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The erythrocyte (or red blood cell) sedimentation rate (ESR) is commonlyinterpreted as a measure of cell aggregation and as a biomarker ofinflammation. It is well known that an increase of fibrinogen concentration, anaggregation-inducing protein for erythrocytes, leads to an increase of thesedimentation rate of erythrocytes, which is generally explained through theformation and faster settling of large disjoint aggregates. However, manyaspects of erythrocyte sedimentation conform well with the collapse of acolloidal gel rather than with the sedimentation of disjoint aggregates. Usingexperiments and cell-level numerical simulations, we systematically investigatethe dependence of ESR on fibrinogen concentration and its relation to themicrostructure of the gel-like erythrocyte suspension. We show that forphysiological aggregation interactions, an increase in the attraction strengthbetween cells results in a cell network with larger void spaces. Thisgeometrical change in the network structure occurs due to anisotropic shape anddeformability of erythrocytes and leads to an increased gel permeability andfaster sedimentation. Our results provide a comprehensive relation between theESR and the cell-level structure of erythrocyte suspensions and support the gelhypothesis in the interpretation of blood sedimentation.

Erythrocyte sedimentation: Effect of aggregation energy on gel structure during collapse