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

This version was published on 1 November 2008

Ann Clin Biochem 2008;45:593-597
© 2008 Association for Clinical Biochemistry



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Original Articles

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}

Background: The principle of the erythrocyte sedimentation rate (ESR) asassessed by TEST 1 is different from that of Westergren-basedmethods. This could result in different influences on the testsby 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 investigatedand 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 differencesbetween methods were present when ESR readings were >40 mm/hour,but clinical interpretation was similar in 90% of cases. Linearregression showed a concentration dependent influence of paraproteinson ESR readings by the StarrSed, especially for immunoglobulinclass IgM.

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

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