Don’t order an erythrocyte sedimentation rate to look for inflammation in patients with undiagnosed conditions. Order a C-reactive protein to detect acute phase inflammation.

Rationale and Comments

C-reactive protein is a more sensitive and specific reflection of the acute phase of inflammation than is the erythrocyte sedimentation rate. In the first 24 hours of a disease process, the C-reactive protein will be elevated, whereas the erythrocyte sedimentation rate may be normal. If the source of inflammation is removed, the C-reactive protein will return to normal within a day or so, whereas the erythrocyte sedimentation rate will remain elevated for several days until excess fibrinogen is removed from the serum.

Sponsoring Organizations

American Society for Clinical Pathology

Sources

Expert consensus

Disciplines

Hematologic
Rheumatologic

References

Crowson CS, Rahman MU, Matteson EL. Which measure of inflammation to use? A comparison of erythrocyte sedimentation rate and C-reactive protein measurements from randomized clinical trials of golimumab in rheumatoid arthritis. J Rheumatol. 2009;36(8):1606-10.
Wu AH, Lewandrowski K, Gronowski AM, Grenache DG, Sokoll LJ, Magnani B. Antiquated tests within the clinical pathology laboratory. Am J Manag Care. 2010;16(9):e220-7.
Black S, Kushner I, Samols D. C-reactive protein. J Biol Chem. 2004:279(47):48487-90.
Henriquez-Camacho C, Losa J. Biomarkers for sepsis. Biomed Res Int. 2014;2014:547818.
Lelubre C, Anselin S, Zouaoui Boudjeltia K, Biston P, Piagnerelli M. Interpretation of C-reactive protein concentrations in critically ill patients. Biomed Res Int. 2013;2013:124021.