What is expected of ESR in rheumatology labs?

What is expected of ESR in rheumatology labs?

• A. Decreased rouleaux
• B. Increased RBC rouleaux
• C. Normal RBC stacking
• D. Decreased plasma proteins

Answer: (B)

ESR rises when red blood cells tend to form rouleaux. In inflammatory states common in rheumatology, acute-phase proteins like fibrinogen and certain immunoglobulins increase in the plasma. These proteins coat the red cells, reducing the usual negative charge that keeps cells apart, so the cells stack into rouleaux. These stacks settle faster in the test tube, leading to an increased ESR. So the best description is increased RBC rouleaux. If rouleaux were decreased or if plasma proteins were lowered, the ESR would be reduced or unchanged, which doesn’t fit the typical inflammatory pattern. Normal stacking wouldn’t explain an elevated ESR either.

ESR rises when red blood cells tend to form rouleaux. In inflammatory states common in rheumatology, acute-phase proteins like fibrinogen and certain immunoglobulins increase in the plasma. These proteins coat the red cells, reducing the usual negative charge that keeps cells apart, so the cells stack into rouleaux. These stacks settle faster in the test tube, leading to an increased ESR. So the best description is increased RBC rouleaux. If rouleaux were decreased or if plasma proteins were lowered, the ESR would be reduced or unchanged, which doesn’t fit the typical inflammatory pattern. Normal stacking wouldn’t explain an elevated ESR either.