Why is the erythrocyte sedimentation rate being phased out in favor of the plasma viscosity?

Why is the erythrocyte sedimentation rate being phased out in favor of the plasma viscosity?

I've heard that the erythrocyte sedimentation rate is being phased out
in favor of the plasma viscosity? Why? And I've also heard you can
replace the ESR w/ C-reactive protein titers. Any reason why the
venerable ESR is losing it's popularity? Thanks!!!!

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-- deleted messages --

Re: Why is the erythrocyte sedimentation rate being phased out in favor of the plasma viscosity?

Hi agin
You wrote:
So, would getting an ESR+CRP be a good test combo? Would an
"inflammation panel" be ESR+CRP+PV+ferritin+haptoglobin
+IL-1+IL-6+IL-13 --though I'm not sure of the last three titers--? Do
you know of anyone who orders those tests together?

.....
I think that would be overkill.
I know very well that there is a tendency to practise "defensive medicine"
when ordering your lab work, but it is simple statistics that if you test
enough parameters you will eventually find one which is out of range. There
will always be a balance between economics and outcome.
measuring interleucines can be useful in some settings, but diagnosis should
be done based on the clinical picture together with relevant lab findings -
Very often it would sufifce with leuc and crp - but again, what kind of
patient are we talking about - look at the patient, talk with the patient -
Basicly - do what mothers do - does it hurt - where - why - fever - tired -
general looks - dizzyness etc etc
Also - what are the setting - patients i general practice is in general
healthy individuals (whatever healthy means) and patients in the hospital
wards are in general sick. You also have to differ between diagnosing and
monitoring.
If diagnosing a patient the clinical picture gives an indication of
disease - you have a tentative diagnosis - which in turn can be confirmed
(or not) with relevant tests.
One should not "fire at will" from the lab-panel.

If you are interested in the use of crp, try google for "crp in clinical
use" and within the first two or three pages you have all the info you want.
You might want to scroll quickly past the cardiac sites until done with the
others...

Re: Why is the erythrocyte sedimentation rate being phased out in favor of the plasma viscosity?

On Feb 26, 3:47 am, "L" <none> wrote:
> Hi aginYou wrote:
>
> So, would getting an ESR+CRP be a good test combo? Would an
> "inflammation panel" be ESR+CRP+PV+ferritin+haptoglobin
> +IL-1+IL-6+IL-13 --though I'm not sure of the last three titers--? Do
> you know of anyone who orders those tests together?
>
> .....
> I think that would be overkill.
> I know very well that there is a tendency to practise "defensive medicine"=

> when ordering your lab work, but it is simple statistics that if you test
> enough parameters you will eventually find one which is out of range. Ther=
e
> will always be a balance between economics and outcome.
> measuring interleucines can be useful in some settings, but diagnosis shou=
ld
> be done based on the clinical picture together with relevant lab findings =
-
> Very often it would sufifce with leuc and crp - but again, what kind of
> patient are we talking about - look at the patient, talk with the patient =
-
> Basicly - do what mothers do - does it hurt - where - why -  fever - tir=
ed -
> general looks - dizzyness etc etc
> Also - what are the setting - patients i general practice is in general
> healthy individuals (whatever healthy means) and patients in the hospital
> wards are in general sick. You also have to differ between diagnosing and
> monitoring.
> If diagnosing a patient the clinical picture gives an indication of
> disease - you have a tentative diagnosis  - which in turn can be confirm=
ed
> (or not) with relevant tests.
> One should not "fire at will" from the lab-panel.
>
> If you are interested in the use of crp, try google for "crp in clinical
> use" and within the first two or three pages you have all the info you wan=
t.
> You might want to scroll quickly past the cardiac sites until done with th=
e
> others...

OK, firing off seven lab tests to test for the same thing is *not* a
good thing. What about ordering an ESR (or PV) every day, and a CRP
every hour while someone's in the ICU? And what's the diff b/w CRP
and hs-CRP?

BTW, when someone's having an attack of PNH, would their RPI be much
greater then 2, since PNH causes massive hemolysis?

Thanks!!!!

Re: Why is the erythrocyte sedimentation rate being phased out in favor of the plasma viscosity?

This very subject came up on one of my List-servs (general lab) lately.
One of our venerable members said that about the only time ESR is still
useful is for autoimmune vasculitis, particularly Polyarteritis Nodosa,
because ESR is sometimes the ONLY test that is abnormal with this
disease. Increases and decreases in sed rates are also apparently used
to track clinical symptoms in PAN patients. I guess there are really no
other tests to help in the diagnosis of PAN. It was also further
mentioned that this test might be really only necessary, in a large lab,
to run one per week.

* en.wikipedia.org/wiki/Polyarteritis nodosa

BTW, hourly ESR's would set off a huge hue and cry from the lab. This is
NOT a test you run that often and somebody would be on the phone to the
floor to check on this.

I do know that a typical outpatient order is ESR, ANA, RA, CRP
(sometimes), and a CBC. Sometimes some other chemistries are thrown in.
This is a starting place for anyone with joint pain, etc.

I know nothing about any of these diseases and am just passing on
information. I have done micro exclusively since 1988, but I was
involved in general lab stuff and lab marketing once upon a time, so I
do have some familiarity with other departments :-). I am not aware of
plasma viscosity. This must be something new.

Judy Dilworth, M.T. (ASCP)
Microbiology

"douglas" <Protoman2050@gmail . com > wrote in message
news:4145a3b4-8b77-4e2a-957d-48047e283326@41g2000hsc.googlegroups . com ...
> I've heard that the erythrocyte sedimentation rate is being phased out
> in favor of the plasma viscosity? Why? And I've also heard you can
> replace the ESR w/ C-reactive protein titers. Any reason why the
> venerable ESR is losing it's popularity? Thanks!!!!

Re: Why is the erythrocyte sedimentation rate being phased out in favor of the plasma viscosity?

On Feb 26, 4:23 pm, "JEDilworth" <bactit...@nospamhortonsbay . com >
wrote:
> This very subject came up on one of my List-servs (general lab) lately.
> One of our venerable members said that about the only time ESR is still
> useful is for autoimmune vasculitis, particularly Polyarteritis Nodosa,
> because ESR is sometimes the ONLY test that is abnormal with this
> disease. Increases and decreases in sed rates are also apparently used
> to track clinical symptoms in PAN patients. I guess there are really no
> other tests to help in the diagnosis of PAN. It was also further
> mentioned that this test might be really only necessary, in a large lab,
> to run one per week.
>
> * en.wikipedia.org/wiki/Polyarteritis nodosa
>
> BTW, hourly ESR's would set off a huge hue and cry from the lab. This is
> NOT a test you run that often and somebody would be on the phone to the
> floor to check on this.
>
> I do know that a typical outpatient order is ESR, ANA, RA, CRP
> (sometimes), and a CBC. Sometimes some other chemistries are thrown in.
> This is a starting place for anyone with joint pain, etc.
>
> I know nothing about any of these diseases and am just passing on
> information. I have done micro exclusively since 1988, but I was
> involved in general lab stuff and lab marketing once upon a time, so I
> do have some familiarity with other departments :-). I am not aware of
> plasma viscosity. This must be something new.
>
> Judy Dilworth, M.T. (ASCP)
> Microbiology
>
> "douglas" <Protoman2...@gmail . com > wrote in message
>
> news:4145a3b4-8b77-4e2a-957d-48047e283326@41g2000hsc.googlegroups . com ...
>
>
>
> > I've heard that the erythrocyte sedimentation rate is being phased out
> > in favor of the plasma viscosity? Why? And I've also heard you can
> > replace the ESR w/ C-reactive protein titers. Any reason why the
> > venerable ESR is losing it's popularity? Thanks!!!!- Hide quoted text -
>
> - Show quoted text -

I did say ESR/day, CRP/hr, I think you misread, Ms. Dilworth. And
could you --or someone else, since you yourself said that this isn't
your forte-- please answer my other questions.

Have you ever had a Dr who flooded the lab w/ tests, and you were
stuck doing his tests, and only his, for quite a while?

Thanks!!!!

Re: Why is the erythrocyte sedimentation rate being phased out in favor of the plasma viscosity?

On 2008-02-26 19:55:18 -0500, douglas <Protoman2050@gmail . com > said:

>>
>
> I did say ESR/day, CRP/hr, I think you misread, Ms. Dilworth. And
> could you --or someone else, since you yourself said that this isn't
> your forte-- please answer my other questions.
>
> Have you ever had a Dr who flooded the lab w/ tests, and you were
> stuck doing his tests, and only his, for quite a while?
>
> Thanks!!!!
Yes, I have been stuck doing unnecessary tests by a doctor. I work in a
teaching hospital and at night the attendings go home leaving the
interns and residents free to go wild with lab tests. Some of the phone
calls we get show that they do not have a good understanding of lab
tests or how the lab works in general. that is a missing piece of
medical education.

We had a lab tech who worked for us for 2 years before going to med
school. she had a much better foundation for lab testing than any doc
in her class. It is well worth considering!

--
John Gentile MS, M(ASCP)
Laboratory Information Mgr.
VA Medical Center
Providence, RI
yjgent@cox . net

Re: Why is the erythrocyte sedimentation rate being phased out in favor of the plasma viscosity?

Much as we hate to lose good MT's to med school, what John said is very
true. My sister-in-law was a med tech in Chemistry and then in
Microbiology for quite awhile. She went back to school in her 40's after
a divorce and became a PA (physician's assistant). She was miles ahead
of everyone in her class as far as the lab went and she ended up
teaching micro at the PA school for awhile until her hours were
increased on her job. The other family practice docs where she works
always defer to her on basic microbiology questions. Another friend of
hers was a med tech and went onto dental school. Same thing - the lab
experience put him way ahead of his classmates.

Another good friend was a med tech in Hematology/Blood
Bank/Chemistry/Urinalysis (i.e. general lab) for many years and was
admitted to med school at the ripe old age of 37. He's been an ER doc
since he graduated in 1986 and is in his 60's now. The lab experience
for his line of work put him ahead of most ER docs we run into.

One of our techs went on and is in Podiatry school now - same story.

Do not discount the laboratory as far as laying an excellent foundation
for medical/dental/other medical professional school. It gives you good
experience and decent income to be able to pursue med school down the
road.

As far as unnecessary testing....with online ordering (as opposed to
paper ordering - most hospitals are going to the former) many tests
cannot be ordered too many times per day anymore. Insurance
companies/Medicare/Medicaid will NOT reimburse a hospital for duplicate
testing so the system just won't let you order them. That being said,
there are ways around a lot of things - docs ranting and raving being
one of them. This does NOT go over well with the lab (we are sharper
than most docs think) and docs that chew out the lab and otherwise rant
at us get "labelled" and their reputations are spread far and wide. In
some hospitals these types of orders are reviewed by the clinical
pathologists first, especially if the test is an expensive send-out with
no clinical reason for ordering it other than ego. The clinical
pathologist is the ultimate boss of any laboratory and what they say
goes. I remember when I first started out there was one resident who
used to routinely order EVERY chemistry test on our requisition. This
required LOTS of blood in the 1970's and I remember drawing these poor
patients with a 50 cc syringe. This does NOT happen anymore. The DRG
(diagnostic related group - all Medicare patients are assigned to one
based on their diagnosis) oversight is too stringent. Hospitals get paid
a flat fee for the DRG the patient is assigned to by coders (based on
their medical records, certain in-house events, etc.). If they code
wrong and the patient is in longer than the DRG will pay for, the
hospitals eat the overage. The docs are under pressure to discharge
patients because of this and they DON'T use up DRG money on too much
unnecessary testing if they can help it. The hospitals monitor which
docs order too much.....

Judy Dilworth, M.T. (ASCP)
Microbiology


"John Gentile" <yjgent@nospamcox . net > wrote in message
news:2008022622110316807-yjgent@nospamcoxnet...
> We had a lab tech who worked for us for 2 years before going to med
> school. she had a much better foundation for lab testing than any doc
> in her class. It is well worth considering!

Re: Why is the erythrocyte sedimentation rate being phased out in favor of the plasma viscosity?

On Feb 26, 9:19 pm, "JEDilworth" <bactit...@nospamhortonsbay . com >
wrote:
> Much as we hate to lose good MT's to med school, what John said is very
> true. My sister-in-law was a med tech in Chemistry and then in
> Microbiology for quite awhile. She went back to school in her 40's after
> a divorce and became a PA (physician's assistant). She was miles ahead
> of everyone in her class as far as the lab went and she ended up
> teaching micro at the PA school for awhile until her hours were
> increased on her job. The other family practice docs where she works
> always defer to her on basic microbiology questions.  Another friend of
> hers was a med tech and went onto dental school.  Same thing - the lab
> experience put him way ahead of his classmates.
>
> Another good friend was a med tech in Hematology/Blood
> Bank/Chemistry/Urinalysis (i.e. general lab) for many years and was
> admitted to med school at the ripe old age of 37. He's been an ER doc
> since he graduated in 1986 and is in his 60's now. The lab experience
> for his line of work put him ahead of most ER docs we run into.
>
> One of our techs went on and is in Podiatry school now - same story.
>
> Do not discount the laboratory as far as laying an excellent foundation
> for medical/dental/other medical professional school. It gives you good
> experience and decent income to be able to pursue med school down the
> road.
>
> As far as unnecessary testing....with online ordering (as opposed to
> paper ordering - most hospitals are going to the former) many tests
> cannot be ordered too many times per day anymore. Insurance
> companies/Medicare/Medicaid will NOT reimburse a hospital for duplicate
> testing so the system just won't let you order them. That being said,
> there are ways around a lot of things - docs ranting and raving being
> one of them. This does NOT go over well with the lab (we are sharper
> than most docs think) and docs that chew out the lab and otherwise rant
> at us get "labelled" and their reputations are spread far and wide. In
> some hospitals these types of orders are reviewed by the clinical
> pathologists first, especially if the test is an expensive send-out with
> no clinical reason for ordering it other than ego. The clinical
> pathologist is the ultimate boss of any laboratory and what they say
> goes. I remember when I first started out there was one resident who
> used to routinely order EVERY chemistry test on our requisition. This
> required LOTS of blood in the 1970's and I remember drawing these poor
> patients with a 50 cc syringe. This does NOT happen anymore. The DRG
> (diagnostic related group - all Medicare patients are assigned to one
> based on their diagnosis) oversight is too stringent. Hospitals get paid
> a flat fee for the DRG the patient is assigned to by coders (based on
> their medical records, certain in-house events, etc.). If they code
> wrong and the patient is in longer than the DRG will pay for, the
> hospitals eat the overage. The docs are under pressure to discharge
> patients because of this and they DON'T use up DRG money on too much
> unnecessary testing if they can help it. The hospitals monitor which
> docs order too much.....
>
> Judy Dilworth, M.T. (ASCP)
> Microbiology
>
> "John Gentile" <yjg...@nospamcox . net > wrote in message
>
> news:2008022622110316807-yjgent@nospamcoxnet...
>
>
>
> > We had a lab tech who worked for us for 2 years before going to med
> > school. she had a much better foundation for lab testing than any doc
> > in her class. It is well worth considering!- Hide quoted text -
>
> - Show quoted text -

I can see this on someone's hospital interview "Well, Dr Carlton,
unfortunately we have to reject you, b/c it seems that you have
brought every hospital laboratory, in every hospital you've worked at
since medical school, to a screeching halt. How do you explain your
lab-o-mania?" "I was just being thorough..."

You know the joke "Internists know everything and do nothing, surgeons
know nothing and do everything, and pathologists know everything and
do everything, just too late"? Where would radiologists fit in to
that?

And what does clinical pathology entail? I've heard that the med techs
interpret most of that, so the pathologists can get to work on the
anatomical pathology stuff.

And does hematopathology fall into AP, or CP?

Thanks!!!!

Re: Why is the erythrocyte sedimentation rate being phased out in favor of the plasma viscosity?

* w w w .ascp.org/careerlinks/pathologist.aspx - this should give you
some more information on clinical pathology, at least.

It is my understanding that Anatomical pathologists do not get into
laboratory administration. They just do their anatomical thing and leave
the administrative stuff to the clinical guys. Clinical pathologists
perform pathology duties but are also involved in the actual
administration of the laboratory and oversee, in our case, the
laboratory administrator and, under him, the laboratory managers and
team leaders (and, ultimately, the medical technologists who perform the
lab work).

They are updating their website soon and the above link may not work
after March 6.

* en.wikipedia.org/wiki/Anatomical pathologist - information for
the US below:

"Anatomic Pathology (AP) is one of the two primary certifications
offered by the American Board of Pathology. The other is Clinical
Pathology (CP). To be certified in anatomic pathology, the trainee must
complete four years of medical school followed by three years of
residency training. Many US pathologists are certified in both AP and
CP, which requires a total of four years of residency. After completing
residency, many pathologists enroll in further years of fellowship
training to gain expertise in a subspecialty of AP."

* en.wikipedia.org/wiki/Clinical Pathology

* en.wikipedia.org/wiki/Hematopathology - Pathologists can
specialize after they go through their regular pathology rotation.
Pathologists usually have an area of expertise. I've known pathologists
who have specialized in hematology, blood banking, thyroid fine needle
aspirations, dermatopathology (a high demand specialty - some labs refer
all their difficult skin biopsy cases to them. When I was marketing many
prospective clients asked if we had a dermatopathologist on staff. The
lab I used to work for got TONS of skin tags, punch biopsies, etc. in
for examination on a daily basis).

We currently have a pathologist assigned to microbiology. At my former
position, we had a similar situation. Tough call results always had to
be cleared through the pathologist before signing out results. This is
also the situation where I work now. That's why they pay them the big
bucks :-). They obviously do their pathology thing also, but our
pathologist's office is located in our department.

Hope this helps.

Judy Dilworth, M.T. (ASCP)
Microbiology

"douglas" <Protoman2050@gmail . com > wrote in message
news:2d167ee5-0e37-4500-89d6-e8fb631800b5@62g2000hsn.googlegroups . com ...

And what does clinical pathology entail? I've heard that the med techs
interpret most of that, so the pathologists can get to work on the
anatomical pathology stuff.

And does hematopathology fall into AP, or CP?

Thanks!!!!

Re: Why is the erythrocyte sedimentation rate being phased out in favor of the plasma viscosity?


"douglas" <Protoman2050@gmail . com > wrote in message
news:4145a3b4-8b77-4e2a-957d-48047e283326@41g2000hsc.googlegroups . com ...
> I've heard that the erythrocyte sedimentation rate is being phased out
> in favor of the plasma viscosity? Why? And I've also heard you can
> replace the ESR w/ C-reactive protein titers. Any reason why the
> venerable ESR is losing it's popularity? Thanks!!!!

The problem with the ESR is that it doesn't specifically measure anything.
It's simply a case of "the higher the number, the iller the patient." Which
is why it's so useful.
As for being relaced by plasma viscosity - I always thought plasma
viscosity was on the way out. For all it's failings,, an ESR is very simple
to perform.