ICSH review of the measurement of the erythocyte sedimentation rate

In recognition of the need for a standardization of the measurement of the erythrocyte sedimentation rate (ESR), the International Council for Standardization in Haematology makes the following recommendations: (i) The reference method for measurement of the ESR should be based on the Westergren method, which is a specific test for the ESR, with modifications, (ii) The reference method for measurement of the ESR should use either whole blood anticoagulated with EDTA and later diluted with sodium citrate or saline (4 : 1) or whole blood anticoagulated with sodium citrate (4 : 1) in Westergren pipettes, (iii) The ESR pipettes can be of glass or plastic (with specific characteristics). It must be colourless; a minimum sedimentation scale of 200 mm, a minimum bore of 2.55 mm, which should be constant within 5%. A protocol for the evaluation of alternative methodologies against the reference method is outlined: The new technologies must be tested over a range of ESR values of 2-120 mm. In this comparison, 95% of the differences should be 5 mm or less, with larger differences associated with higher ESR values. A minimum of 40 samples should be tested in 3 different groups of values: 1-20, 21-60 and more than 60 mm. The statistical methods recommended for ESR evaluations are the coefficient of correlation, the Passing-Bablock regression and the Bland-Altman statistical method. This reference method replaces all earlier standardized and reference methods.