The Sed Rate of Micro
We laboratorians (ha ha, really) must seem a humorless clique. We stick together at breaks and lunch, are all business on the telephone, and are otherwise inside our black laboratory box. And like most work teams, we have pet peeves funny to only us. They’re too difficult to explain to outsiders.
But I’ll give it a try.
ESR is described by Lab Tests Online as “an easy, inexpensive, nonspecific test that has been used for many years to help detect conditions associated with acute and chronic inflammation... ESR is said to be nonspecific because increased results do not tell the doctor exactly where the inflammation is in the body or what is causing it.”
Fair enough. There is a negative predictive value in ordering nonspecific, sensitive tests. But in all the labs I’ve worked the sed rate has been maligned by techs as mostly useless. “What does it tell doctors?” “Who cares if it’s thirty or fifty!” “Why don’t they just order a C-reactive protein?” Once, I suggested half-jokingly to a pathologist that we round off sed rates to the nearest five millimeters.
Fair enough again. We have a legitimate role in educating peers and physicians in the uses and misuses of diagnostic testing. We often know our tests better than anyone, and providers can’t remember everything. But along the way the sed rate was branded as THE nonspecific test. I picked up on this early in my career and have taken it from lab to lab. Every time I run across a nonspecific assay it becomes “The sed rate of...”
The DAT, for instance, is the sed rate of blood bank. The D-dimer is the sed rate of coagulation. You get the idea. The sed rate of hematology, interestingly, is RBC morphology. At this point the whole concept collapses like rouleaux in a Westergren tube.
Maybe this is funny, maybe not. Humor can be a frustration release valve, and pet peeves often create the pressure. But just in case you get the joke, I’ll leave you with a riddle: what’s the sed rate of micro?
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