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This version was published on 1 November 2008
Ann Clin Biochem 2008;45:593-597
doi:10.1258/acb.2008.008062
© 2008 Association for Clinical Biochemistry

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Original Articles

The effect of paraproteins on the erythrocyte sedimentation rate: a comparison between the StarrSed and TEST 1

Maarten T M Raijmakers, Philip H M Kuijper, Dirk L Bakkeren and Huib L Vader


Laboratory of Clinical Chemistry, Máxima Medical Centre, Veldhoven, The Netherlands


Corresponding author: Dr M T M Raijmakers. Email: m.raijmakers{at}mmc.nl

Background: The principle of the erythrocyte sedimentation rate (ESR) as assessed by TEST 1 is different from that of Westergren-based methods. This could result in different influences on the tests by paraproteins.

Methods: We investigated the effect of paraproteins on ESR readings by TEST 1 (y) and the StarrSed (x), a Westergren-based method, in 142 patients with paraproteinaemia. Agreement (Passing-Bablok) and bias (Bland–Altman) between methods was investigated and compared with that of a control population.

Results: A poor agreement between the two methods was found in patients with a paraprotein (y = 0.67x + 3.3) in comparison with that of the control population (y = 0.96x + 0.2). Large differences between methods were present when ESR readings were >40 mm/hour, but clinical interpretation was similar in 90% of cases. Linear regression showed a concentration dependent influence of paraproteins on ESR readings by the StarrSed, especially for immunoglobulin class IgM.

Conclusion: ESR readings by TEST 1 result in similar clinical interpretation for most subjects, but readings are less influenced by the presence of a paraprotein than those of a Westergren-based method.


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