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Erythrocyte sedimentation rate: the extinction of a dinosaur laboratory test?

The debate about erythrocyte sedimentation rate versus plasma viscosity has gone on for a considerable length of time. Here, Sabrina Chetcuti provides an update on current thinking.

Many laboratories have historically clung on to erythrocyte sedimentation rate (ESR) as a test to confirm that patients are unwell. Even though the science behind ESR is seen as dubious by laboratory scientists and many clinicians including consultant haematologists, why is the ESR still requested?

Is it just out of habit that we continue to use a test that has no quality control (QC), producing results that will vary without any change in the patient’s condition? Aspirin and steroids are the backbone of many treatments for patients with inflammation, and yet they are the very drugs that will significantly interfere with ESR results, suggesting an improvement which may not have occurred.

Plasma viscosity (PV) testing was seen as the ‘cure’ for this habit more than 30 years ago, and yet this easy-to-use, rapid and stable diagnostic tool has been overlooked by many laboratories as the high-volume alternative. Over the years, more and more laboratories have elected to use PV testing as a significant tool in their repertoire. Some noteworthy centres of excellence, including Leeds General Infirmary, the Royal United Hospital Bath, Nobles Hospital on the Isle of Man, and the Royal Devon and Exeter, have made the ambitious commitment to eliminate ESR and replace it with PV

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