Journal of Hematology & Thrombosis
Research Article
Understanding Variation in the Value of Esr in Anaemic Patients Using Different Automated Analysers And Its Comparison With Gold Standard Westergren Method
Hidangmayum A, Gupta A*, Lal SK, Bhardwaj S, Singh KK and Jaine NS
National Reference Laboratory, Dr Lal Path labs, Rohini, New Delhi, India
*Address for Correspondence:Gupta A, National Reference Laboratory, Dr Lal Path labs, Rohini,
New Delhi, India. E-mail Id: ajay.gupta@lalpathlabs.com
Submission:20 May, 2025
Accepted: 06 June, 2025
Published:10 June, 2025
Copyright: ©2025 Hidangmayum A, et al. This is an open access article
distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.
Keywords:Automated ESR Analysers; Manual Westergren ESR; Fabry’s
Formula; Hematocrit; Anaemia
Abstract
This study was conducted on 500 samples in the Department of
Haematology, Dr Lal path labs, National Reference Laboratory, Rohini,
Delhi, to analyse the variation in the value of ESR in anaemic patients using
different automated analysers and its comparison with gold standard,
Westergren method. Samples with Hb < 11gm% and hct < 35% were
included in the study, these samples were initially analysed in automated
ESR analysers- AlcoriSed as (method 1) and then in Alifax test1 analyser as
(method 2) and subsequently by the manual Westergren method. Fabry’s
formula was used to correct the Westergren ESR.
The observed ESR was graded as normal (n=110), Intermediate (n=192), High (n=194) and very high (n=4). The mean difference between corrected ESR and Alcor iSed(Method 1) for normal, intermediate, high and very high was 22.8, 39.1,62.3 and 93.1 mm/hr respectively. Bland Altman analysis of Alcor iSed and the Westergren method show wide limits of agreement (LOA) range from -47.2 mm/hr to +56.6 mm/hr, between the two methods, particularly at higher ESR values. The comparison between Alifax test 1 and the Westergren method observed a mean difference with LOA of 22.8 (-29.7 to 62.3),39.7 (-36.4 to 50.6), 63.8 (-48.1 to 47.7) and 92.1 (-106.5 to 36.3)mm/hr respectively for normal intermediate high and very high ESR. Bland Altman analysis of the same observed a mean difference (bias) of 5.96 mm/hr with LOA ranging from -42.1 mm/hr to +54.0 mm/hr, indicating a considerable spread in differences. The mean difference (bias) between the two automated analysers of -1.24 mm/hr suggests a slight difference in estimation of ESR values by the Alcor iSed compared to the Alifax test1.
In referral laboratories with copious sample loads, the automated ESR analysers can safely replace the Westergren method for normal to intermediate ESR values in anaemic patients. The result deteriorates as ESR values increase (>100mm/hr) leading to greater variability and reduced correlation in the high and very high ESR.
In anaemic patients with high ESR (>100mm/hr), confirmation and verification by the standard Westergren method may be required.
The observed ESR was graded as normal (n=110), Intermediate (n=192), High (n=194) and very high (n=4). The mean difference between corrected ESR and Alcor iSed(Method 1) for normal, intermediate, high and very high was 22.8, 39.1,62.3 and 93.1 mm/hr respectively. Bland Altman analysis of Alcor iSed and the Westergren method show wide limits of agreement (LOA) range from -47.2 mm/hr to +56.6 mm/hr, between the two methods, particularly at higher ESR values. The comparison between Alifax test 1 and the Westergren method observed a mean difference with LOA of 22.8 (-29.7 to 62.3),39.7 (-36.4 to 50.6), 63.8 (-48.1 to 47.7) and 92.1 (-106.5 to 36.3)mm/hr respectively for normal intermediate high and very high ESR. Bland Altman analysis of the same observed a mean difference (bias) of 5.96 mm/hr with LOA ranging from -42.1 mm/hr to +54.0 mm/hr, indicating a considerable spread in differences. The mean difference (bias) between the two automated analysers of -1.24 mm/hr suggests a slight difference in estimation of ESR values by the Alcor iSed compared to the Alifax test1.
In referral laboratories with copious sample loads, the automated ESR analysers can safely replace the Westergren method for normal to intermediate ESR values in anaemic patients. The result deteriorates as ESR values increase (>100mm/hr) leading to greater variability and reduced correlation in the high and very high ESR.
In anaemic patients with high ESR (>100mm/hr), confirmation and verification by the standard Westergren method may be required.