Asmaa A/LinkedIn
Oct 25, 2025, 07:41
Asmaa A: Common Sources of Error in ESR Testing
Asmaa A, DHA Medical Laboratory Technologis at Al-Ahrar International Hospital, shared a post on LinkedIn:
”ESR (Erythrocyte Sedimentation Rate): Sources of Errors — Increased and Decreased
Even a simple test like ESR can give misleading results if technical or sample-related factors aren’t right.
Here’s what can falsely decrease or increase ESR.
Falsely Decreased ESR
- Abnormal RBC morphology (sickle cells, spherocytes, anisocytosis) → prevents rouleaux formation.
- Polycythemia / Increased blood viscosity → RBCs settle slower.
- Clotted or partially clotted sample → false low ESR.
- Underfilled tube (excess anticoagulant ratio) → alters plasma/RBC balance, lowering ESR.
- Old blood sample → shape changes (spherocytes) reduce sedimentation.
- Low storage temperature → slows down the sedimentation rate.
- Vibration or shaking of the tube (e.g. near centrifuge) → may falsely decrease ESR by disturbing RBC settling.
Falsely Increased ESR
- Hemolyzed sample → may cause unreliable or falsely high results.
- Anemia (low RBC count) → less crowding, faster fall.
- Tube not vertical or tilted → increases ESR.
- High room temperature → increases sedimentation rate.
- Delay in testing (>2 hrs after collection) → RBC shape changes increase rouleaux formation.
- Overfilled tube (insufficient anticoagulant) → ↑ Falsely high ESR
Sometimes the issue isn’t the patient it’s the sample handling!
Always check pre-analytical factors before trusting the numbers.”
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