Fever was the most common onset symptom (67.59%), followed by cough (48.15%) and fatigue (37.04%). Comorbidities were important factors affecting the severity of COVID-19, and among the patients with severe disease, the proportion with comorbidities was 70.83%, and the proportion without comorbidities was 29.17%. The intergroup difference was significant (P < 0.05). In patients with CRP levels (mg/L) of ≤8, >8–≤20, >20–≤40, and >40, the proportions of those with severe and nonsevere disease were 0 to 32, 7 to 19, 6 to 23, and 11 to 10, respectively; the intergroup difference was significant (P < 0.05). Conclusion The presence or absence of comorbidities and CRP elevation were independent significant predictors of COVID-19 severity, and hypertension was found as the most common comorbidity in patients with severe disease.

GRANULOMATOUS MASTITIS IS NOT ALWAYS TUBERCULAR: ROLE OF FINE NEEDLE ASPIRATION CYTOLOGY IN EVALUATION OF GRANULOMATOUS MASTITIS

INTRODUCTION AND OBJECTIVES:&#x0D; Granulomatous mastitis is rare chronic inflammatory benign breast lesion, which clinically and radiologically resembles carcinoma breast thus creating a diagnostic dilemma. The term granulomatous mastitis includes two broad categories namely specific granulomatous mastitis for which aetiological factors can be defined such as infectious causes like Mycobacterium tuberculosis, blastomycosis, cryptococcosis, histoplasmosis, actinomycosis and filarial infection. Other factors include association with autoimmunue diseases such as Wegner’s granulomatosis and giant cell arteritis and there are other rare causes such as include duct ectasia, foreign body reaction and fat necrosis which also leads to granulomatous lesions of breast.&#x0D; Cytological features of granulomatous mastitis(GM) have not been widely discussed and described in literature, so through this study we have made an attempt to thoroughly discuss cytological spectrum of granulomatous mastitis.&#x0D; MATERIALS AND METHODS:&#x0D; A retrospective study was performed over a period of four years from 2016 to 2019. A total of 465 cases of breast lump reported to cytopathology section out of which 24 cases of GM diagnosed on FNAC were included in our study. Results of Erythrocyte sedimentation rate (ESR) and Mantoux test along with TB-PCR were recorded. FNAC slides were retrieved pertaining to study period.&#x0D; Granulomatous lesions of breast were further categorized broadly into IGM/ NGM, granulomatous mastitis without caseous necrosis and tubercular mastitis where diagnosis were made definite on basis of demonstration of AFB or positive TB-PCR .&#x0D; RESULTS:&#x0D; Patient age ranged from 23 years to 55 years with the mean age of 36.6 years with maximum of patients falling in second decade followed by third decade. Granulomatous lesions were broadly categorized into Idiopathic/ Non specific granulomatous mastitis(11 cases,45.8%), GM with caseous necrosis(8 cases, 33.3%) and tubercular mastitis(5 cases, 20.9%). Histopathology was available in 7 cases(29.2%). TB-PCR was sent in all cases of granulomatous mastitis diagnosed on cytology and was positive in 10 cases(41.7%).&#x0D; CONCLUSION:&#x0D; Idiopathic granulomatous mastitis and tubercular mastitis are rare inflammatory diseases of breast which mimic malignancy clinically and radiologically. FNAC plays important role in diagnosis of granulomatous diseases of breast and also their differentiation from malignant tumors. Tubercular mastitis needs to be differentiated from IGM since treatment options are different in both the cases. Cytopathology plays an important role in differentiationg both the diseases supplemented by radiological and microbiological investigations.&#x0D; The present study thus highlights the importance of FNAC as an infalliable tool in diagnosis of granulomatous mastitis and its differentiation from neoplastic lesions of breast thus avoiding time consuming histopathological work up of cases.

Differences in erythrocyte sedimentation rates using a modified Westergren method and an alternate method.

Worldwide laboratories have adopted the use of modified or alternate methods for measurement of the erythrocyte sedimentation rate (ESR). The iSED from Alcor Scientific is a novel, alternate ESR method based on photometric aggregometry which offers improved operator safety and reduced analysis time. This study evaluated the diagnostic utility of the iSED in a South African patient population with a range of inflammatory disorders. We compared the iSED with the predicate modified Westergren method (StaRRsed, Mechatronics, Zwaag, the Netherlands) measured at 60minutes. Analysis was performed on K2 EDTA samples at three ESR measurement ranges (<20, 20-80 and >80mm/h) in 120 pediatric and adult inpatients and outpatients over a 2-week period. Precision, stability, and carryover were performed in accordance with the revised International Council for Standardisation in Haematology guidelines. The iSED demonstrated acceptable imprecision with minimal carryover (2.86%). The correlation coefficients at the 3 ESR measurement ranges were r=0.58, r=0.71, and r=0.56, respectively. The y-intercepts were -10.74 (CI -29.17 to 7.69), -5.95 (CI -18.60 to 6.69) and 246.05 (CI 591.42-99.31). This indicated a difference of a constant nature with an overall mean difference of 7.99mm/h (CI 5.87-10.13) (P<0.001). iSED ESR measurements were stable up to 24hours when stored at room temperature or at 4-8°C. This study demonstrated differences in ESR results, predominantly at extremes of the analytical range, using an alternate method. Careful consideration and performance monitoring of these novel methods are advised.

Correlations between the Maximum Standard Uptake Value of Positron Emission Tomography/Computed Tomography and Laboratory Parameters before and after Treatment in Patients with Lymphoma.

Background:After the first examination of patients with lymphoma diagnosis, important laboratory tests such as complete blood count; albumin, kidney and liver function tests; uric acid; β2-microglobulin; C-reactive protein (CRP); erythrocyte sedimentation rate (ESR); and lactate dehydrogenase (LDH) examinations are recommended. In this study, our aim was to find the relationship between laboratory parameters and the maximum standard uptake value (SUVmax) of positron emission tomography/computed tomography (PET/CT) in patients with lymphoma at the diagnosis and after treatment.Methods:Thirty-four lymphoma patients treated at Mustafa Kemal University Internal Medicine Clinic between 2014 and 2017 were included in this retrospective study. Results of CRP, ESR, LDH, albumin, and white blood cell (WBC) count were recorded before each PET scan test, and each parameter was analyzed for correlation with SUVmax measurements.Results:Spearman's correlation test showed that the after-treatment SUVmax values were significantly correlated with the after-treatment LDH, ESR, and CRP values (for LDH, ESR, and CRP, R2: 0.453, 0.426, and 0.351; P = 0.007, 0.012, and 0.042, respectively). On the other hand, albumin and WBC count did not show a significant correlation with the after-treatment SUVmax values (all P > 0.05).Conclusions:CRP, ESR, and LDH values may also be good predictors in patients for whom PET/CT imaging cannot be performed.

Test-1 analyzer and conventional Westergren method for erythrocyte sedimentation rate: A comparative study between two laboratories.

Measurement of the length of sedimentation reaction in blood (LSRB), also called erythrocyte sedimentation rate (ESR), is a widely used hematology test. This study intends to compare ESR levels measured by Test-1 method and International Council for Standardization in Hematology's (ICSH) reference method, and analyzes the effect of hematocrit (Hct) on ESR results. A total of 755 patients from 2 hospitals were included in the study, and samples with EDTA were studied by Test-1 method for ESR measurement and total blood count, whereas citrated samples were studied with reference Westergren method. Then, 2 methods were compared. Distribution of ESR results according to the ESR(≤20, >20mm/h) and Hct(≥35%, <35%) levels and hospital type was analyzed. ESR levels with Hct levels<35% were corrected with Fabry's formula. The mean and SD values for the Test-1 method, reference Westergren method, and corrected ESR measurement were 21.30±18.39, 28.59±25.82, and 24.92±20.58mm/h, respectively. Within the whole group, the correlation coefficient (r) was .77 (.7-.80) with a significance level P<.001. Passing-Bablok regression analysis of the methods resulted in a regression equation y=1.00 (95% Cl: 0.43-1.88)+0.75 (95% Cl: 0.70-0.78)x while the significance of linearity was acceptable (P<.01). All subgroup linear regression analyses revealed that the correlation was acceptable, except ESR>20mm/h group, Hct<35% group, and corrected ESR group (significance level were P>.10). The study showed that the role of the hospital and the capacity of testing are important in choosing the instrument for measuring ESR. Furthermore, the patient profile, especially malignancy possibility and Hct level, may be important for instrument selection.

Correlation between erythrocyte sedimentation rate and C-reactive protein level in patients with rheumatic diseases.

ObjectivesErythrocyte sedimentation rate (ESR) and serum level of C-reactive protein (CRP) are the acute phase reactants most commonly determined in patients with rheumatic diseases. The indices are affected by different factors, but both of them are applied for evaluation of the disease activity in patients with inflammatory disorders of the musculoskeletal system.Material and methodsThe authors compared the results of ESR and CRP, which were carried out during routine diagnosis in 200 patients admitted to the Department of Rheumatology.ResultsA significant correlation between ESR and CRP was found (ESR after 1 h/CRP: correlation coefficient 0.6944, ESR after 2 h/CRP: correlation coefficient 0.6126). There was no difference in ESR or CRP between male and female patients, and patients older than 40 years had higher ESR and CRP.ConclusionsThe obtained results support the usefulness of both indices in the clinical practice of rheumatologists.

Erythrocyte Sedimentation Rate Measurement Using as a Rapid Alternative to the Westergren Method.

Erythrocyte sedimentation rate (ESR) remains as one of the most reliable tests in clinical practices. Yet its use is time consuming and requires a large blood sample. The aim of this study was assessing a faster and reliable method of ESR estimation. An ESR estimation method was described and performed on 108 patients using capillary tube (micro ESR) and capillary peripheral blood. Micro ESR results at different intervals were measured and compared with Westergren ESR (conventional ESR) estimation by Pearson and Spearman's coefficients. A regression equation was derived to predict conventional ESR values based on micro ESR results. The agreement of two measurements was demonstrated using the Bland-Altman plot. Micro ESR results at 20 minutes showed the earliest close correlation with conventional ESR results at one hour (r = 0.987). The presented regression equation was able to closely predict ESR values (r(2) = 0.974) and the Bland-Altman plot showed an acceptable agreement between converted and conventional ESR measurements. Using capillary tube and capillary blood sample (micro ESR) appears to be a faster, cheaper, more reliable, and precise tool for ESR measurement in the ED. The results have acceptable correlation with conventional ESR, especially at 20 minutes of measurement.

Primary tuberculosis of the clavicle.

Tuberculosis of the clavicle is a rare lesion, accounting for less than 1% of all osteoarticular tuberculosis. The lesion has been described in a few case reports. The lesion can have a varied presentation, ranging from dull, aching pain to bony swelling and a draining sinus. The rarity of the lesion, its nonspecific symptoms, and its striking resemblance to common cystic conditions such as bone tumors and metabolic conditions such as rickets make diagnosis difficult. The authors describe a series of 17 patients with primary tuberculosis of the clavicle. Radiographs and magnetic resonance images were obtained for all patients, and a preliminary diagnosis was made on the basis of clinical features and the results of erythrocyte sedimentation rate, C-reactive protein, and Mantoux tests. Erythrocyte sedimentation rate was uniformly elevated. Radiographs showed diffused thickening and honeycombing, eccentric expansile lytic lesions with surrounding osteopenia, or sequestration not unlike pyogenic infection. Magnetic resonance imaging is useful for determining the extent of the lesion and soft tissue involvement. The radiological and laboratory findings provided complementary information. The diagnosis was confirmed on biopsy material that was analyzed with histopathology, pus culture and sensitivities, gram stain, acid-fast stain, and cultures on Löwenstein-Jensen medium. Patients were treated with multidrug antitubercular chemotherapy for 18 months and were assessed on pre- and posttreatment radiology, erythrocyte sedimentation rate, and University of California, Los Angeles (UCLA) shoulder rating scale. The results of conservative management of tubercular osteomyelitis were uniformly good, and all patients recovered well.

C-reactive protein and erythrocyte sedimentation rate: Continuing role for erythrocyte sedimentation rate

Background: Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP) tests are often done to detect or monitor patients with suspected inflammatory disorders. The objective of the study was to ascertain if the manual ESR test added value to the information available from automated CRP results alone. Methods: In this retrospective, observational study at a safety-net hospital, the ESR and CRP values were compared in 4527 instances when both tests were done. In 150 instances, involving 97 patients; when ESR was >60 mm/hr and CRP was ≤1.0 mg/dL, the medical records were reviewed to discern the cause of disparity between the ESR and CRP results and to assess the utility of continued use of the ESR test. Results: Review of medical records did not reveal an explanation for elevated ESR in 20 patients with normal CRP results. In the remaining 77 (79%) patients, an inflammatory disorder was noted despite a normal CRP value; in 27 (28%) patients, the disorder was osteomyelitis. Presence of skin necrosis was also a prominent factor in the discrepant results. Conclusions: ESR has value in detecting inflammatory disorders that may not be obvious by clinical examination or CRP results. ESR has a particularly useful role in patients with suspected bone lesions and osteomyelitis.

The role of surgical timing in the treatment of thoracic and lumbar spinal tuberculosis

To determine the outcome and safety of surgical treatment of thoracic and lumbar spinal tuberculosis in patients without obvious clinical and laboratory improvement after preoperative short-time chemotherapy. Data of 86 patients with single-level thoracic and lumbar tuberculosis, treated by one-stage posterior instrumentation combined with anterior radical debridement and fusion, were studied retrospectively. Patients were divided into two groups based on the results of erythrocyte sedimentation rate (ESR) after preoperative 2-week chemotherapy. Surgical outcome and prognosis were compared between the two groups. After antituberculous chemotherapy for 2 weeks, the ESR did not decrease or even increase in 57 patients (group A), but decreased in 29 patients (group B). However, the ESR decreased gradually after surgery and returned to a normal level at the final follow-up in both groups. Between group A and B, no significant difference was observed in pain improvement (6.3 ± 1.4, 6.4 ± 1.4, respectively, P = 0.805). The corrected angle was 12.4° ± 5.9°, 13.8° ± 6.4°, respectively, for group A and group B (P = 0.305). It is safe and effective to carry out the surgery just after a short-time antituberculous chemotherapy. And it is the postoperative drugs, not the preoperative drugs, that play an important role in reinforcing the surgical outcome.

Chorioamnionitis and Diagnostic Value of C-reactive Protein, Erythrocyte Sedimentation Rate and White Blood Cell Count in its Diagnosis Among Pregnant Women with Premature Rupture of Membranes

Several laboratory parameters have been used in these studies to diagnose chorioamnionitis leading to controversies to some extent. The aim of this study was to assess the diagnostic value of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) count in chorioamnionitis among pregnant women with premature rupture of membranes (PROM). In a cross-sectional diagnostic test research, 71 patients presented with PROM before the 37th week of gestation were enrolled. A blood sample was taken from all the patients. Hematologic automatic blood cell counter was used to count the blood cells and their differentiation. ESR and CRP were also measured using the same blood sample at the laboratory. Sensitivity, specificity, correct classification rate and likelihood ratios were calculated. Receiver operating curves were plotted and area under curve was estimated along with its 95% confidence interval. A total of 71 patients were studied. None of the patients had a positive drug history or a history of hypertension before the 20th week of gestation or during her previous pregnancy. Contrary to ESR, WBC count and CRP results didn't provide minimum acceptable diagnostic accuracy measures for diagnosis of chorioamnionitis. The sensitivity and specificity of a positive ESR test at a cutoff value of 52 were 66.7 and 60%, respectively. The area under curve was calculated to be 0.62. The findings of the present study were not supportive of using CRP, WBC as a reliable diagnostic test to identify chorioamnionitis in women with PROM. The results of CRP and WBC were not acceptable but ESR diagnostic value was minimally acceptable.

The Fall of the Erythrocyte Sedimentation Rate

Abstract 4774The Fall of the Erythrocyte Sedimentation Rate, Ashley J. Archambault, MLS(ASCP), Gyorgy Abel, MD, PhD, John Gawoski, MD, Tim Skelton, MD, PhD, Charles Arkin, MD, Department of Laboratory Medicine, Lahey Clinic Medical Center, Burlington MAThe Erythrocyte Sedimentation Rate (ESR) is widely used to indicate the presence of active inflammation, particularly in rheumatic and infectious disorders. It has long been a mainstay in diagnostic protocols, as well as being a standard in the work-up of temporal arteritis. However, despite its entrenchment in the minds of many physicians, an increasing number of medical professionals believe that the ESR should be eliminated since its results are often misleading and too nonspecific. Moreover other indicators of inflammation such as the C-reactive protein (CRP) and fibrinogen are now readily available to provide more reliable information. The ESR is also costly, labor intensive, and hazardous to laboratory personnel.Based on the above, Lahey Clinic Medical Center eliminated ESR testing in April of 2010. To accomplish this, an initial informational campaign was launched among the Lahey Clinic medical staff. Literature was distributed and face-to-face meetings were conducted with the most frequent users of the test. Details of the ESR's limitations and the suitability of its replacement by the CRP were emphasized. To strengthen the contention that ESRs are not essential to our institution, two in-house studies were performed: Study 1 reviewed 6 months of patient data from 2008 in order to evaluate cases where the CRP was negative and the ESR was positive. Study 2 used multiple regression analysis to show that ESR values could be calculated from, and presumably replaced by, other clinical data.Study 1: The table below shows that among 4,858 paired ESR/CRP results collected over 6 months there were 17 cases with markedly elevated ESRs (> 50) and normal CRPs (≤5). There were 5,944 unpaired ESRs for this period. Chart reviews of the 17 cases showed that the ESR provided no additional clinical value and, of note, 4 of the 17 patients did have elevated CRPs in the course of their illness. In Study 2, multiple regression analysis of 155 specimens identified 4 independent correlates of the ESR among 8 variables studied: Fibrinogen, Globulin, Hematocrit and Age (collective r2 = 0.85). The scatter plot in the figure displays the relation of the observed to the calculated ESRs.Table:Results of 4858 Paired CRP/ESR Tests over 6 Months in 2008ESRCRP≤20>20 ≤50>50TOTAL≤51830304172151>5 ≤10818326561200>104466144471507TOTAL309412445204858 [Display omitted] In late 2009 a memo went out to our physicians giving three months notice of the ESR's discontinuation and recommending use of the CRP in its place. During this period, reminders of the approaching deadline were appended to all ESR results. For the Departments of Rheumatology and Infectious Diseases, an additional three months were granted during which time calculated ESR, fibrinogen, globulin, and hematocrit values were reported for every ESR ordered.In comparison to Study 1, the same six month period in 2011 shows a fall of 10,802 ESRs, a gain of 5,669 CRPs, and a drop in utilization of about 5,000 tests or 10,000 per year. These numbers suggest that CRPs replaced the unpaired ESRs and the utilization drop was due primarily to deletion of ESRs from paired orders.Over sixteen months of post ESR testing, the laboratory received only four inquiries from the medical staff: a complaint that a CRP did not automatically replace an ESR order; a request for supportive literature; and two requests for ESR values that were needed to satisfy standard treatment protocols. The latter were provided with calculated ESRs.In summary, ESR elimination occurred smoothly and with minimal incident. Sixteen months of experience have yielded no negative clinical effects but have produced the perceived benefits of utilization reduction, more available technologist time, less bio-hazard exposure, and elimination of an obsolete test. Disclosures:No relevant conflicts of interest to declare.