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2025, Number 1

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Rev Hematol Mex 2025; 26 (1)

Erythrocyte sedimentation rate in clinical practice: Applications and limitations

Grimaldo L, Climaco AS

Language: Spanish
References: 34
Page: 1-12
PDF size: 835.09 Kb.


ABSTRACT

BACKGROUND: Erythrocyte sedimentation rate is a classic hematological test used as a nonspecific marker of inflammation. Although newer biomarkers such as C-reactive protein, interleukin 6, procalcitonin, and calprotectin offer greater sensitivity and specificity, erythrocyte sedimentation rate remains widely utilized, particularly in settings with limited access to advanced laboratory diagnostics.
OBJECTIVE: To assess the diagnostic accuracy and clinical utility of erythrocyte sedimentation rate in comparison to modern inflammatory biomarkers in diseases other than polymyalgia rheumatica and temporal arteritis.
METHODOLOGY: A narrative and systematic review conducted in accordance with PRISMA 2020 guidelines. The review included clinical studies involving adults, retrieved from PubMed and Scopus databases (2010-2025), that directly compared erythrocyte sedimentation rate with at least one modern biomarker and reported sensitivity, specificity, or other relevant diagnostic metrics.
RESULTS: Out of the 198 publications initially screened, 10 studies fulfilled the eligibility criteria and were included in the qualitative synthesis. Overall, erythrocyte sedimentation rate demonstrated lower sensitivity and specificity compared to C-reactive protein, interleukin 6, procalcitonin and calprotectin in most clinical settings. Nonetheless, erythrocyte sedimentation rate retained clinical value in specific contexts, particularly when used in combination with other tests or in cases where values exceeded defined thresholds (e.g., > 30 mm/h).
CONCLUSION: Erythrocyte sedimentation rate remains a relevant, low-cost complementary test in inflammatory and infectious disease assessment. However, its interpretation must be integrated with clinical findings and other laboratory parameters, especially in resource-constrained environments where more specific biomarkers may be unavailable.


REFERENCES

  1. Diario Oficial de la Federación. Norma Oficial MexicanaPROY-NOM-007-SSA3-2017, Para la organización y funcionamientode los laboratorios clínicos.

  2. Gondres Legró KM, Domínguez Cardosa M, Gonzáles FloresAJ, Paez Candelaria Y. Medisan. MEDISAN 2009; 28 (1).

  3. Hatton C. Introduction to haematology. In: Hatton C, HayD, editors. Oxford Textbook of Medicine. Oxford UniversityPressOxford; 2020: 5169-71. https://doi.org.10.1093/med/9780198746690.003.0510

  4. Costenbader KH, Chibnik LB, Schur PH. Discordancebetween erythrocyte sedimentation rate and C-reactiveprotein measurements: clinical significance. Clin ExpRheumatol 2007; 25 (5): 746-9.

  5. Tishkowski K, Gupta V. Erythrocyte Sedimentation Rate.StatPearls 2020.

  6. Grzybowski A, Sak J. Edmund Biernacki (1866-1911): Discovererof the erythrocyte sedimentation rate. On the 100thanniversary of his death. Clin Dermatol 2011; 29 (6): 697-703. https://doi.org.10.1016/j.clindermatol.2011.08.033

  7. Grzybowski A, Sak J. A short history of the discovery ofthe erythrocyte sedimentation rate. Int J Lab Hematol2012; 34 (4): 442-4. https://doi.org.10.1111/j.1751-553X.2012.01430.x

  8. McCabe BH. A brief history of the erythrocyte SedimentationRate Lab Med 1985; 16 (3): 177-8. https://doi.org.10.1093/labmed/16.3.177

  9. Zlonis M. The mystique of the erythrocyte sedimentationrate. A reappraisal of one of the oldest laboratory tests stillin use. Clin Lab Med 1993; 13 (4): 787-800.

  10. Jou JM, Lewis SM, Briggs C, et al. ICSH review of the measurementof the erythocyte sedimentation rate. Int J LabHematol 2011; 33 (2): 125-32. https://doi.org.10.1111/j.1751-553X.2011.01302.x

  11. Navarro MP. Velocidad de sedimentación globular: métodosy utilidad clínica. Comunidad y Salud 2019; 17 (2).

  12. Fabry T. Mechanism of erythrocyte aggregation and sedimentation.Blood. 1987; 70 (5): 1572-6.

  13. Hashemi R, Majidi A, Motamed H, et al. Erythrocyte sedimentationrate measurement using as a rapid alternative tothe Westergren method. Emerg (Tehran) 2015; 3 (2): 50-3.

  14. Kahar MA. Erythrocyte sedimentation rate (with its inherentlimitations) remains a useful investigation in contemporaryclinical practice. Ann Pathol Lab Med 2022; 9 (6):R9-17. https://doi.org.10.21276/APALM.3155

  15. Brigden M. The erythrocyte sedimentation rate. Still ahelpful test when used judiciously. Postgrad Med 1998;103 (5): 257-74. https://doi.org.10.3810/pgm.1998.05.493

  16. Parghane RV, Singh B, Sharma A, et al. Role of 99mTcmethylenediphosphonate SPECT/CT in the detection of sacroiliitisin patients with spondyloarthropathy: Comparisonwith clinical markers and MRI. J Nucl Med Technol 2017;45 (4): 280-4. https://doi.org.10.2967/jnmt.117.193094

  17. Kuo FC, Lu YD, Wu CT, et al. Comparison of moleculardiagnosis with serum markers and synovial fluid analysisin patients with prosthetic joint infection. Bone Joint J2018; 100-B (10): 1345-51. https://doi.org.10.1302/0301-620X.100B10.BJJ-2018-0096.R1

  18. Costa CR, Johnson AJ, Naziri Q, et al. Efficacy of erythrocytesedimentation rate and C-reactive protein level in determiningperiprosthetic hip infections. Am J Orthop (BelleMead NJ) 2012; 41 (4): 160-5.

  19. Fu J, Ni M, Chai W, et al. Synovial fluid viscosity test ispromising for the diagnosis of periprosthetic joint infec tion. J Arthroplasty 2019; 34 (6): 1197-200. https://doi.org.10.1016/j.arth.2019.02.009

  20. Koh IJ, Han SB, In Y, et al. The leukocyte esterase striptest has practical value for diagnosing periprosthetic jointinfection after total knee arthroplasty: A multicenterstudy. J Arthroplasty 2017; 32 (11): 3519-23. https://doi.org.10.1016/j.arth.2017.06.008

  21. Yang F, Zhao C, Huang R, et al. Plasma fibrinogen in thediagnosis of periprosthetic joint infection. Sci Rep 2021;11 (1): 677. https://doi.org.10.1038/s41598-020-80547-z

  22. Domecky P, Rejman Patkova A, et al. Inflammatory bloodparameters as prognostic factors for implant-associatedinfection after primary total hip or knee arthroplasty: asystematic review. BMC Musculoskelet Disord 2023; 24(1): 383. https://doi.org.10.1186/s12891-023-06500-z

  23. Menees SB, Powell C, Kurlander J, et al. A meta-analysisof the utility of C-reactive protein, erythrocyte sedimentationrate, fecal calprotectin, and fecal lactoferrin toexclude inflammatory bowel disease in adults With IBS.Am J Gastroenterol 2015; 110 (3): 444-54. https://doi.org.10.1038/ajg.2015.6

  24. Park JH, Wee JH, Choi SP, Park KN. Serum procalcitoninlevel for the prediction of severity in women with acutepyelonephritis in the ED: value of procalcitonin in acutepyelonephritis. Am J Emerg Med 2013; 31 (7): 1092-7.https://doi.org.10.1016/j.ajem.2013.04.012

  25. Zhang ZL, Hou YL, Li DT, Li FZ. Laboratory findings of COVID-19: a systematic review and meta-analysis. Scand J ClinLab Invest 2020; 80 (6): 441-7. https://doi.org.10.1080/00365513.2020.1768587

  26. Singh P, Vajpayee AB. ESR in modern era. J Assoc PhysIndia 2017; 2: 35-7.

  27. Romero JM. Utilidad diagnóstica de la velocidad de sedimentaciónglobular. Med Integral 2002; 39 (7): 325-34.

  28. Brigden ML. Clinical utility of the erythrocyte sedimentationrate. Am Fam Physician 1999; 60 (5): 1443-50.

  29. Saadeh C. The erythrocyte sedimentation rate: old andnew clinical applications. South Med J 1998; 91 (3): 220-5.

  30. Bochen K, et al. ESR: an old marker with new applications.J Pre-Clin Clin Res 2011; 5 (2): 50-5.

  31. Saurav A, Rina M. Polymyalgia Rheumatica. StatPearls.2024.

  32. Kara M, Alp G, Koç AM. Diagnostic difficulties in polymyalgiarheumatica cases with normal erythrocytesedimentation rate and C‑reactive protein values. Medicine2023; 102 (39): e35385. https://doi.org.10.1097/MD.0000000000035385

  33. Chan FLY, Lester S, Whittle SL, Hill CL. The utility of ESR,CRP and platelets in the diagnosis of GCA. BMC Rheumatol2019; 3 (1): 14. https://doi.org.10.1186/s41927-019-0061-z

  34. Carvajal Alegria G, Nicolas M, van Sleen Y. Biomarkersin the era of targeted therapy in giant cell arteritis andpolymyalgia rheumatica: is it possible to replace acutephasereactants? Front Immunol 2023; 14. https://doi.org.10.3389/fimmu.2023.1202160




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