Haemoglobin concentration and erythrocyte sedimentation rate in primary care patients.

The erythrocyte sedimentation rate (ESR) remains a commonly measured indicator of disease, but is subject to several non-disease influences. The haemoglobin concentration (Hb) and ESR were measured in 1249 consecutive patients (492 men, 757 women) from primary care practices. An inverse correlation was found between Hb and ESR throughout the range of measured Hb, and in particular there was a significant difference in the median ESR of patients in the highest and lowest quartile for non-anaemic Hb (P < 0.001). These results indicate that correct clinical analysis of an ESR result should take into account the Hb, both in anaemic and in non-anaemic patients. Interpretative difficulties due to external influences on the measured ESR could be resolved by replacement of this test with plasma viscosity estimation.     

Limited value of elevated erythrocyte sedimentation rate as an indicator of malignancy

BACKGROUND: Patients with an elevated erythrocyte sedimentation rate (ESR) are often suspected of having malignant disease and are subjected to extensive investigations. Thus, the finding of an elevated ESR can result in considerable costs and might even be dangerous for the patient if invasive studies are ordered. OBJECTIVES: Our aims were to establish (i) the prevalence of malignant diseases in hospitalized patients and out-patients with elevated ESR; and (ii) the long-term incidence of malignant diseases in patients during 5 years after unsuccessful investigation for elevated ESR. METHODS: A cross-sectional survey was carried out in 128 patients admitted to the Department of General Internal Medicine, University of Kiel and in 94 out-patients under the care of a GP. A retrospective cohort study of 50 patients was also carried out by contacting GPs of patients discharged from hospital after unsuccessful investigation. RESULTS: In the hospitalized patients, the ESR was elevated in 53.1% (68/128) and was normal in 46.9% (60/128). Malignancy was found in 25.0% (17/68) of patients with elevated ESR and in 15% (9/60) of patients with normal ESR (P = 0.16). Of the out-patients, 94 patients with elevated ESR were investigated, of whom 8.5% (8/94) had malignancies (P = 0.004 compared with hospitalized patients). In the follow-up study of 50 patients who had been discharged with the diagnosis "elevated ESR of unknown origin", follow-up information was available from 38 individuals. Of these, 71.0% (27/38) had not developed signs or symptoms of any disease at the time of investigation. Malignant disease had developed in only 5.3% (2/38). CONCLUSION: The prevalence of malignancy in patients with elevated ESR is low, in both the clinical and the general practice setting. Elevation of ESR is not an early sign of malignant disease and does not justify extensive investigation in a patient who has no symptoms which are suggestive of a tumour.     

Leukocyte count and erythrocyte sedimentation rate as diagnostic factors in febrile convulsion

Febrile convulsion (FC) is the most common seizure disorder in childhood. white blood cell (WBC) and erythrocyte sedimentation rate (ESR) are commonly measured in FC. Trauma, vomiting and bleeding can also lead to WBC and ESR so the blood tests must carefully be interpreted by the clinician. In this cross sectional study 410 children(163 with FC), aged 6 months to 5 years, admitted to Bahrami Children hospital in the first 48 hours of their febrile disease, either with or without seizure, were evaluated over an 18 months period. Age, sex, temperature; history of vomiting, bleeding or trauma; WBC, ESR and hemoglobin were recorded in all children. There was a significant increase of WBC (P<0.001) in children with FC so we can deduct that leukocytosis encountered in children with FC can be due to convulsion in itself. There was no significant difference regarding ESR (P=0.113) between the two groups. In fact, elevated ESR is a result of underlying pathology. In stable patients who don't have any indication of lumbar puncture, there's no need to assess WBC and ESR as an indicator of underlying infection. If the patient is transferred to pediatric ward and still there's no reason to suspect a bacterial infection, there is no need for WBC test.     

骨折内固定术后血沉变化原因的探讨

目的 探讨骨折内固定术后血沉变化的原因及其临床意义.方法 对笔者所在医院34例股骨骨折行内固定手术者与23例股骨内固定拆除者和30例胆石症行开腹手术者在不同时间检测血沉,同时在术后4 d检测与血沉相关主要指标进行统计分析,再结合回顾性临床分析,最终分析骨折内固定术后血沉升高的原因.结果 股骨内固定组在术后6 d达到峰值（73.3±18.2）mm/h,而其他两组都在术后4 d达到峰值.股骨内固定拆除组（30.4±14.1） mm/h,胆石症手术组（41.8±12.6）mm/h）,然后均逐渐降低.WBC、RBC、PLT和HCT术后4 d与术前变化率在股骨骨折内固定组和对照组无差异,球蛋白和纤维蛋白原具有统计学意义.结论 骨折内固定的血沉升高不仅与创伤应急有关,而且与内固定材料引起机体一系列病理生理变化有关,在术后2周内血沉变化不能作为术后继发感染等灵敏指标,但血沉的动态变化可以初步判断机体对内固定材料的适应性.     

Serum protein analysis and bone marrow cytology in patients with an extreme elevation of the erythrocyte sedimentation rate

One hundred patients in whom an Erythrocyte Sedimentation Rate (ESR) in excess of 100 mm. in the first hour was found on 2 consecutive occasions were investigated. Serum protein electrophoresis was performed on 96 of these patients and bone marrow examination on 55 patients. Acute infection was the commonest diagnosis though the majority of patients had 2 or more separate conditions each contributing to the elevation of the ESR. Quantitive serum protein electrophoresis was abnormal in all but one patient and was of limited diagnostic value. A definite band in the globulin region was detected in 11 patients, 7 of whom were found to have myelomatosis. Bone marrow examination was useful only in patients with a discrete band in the globulin fraction or with a specific haematological abnormality. It is suggested, therefore, that bone marrow examination be confined to patients with such abnormalities irrespective of an elevation of their ESR.     

Diagnostic impact of the erythrocyte sedimentation rate in general practice: a before-after analysis.

Despite its frequent use and long history, little is known about the diagnostic impact of the measurement of the erythrocyte sedimentation rate (ESR) in general practice. We prospectively followed 362 patients who were seen by their general practitioner (GP) because of a new complaint, for which the GP wanted to know the ESR. The GPs recorded the most probable diagnosis, as well as their clinical judgements in terms of 'severe' and 'not severe', and the expected ESR values, before and after the determination of the ESR in the local hospital laboratory. Having compared the results before ESR determination with the results after, we conclude that ESR is valuable in reassuring the patient and the doctor when 'no pathology' is suspected rather than in confirming the presence of inflammatory diseases and malignancies.     

Temporal arteritis: an atypical presentation

Temporal (giant cell) arteritis is a systemic granulomatous vasculitis primarily involving branches of the carotid arteries in patients aged 50 years and greater. Its classic symptoms and signs are headache and elevated erythrocyte sedimentation rate (ESR), but this is not the only presentation. This case is the first reported in a Korean, whose chief complaint was pain in the tongue and headaches and whose ESR was normal. The diagnosis was confirmed by biopsy. Her symptoms abated when treated with prednisone, but she developed diabetes mellitus, osteoporosis, and compression fracture of lumbar vertebrae while being treated. Primary physicians should become aware of the atypical features of this disease, as well as the potential complications of treatment.     

两种抗凝血测定红细胞沉降率结果的比较

目的:探讨以EDTA-K2为抗凝剂做为检测血沉方法的可行性.方法:收集住院患者血液标本,分别采用109mmol/L枸橼酸钠抗凝剂与EDTA-K2抗凝剂抗凝同一人份血样标本(血常规真空采血管采集两管),采用魏氏法测定ESR,在ESR检测前用XT-2000i全自动血液分析仪测定EDTA-K2抗凝剂抗凝血的红细胞压积,将用两种抗凝剂抗凝血所测的ESR结果作配对t检验分析.结果:当HCT≤0.35L/L时,枸橼酸钠与EDTA-K2两种抗凝剂抗凝的血样所测的ESR结果差异无显著性(P>0.05);当HCT>0.35L/L时,枸橼酸钠与EDTA-K2两种抗凝剂抗凝的血样所测的ESR结果差异有统计学意义(P<0.05),但稀释后的EDTA-K2抗凝血与枸橼酸钠抗凝血的ESR结果无统计学差异(P>0.05).结论:EDTA-K2抗凝全血可以替代枸橼酸钠抗凝血用于ESR检测.