Comparison of the erythrocyte sedimentation rate measured by the Micro Test 1 sedimentation analyzer and the conventional Westergren method

Comparison of erythrocyte sedimentation rate measurement between Westergren method and automated method among patients attending Jigjiga University Sheik Hassen Yabare Referral Hospital, Jigjiga, Ethiopia

Introduction

Erythrocyte sedimentation rate (ESR) is a widely used screening test in clinical practice as an indicator of inflammatory and degenerative malignant diseases. The Westergren method, renowned as the gold standard, is valued for its accuracy and cost-effectiveness but demands considerable time and blood volume. Emerging automated methods offer quicker and more convenient alternatives, aiming to replace manual techniques. Nonetheless, validating these automated methods against the reference Westergren method is essential to ensure reliability. Therefore, this study aimed to evaluate ESR measurement results obtained from both the reference Westergren method and the automated (SFRI ESR 3000) method.

Methods

A Hospital-based comparative cross-sectional study was conducted at Jigjiga University Sheik Hassen Yabare Referral Hospital from July 15 to September 16, 2023. Following the acquisition of informed consent, blood samples were obtained from 158 participants, five milliliters of blood from each participant. These samples were then subjected to ESR estimation using both the Westergren (reference) method and the automated (SFRI ESR 3000) method. Subsequently, the collected data were analyzed using SPSS version 20 and MedCalc version 12.3.0.0 statistical Softwares. Statistical analyses such as Paired t-tests, Pearson correlation, linear regression, and the Bland and Altman plot were employed. A p-value of < 0.05 was considered statistically significant.

Results

The paired sample t-test analysis revealed no significant difference between the use of the reference Westergren method and the automated method for ESR determination, with a mean difference (MD) of 0.7 ± 9.2 mm/h (P = 0.36). Additionally, a significant correlation was observed between the two methods, with a remarkable correlation coefficient (r = 0.94, p < 0.001). The Bland-Altman data analysis indicated no evidence of systematic bias and demonstrated good agreement of ESR values between the two methods, with a limit of agreement of -17.3 to +18.7. Moreover, within-run imprecision analysis for the automated method across a range of ESR values showed coefficient of variation of 27.08, 12.65, and 10.32% for low, medium, and high ESR levels, respectively.

Conclusions

The SFRI ESR 300 automated method demonstrates the potential for interchangeable use with the Westergren method for determining ESR, given the strong correlation and good agreement. Additionally, the same reference range could be applied during interpretation.

Method Comparison of Erythrocyte Sedimentation Rate Automated Systems, the VES-MATIC 5 (DIESSE) and Test 1 (ALIFAX), with the Reference Method in Routine Practice

Background: The erythrocyte sedimentation rate (ESR) is a routine and aspecific test that is still widely used. The reference-manual method for ESR determination is the Westergren method. The VES-MATIC 5 is a novel, fully automated, and closed system based on a modified Westergren method. This study conceived the aim of comparing two ESR analytical analysers, Test 1 and the VES-MATIC 5, with the reference method in routine practice. Methods: This study included 264 randomly analysed samples. A comparison between the two methods and Westergren was performed, and they were evaluated for inter-run and intra-run precision. In addition, we investigated possible interferences and different sensitivities to conventional analytes. Results: The comparison of methods by Passing-Bablok analysis provided a good agreement for both systems, with a better correlation for VES-MATIC 5 (p = 0.96) than Test 1 (p = 0.93), and sensitivity studies did not show any significant influence. Conclusions: The VES-MATIC 5 analyser demonstrated excellent comparability with the reference method, and it had better performance than Test 1. It can be employed in routine practice, bringing advantages such as a reduction in the probability of human error compared to the manual method, as well as an increase in operator safety and environmental protection.

Comparative Analysis of Erythrocyte Sedimentation Rate Measured by Automated and Manual Methods in Anaemic Patients

Purpose  Erythrocyte sedimentation rate (ESR) is a widely used indicator of inflammation and a routinely done hematology investigation to monitor patients of autoimmune and infectious diseases. We aimed to compare the ESR results obtained by Roller 20LC automated instrument and standard reference Westergren method and analyzed the effect of anemia (hematocrit) on ESR measurements through the automated method.

Methods  We analyzed 1377 random anemic OPD patients (hematocrit [HCT] < 35%) for ESR levels measured by Roller 20LC using EDTA blood and Westergren method using citrated blood for a one and half year period from January 1, 2018 to June 30, 2019. Fabry’s formula was used to correct the Westergren ESR.

Results  The total number of samples after evaluation were divided into low ( n = 232), intermediate ( n = 417), high ( n = 406), and very high range of ESR (≥100 mm/hr; n = 422). Mean difference between values of corrected and automated ESR for the low, intermediate, high and very high ESR range was 2.33 ± 5.03, 10.95 ± 8.04, 28.22 ± 19.11 and 43.3 ± 19.22 mm/hr, respectively. The 95% limit of agreement calculated by the Bland–Altmann analysis between the two methods for low-ESR range was −7.53 to 12.2 (highest correlation coefficient –0.65), while for very high ESR, range was −5.1 to 81.5 (least coefficient of 0.18) ( p < 0.001).

Conclusion  In laboratories with high-sample load and where manual measurement may be tedious, the automated method of ESR measurement can safely replace the Westergren method for low-ESR values in patients with low hematocrit. While for high-ESR values, validation by the standard Westergren method may be needed.

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

BACKGROUND

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.

MATERIAL AND METHODS

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, >20 mm/h) and Hct(≥35%, <35%) levels and hospital type was analyzed. ESR levels with Hct levels<35% were corrected with Fabry's formula.

RESULTS

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 ± 20.58 mm/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 > 20 mm/h group, Hct < 35% group, and corrected ESR group (significance level were P > .10).

CONCLUSION

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.