Journal of Postgraduate Medicine
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Year : 1983  |  Volume : 29  |  Issue : 3  |  Page : 165-8  

A simple method of distinguishing between inflammatory and neoplastic elevation of erythrocyte sedimentation rate.

KS Kulkarni, SM Kendurkar, SD Bhandarkar 
 

Correspondence Address:
K S Kulkarni





How to cite this article:
Kulkarni K S, Kendurkar S M, Bhandarkar S D. A simple method of distinguishing between inflammatory and neoplastic elevation of erythrocyte sedimentation rate. J Postgrad Med 1983;29:165-8


How to cite this URL:
Kulkarni K S, Kendurkar S M, Bhandarkar S D. A simple method of distinguishing between inflammatory and neoplastic elevation of erythrocyte sedimentation rate. J Postgrad Med [serial online] 1983 [cited 2020 Apr 1 ];29:165-8
Available from: http://www.jpgmonline.com/text.asp?1983/29/3/165/5524


Full Text



 INTRODUCTION



Erythrocyte sedimentation rate (E.S.R.) is elevated in a variety of diseases. It is a non-specific indicator of an inflammatory or a malignant process in the body. Gross et al[1] reported a modification of Ruhenstroth-Bauer's[2] method of distinguishing between elevated E.S.R. due to inflammatory disorder and that due to malignant disease. They showed that in inflammatory disorder the E.S.R. shows a marked reduction when it is repeated after resuspending the cells in incubated plasma. In malignancies, the reduction is much less marked. We reported below a study to evaluate that method.

 MATERIAL AND METHODS



The test was carried out in 24 patients with various inflammatory conditions (Group A) and in 21 patients with proven malignancies (Group B) admitted to the wards of K.E.M. Hospital, Bombay. Sixteen ml of venous blood was withdrawn into a syringe containing 4 ml of 3.8% aqueous, sodium citrate solution. It was centrifuged at 3000 r.p.m. at room temperature for 10 minutes. The supernatant citrated plasma was pipetted out into a glass container. The cell sediment was washed three times with isotonic saline and then kept aside at room temperature. The citrated plasma was divided into two halves; one was allowed to stand at room temperature, and the other incubated at 37C for 4 hours. Then, the two sedimentation test mixtures were made up (a) with unincubated plasma (E.S.R. I) and (b) with incubated plasma (E.S.R. II), as follows: citrated plasma (unincubated or incubated) 1.4 ml + isotonic saline 0.6 ml + washed cells 1 ml. The two ESR tests were set up in Westergreen tubes and read at the end of one hour.

The difference between the two E.S.R. readings (E.S.R. I - E.S.R. II) was calculated for each patient; it was also expressed as %age of E.S.R. I. Mean and standard deviation were calculated for the data on E.S.R. I, difference between E.S.R. I and E.S.R. II and % difference between E.S.Rs I and II. Unpaired, two tailed, Students "t" test was used to compare the data in inflammatory disorders and malignancies. Further, 95% confidence limits for the above data were calculated.

 RESULTS AND DISCUSSION



[Table 1] and [Table 2] show the results in patients with inflammatory disorders and malignant diseases respectively. [Table 3] shows the means, standard deviation, 95% confidence limits, and "t" and p values for the data. The means of E.S.R. I in inflammatory and malignant conditions are significantly different at 5% level, whereas those of differences between E.S.R. I and E.S.R. II, and % difference between E.S.R. I and E.S.R. II are significant at 0.1% level. As seen from [Fig. 1] there is an overlap between the 95% confidence intervals in the case of E.S.R. I, and the % difference between E.S.R. I and E.S.R. II. However, the confidence intervals in ,,the case of the absolute difference between E.S.R. I and E.S.R. II do not show an overlap. It is, therefore, suggested that the absolute difference between E.S.R. I and E.S.R. II might be a good measure to differentiate elevation of E.S.R. in inflammatory disorders from that due to malignant diseases. By the present reckoning, a difference of 12 mm or larger between E.S.R. I and E.S.R. II would suggest an inflammatory disorder, whereas a difference of 10 mm or smaller would indicate a malignancy. This work is being continued in order to narrow down the confidence intervals and thus give better separation between the 2 groups of patients.



 ACKNOWLEDGEMENT



We thank the Dean, Seth G.S. Medical College and K.E.M. Hospital for his permission to publish this material.

References

1Gross, R, Gerrard, W. and Rassner, G.: A simple method for distinguishing inflammatory and neoplastic increase in erythrocyte sedimentation rate. German Med. Monthly, 12: 6-10,1967.
2Ruhenstroth-Bauer, G.: Der Mechanisimus der Blut korperchensenkung. Acta. Hematol, 18: 98-108, 1957.

 
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