Erythrocyte Sedimentation Rate ESR Sed Rate

[DrBaboon]

From way back in med school, I recall some of my teachers mentioning the use of a hematocrit capillary for measuring a Sed Rate.

I did some searching:

Pediatr Med Chir. 1992 Sep-Oct;14(5):507-8.
[The micro-ESR with the capillary tube inclined to 45 degrees in the "sepsis screen" of neonatal infection due to beta-hemolytic B-group Streptococcus]
[Article in Italian]
Trevisanuto D, Dani C, Chiodin E, Cantarutti F, Zanardo V.
Dipartimento di Pediatria dell'Universita di Padova, Italia.
The authors describe the advantages of a new method to determinate the erythrocyte sedimentation rate (micro-ESR) during neonatal GBS infections. They utilize a capillary tube placed at a 45 degrees angle and have the results of this test only after 15 minutes. The micro-ESR is proposed as a simple and quick method of sepsis screen in term and preterm newborns.



Med Lab Sci. 1983 Apr;40(2):183-5.
Erythrocyte sedimentation rate: evaluation of a commercial capillary-ESR tube in a paediatric haematology laboratory.
Hackett MC, Hinchliffe RF, Laycock BJ, Lilleyman JS.
PMID: 6888204


I may try to get these articles on paper to see what they say.

There is also this citation - it appears to be the type of longer abstract that is used for a poster presentation at a meeting. I believe the author is a student:

http://www.findarticles.com/p/articles/mi_qa3890/is_200407/ai_n9457279

Following up on her choice of capillaries for this experiment:

https://www1.fishersci.com/Coupon?gid=178499&cid=1328

ESR/Sed Rate has shown up on quite a few laboratory test lists.

There are commercially available "kits" that are pretty bare bones. The difference is that the "kits" use tubes that are pretty long - compared to hematocrit capillaries. The tubes from the "kits" also have larger internal diameters than hematocrit capillaries.

Of course, it would be handy to have an off-the-shelf capillary that was acceptable for ESR - preferably doing double duty with hematocrit.

Intuitively, I'm not surprised by the results the student reports in her experiment. IOW - if there is enough capillary action "wicking" the blood, it is bound to have some effect on sedimentation. And her results show the weakest correlation between real ESR Westergren tubes and hematocrit capillaries. The capillaries that fared better are the ones with larger internal diameters - and the trend seems to be that the larger the bore, the better the results in that tube correlate with what is obtained in a real Westergren tube.

The catalog listing from Fisher Scientific is for 2 types of those "better" capillaries.

I've noted a few folks saying that they don't find ESR's helpful. I suspect that in a situation where you are mainly dealing with trauma, it won't be helpful.

I use ESR data IRL. I'm pretty sure that I would *not* be incapacitated if I could not get ESRs. However, when you think of how you might use them for prolonged medical management if you don't have other tests available, or as a supporting test to track progress, I can see the utility of ESR.

SOME EXAMPLES: What is your treatment goal for a rheumatoid arthritis patient? Is it reduction in active synovitis, or subjective improvement reported by the patient? Whether you're using salicylates (ASA or otherwise, made/extracted or bought), NSAIDs or steroids, I doubt that serology is going to be available to see that the Rheumatoid Titre is coming down. Likewise ANA. At least RA factor can be a card test, even if it's doubtful you've got a few reagents left.

Similarly, if I were treating an osteomyelitis, what laboratory or other diagnostic parameters would track progress/successful treatment? WBC may or may not be helpful. X-ray may or may not be available.

I guess it's another example of whether the individual practitioner decides it's useful enough for them to invest the effort to squirrel away some supplies for ESR.

I posted to aid that discussion, but also to point out that I'm not confident of getting reliable ESR results by using regular hematocrit capillaries.


Footnote: For those who don't know what ESR is, or how it's done...

It's tempting to claim mysterious, high-tech, even magical properties for ESR.

The reality is that it is about a LOW TECH as any lab test in modern medicine.

You fill a long, skinny tube with blood, and stand the tube upright. You have a way of measuring down from the top of the blood in the tube. You set a timer for 1 hour. An hour later, the blood cells (mostly RBCs) will have settled, and you will see the plasma at the top mark where you started, and compacted blood some distance below the top mark. That distance in millimeters is the ESR in mm/hr. Higher rates of sedimentation correlate with inflamation, fibrin, etc.

So using the examples above - you might have a Rheumatoid Arthritis patient who has a ESR of 115mm/hr in addition to their "hot" joints with active synovium, etc. A month after good doses of aspirin, perhaps some steroids, or whatever you have used, their ESR might have come down as their symptoms and physical findings improve - perhaps an ESR of 50-60-70mm/hr or whatever.

The osteomyelitis patient would likely also have an elevated ESR, which would probably gradually come down as it is treated.

[tangent]

Am I to understand that you have a reading comprehention of scientific Italian doc?

Just something I'd like to file away, if you do - I have nothing in Itallian right now, but I do have papers in about 8 other languages waiting translation (incl: German, Russian, Portugese, Sweedish, Polish, etc.)

> The reality is that it is about a LOW TECH as any lab test in modern medicine.

I thought the lowest tech you could get in a med lab was sticking your finger in the urine sample and tasting it to determine the presence of glucose...

;)


thanks,

-t

[DrBaboon]

I'm functional with scientific german. I am not quite as capable in spanish. I have a more or less first grade reading level in russian. I have friends who might help me if I needed something badly enough in several other languages.

If you've ever translated something, you know it's quick and easy to read it for yourself, and another to translate it so everyone else can use it.

If I attempted written translation of scientific papers myself, it would be german-to-english.

Over the years, I've ended deciding it's better to get an article that seems useful, and figure out how to squeeze information from it later.

You see - it might very well be that this recent italian article is not that helpful explaining their method for us to potentially duplicate - they may be more (appropriately) focused on reporting their own results. They may simply state they duplicated a method that so-and-so used in another paper. But since I haven't heard this topic discussed recently among physicians in training programs, I do think that it's likely the italian article will have a list of references that will go back 10-20-perhaps 30 years, and it may be more likely that those references will be the ones that are more helpful.

Whether or not it gets to the point of a written translation of the Italian article, I suspect it will be pretty easy to read their list of references.

The discussions of micro-capillary ESR I encountered in training were almost 25 years ago - an era that has not been completely integrated into electronic information. It was actually a topic that came up on pediatrics in 1981.

My hunch is that pediatric attending physicians and older residents were talking about capillary ESR from what they did in the past - even then. I don't actually recall seeing anyone perform one at the time. I think we're looking for some *old* information. For one thing - there's no daily need to do an ESR this way in "the real world."

If I was going to see someone do a micro-capillary ESR, it wold have been then. My pediatrics rotation at the university hospital had a wet lab for use by the residents and students - right on the floor. The expectation was that we would be present our own lab data at morning report a few hours after admitting a patient - whether or not there was anything else available from the hospital lab. It was expected that if the attending physician wanted to look at a slide or something, we'd be able to produce it for the group to look at. This was 1981. I never saw another lab for housestaff that was as capable as that one.

Within a year, that lab was shut down. There were concerns about occupational health, worries that people might not have learned to do tests reliably, concerns about costs, etc.

Each hospital where I did clinical rotations for the next 2 years had fewer and fewer things available to students and residents. By the time I began my residency in 1983, we were down to having to beg for a card to check fecal occult blood.

CLIA (Clinical Laboratory Improvement Act) came a few years later in the US. That greatly reduced what people were doing in their offices. I continued much of my office lab capability into the early 1990's, and complied with CLIA requirements while doing so. Based on my interest in office labs, I did some public policy work for two of the state medical organizations, and attended the state's department of public health meetings to report to these organizations. About that time, I also served a year on the state medical society's laboratory and blood banking committee.

All of that to say that I think it's going to be more work to get information on micro-capillary ESRs.