Influence of Plasma Proteins on Erythrocyte Morphology and Sedimentation

Abstract

The influence of plasma proteins on erythrocytes was studied by interference microscopy, scanning electron microscopy (SEM), and by Westergren erythrocyte sedimentation rate (ESR). Albumin kept erythrocytes dispersed as discoid spheres. Fibrinogen seemed responsible for the rouleaux phenomenon, but needed the co‐influence of an immunoglobulin to induce rouleaux type of aggregates and high ESR. IgG, IgA and IgM caused immunologic type of aggregates. Albumin acted synergistically with fibrinogen and immunoglobulins. Normal blood contained a network of rouleaux, which probably explained the low normal ESR. High ESR was either due to rouleaux type aggregates where fibrinogen was dominant, or immunologic type aggregates where IgG, IgA or IgM were dominant proteins. Cold agglutinin disease showed normal blood morphology and normal ESR at 37°C and immunologic type aggregates and high ESR at 25°C.

Association of Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio, and Mean Platelet Volume with Systemic Lupus Erythematosus Disease Activity: A Meta-analysis

“…ESR and CRP level are the most widely used markers for measuring acute-phase response to indicate inflammation in RA. ESR and CRP are influenced by several factors unrelated to inflammation such as age, sex, anemia, and renal failure [37]. However, NLR and PLR are not affected by age, gender, and hemoglobin level [38].…”

Comparison of Disease Activity Score 28 Using C-reactive Protein and Disease Activity Score 28 Using Erythrocyte Sedimentation Rate in Assessing Activity and Treatment Response in Rheumatoid Arthritis: A Meta-analysis

“…Thus, CRP is more sensitive to short-term changes in disease activity. Furthermore, ESR level is more affected by several factors including sex, age, immunoglobulin levels, fibrinogen levels, rheumatoid factor, and anemia than CRP level [4]. When the cut-off values for DAS28-ESR are applied to DAS28-CRP, the disease activity could be overestimated, and the proportion of patients classified as being in remission could be increased.…”

“…Since ESR is used as an inflammation marker, this version is referred to as DAS28-ESR. ESR is affected by age, sex, anemia, fibrinogen levels, hypergammaglobulinemia, plasma viscosity, and reflects disease activity of the past few weeks [4], while C-reactive protein (CRP) is less confounded by these factors, and reflects more short-term changes in disease activity [5]. DAS28 using CRP (DAS28-CRP) was developed by the modification of DAS28-ESR, which had previously been developed by modification of the DAS [3].…”

Comparison of Disease Activity Score-28 Based on Erythrocyte Sedimentation Rate and C-reactive Protein Level in Rheumatoid Arthritis

“…DAS28-ESR has been widely used and validated in clinical practice and trials for monitoring RA disease activity and determining the treatment response using the European League Against Rheumatism (EULAR) response criteria [3]. ESR is affected by age, sex, anemia, fibrinogen levels, hypergammaglobulinemia, and plasma viscosity, and reflects the disease activity of the past few weeks [4]. On the other hand, C-reactive protein (CRP) is less confounded by these factors, and reflects the more short-term changes in disease activity [5].…”