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Too slow Erythrocyte Sedimentation Rate: Deeper biophysical understanding, novel accurate parameters and new medical applications

Darras, A.; Qiao, M.; Peikert, K.; Hecksteden, A.; John, T.; Glass, H.; Stauffer, E.; Muniansi, I.; Champigneulle, B.; Pichon, A.; Furian, M.; Hancco Zirena, I.; Brugniaux, J. V.; Mühlbäck, A.; Simmonds, M. J.; Nader, E.; Joly, P.; Meyer, T.; Verges, S.; Hermann, A.; Danek, A.; Connes, P.; Wagner, C.; Kaestner, L.

2026-09-01 hematology
10.64898/2026.08.26.26360269 medRxiv
Show abstract

The erythrocyte sedimentation rate (ESR) is one of the most common and widely used laboratory diagnostic parameters in connection with inflammatory reactions and it is probable that every reader has already experienced a determination of their ESR. A rapid ESR is a non-specific parameter that provides information about the inflammatory process. Although the origins of this methodology date back to antiquity, the description of the process as the collapse of a percolating gel formed from erythrocytes has only recently been achieved. It was not yet known whether slow ESR has any medically relevant significance. Here we show a variety of clinical pictures that exhibit a systematically slow ESR (e.g., sickle cell disease, neuroacanthocytosis syndromes, chronic mountain sickness). Using a combination of measured data and physical modelling, we show how the accuracy and significance of ESR data can be increased. With this improved ESR (supraESR), we introduce a completely new, cost-effective diagnostic parameter, based on an established and easily automated measurement method, that enables low-cost screening for neuroacanthocytosis syndrome, a group of rare neurodegenerative diseases previously detectable only through complex diagnostic tests.

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