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[02-007 ] Erythrocyte sedimentation rate (ESR)

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A test that evaluates the rate at which blood separates into plasma and red blood cells. The rate of separation is mainly determined by the degree of their aggregation, i.e., the ability to stick together with each other.

Russian synonyms

Erythrocyte sedimentation reaction, ROE, ESR.

SynonymsEnglish

Erythrocyte sedimentation rate, Sed rate, Sedimentation rate, Westergren sedimentation rate.

Research method

Method of capillary photometry.

Units

mm/h (millimeter per hour).

What biomaterial can be used for research?

Venous, capillary blood.

How to properly prepare for research?

  • Eliminate alcohol from the diet for 24 hours prior to the study.
  • Do not eat for 2-3 hours before the study (you can drink clean non-carbonated water).
  • Stop taking medicines 24 hours before the study (as agreed with the doctor).
  • Eliminate physical and emotional overstrain for 30 minutes before the study.
  • Do not smoke for 30 minutes prior to the study.

General information about the study

Determination of the erythrocyte sedimentation rate (ESR) is an indirect method for detecting an inflammatory, autoimmune, or oncological disease. It is performed on a sample of venous or capillary blood, which has been added to a substance that allows it not to clot (anticoagulant). When analyzing ESR by the Panchenkov method, blood is placed in a thin glass or plastic test tube and monitored for an hour. At this time, erythrocytes (red blood cells), as having a large specific gravity, settle, leaving a column of transparent plasma above them. By distance from upper bound plasma to erythrocytes and calculate the ESR. Normally, red blood cells settle slowly, leaving very little pure plasma. For this method, a Panchenkov apparatus is used, consisting of a stand and capillary pipettes with a scale of 100 mm.

In capillary photometry (automatic analyzers ROLLER, TEST1) the kinetic method of "stopped jet" is used. At the beginning of the ESR analysis, a programmed mixing of the sample takes place in order to disaggregate the erythrocytes. Ineffective disaggregation or the presence of microclots can affect the final result, since the analyzer actually measures the kinetics of erythrocyte aggregation. In this case, the measurement takes place in the range from 2 to 120 mm / h. The results of measuring ESR by this method have a high correlation with the Westergren method, which is the reference for determining ESR in the blood, and the same reference values.

The results obtained when using the method of capillary photometry, in the region of normal values, coincide with the results obtained when determining the ESR by the Panchenkov method. However, the capillary photometry method is more sensitive to an increase in ESR, and the results in the zone of elevated values ​​are higher than the results obtained by the Panchenkov method.

An increase in the level of pathological proteins in the liquid part of the blood, as well as some other proteins (the so-called acute-phase proteins that appear during inflammation) contributes to the "gluing" of red blood cells. Because of this, they settle faster and the ESR rises. It turns out that any acute or chronic inflammation can lead to an increase in ESR in the blood.

The fewer red blood cells, the faster they settle, so women have a higher ESR than men. The norm of ESR is different depending on gender and age.

What is research used for?

  • To diagnose diseases associated with acute or chronic inflammation, including infections, oncological diseases and autoimmune diseases. The determination of ESR is sensitive, but one of the least specific laboratory tests, since an increase in ESR in the blood alone does not allow determining the source of inflammation, in addition, it can occur not only due to inflammation. That is why the ESR analysis is usually used in combination with other studies.

When is the study scheduled?

  • During diagnostics and monitoring:
    • inflammatory diseases,
    • infectious diseases,
    • oncological diseases,
    • autoimmune diseases.
  • When conducting preventive examinations in conjunction with other studies (general blood count, leukocyte formula, etc.).

What do the results mean?

Reference values ​​(ESR norm - table)

The results of this analysis must be interpreted in the light of clinical findings, medical history, and other analyses.

Causes of increased ESR in the blood

  • Infectious diseases (usually bacterial causes). ESR can increase in both acute and chronic infectious diseases.
  • Inflammatory diseases.
  • Diseases connective tissue (rheumatoid arthritis, systemic lupus erythematosus, systemic scleroderma, vasculitis).
  • Inflammatory bowel disease (Crohn's disease, ulcerative colitis).
  1. Oncological diseases:
    1. Myeloma. As a rule, it is accompanied by a very high level of ESR in the blood, because with it pathological proteins are synthesized in large quantities, which cause the formation of erythrocyte "coin columns".
    2. Hodgkin's disease malignant disease lymph nodes. The ESR indicator is usually used not to make a diagnosis, but to monitor the course and effectiveness of treatment of an already diagnosed disease.
    3. Cancer of various localizations, especially hemoblastoses. It is believed that an extremely high level of ESR in the blood indicates the spread of the tumor beyond the primary focus (i.e., metastases).
  • Myocardial infarction. With it, damage to the heart muscle occurs, which causes a systemic inflammatory response and, accordingly, an increase in ESR. After a heart attack, ESR peaks about a week later.
  • Anemia. A decrease in the number of erythrocytes can lead to an increase in their sedimentation rate.
  • Burns, injuries.
  • Amyloidosis is a disease associated with the accumulation of an abnormal protein in the tissues.

Causes of a decrease in ESR in the blood

  • Diseases that are accompanied by a change in the shape of red blood cells, such as sickle cell anemia or hereditary spherocytosis (these make it difficult for red blood cells to settle).
  • Polycythemia (an increase in the number of red blood cells) and conditions that lead to it, such as, for example, chronic heart failure or lung disease.

What can influence the result? Leukocyte formula

Who orders the study?

Therapist, oncologist, hematologist, infectious disease specialist.

You feel normal, nothing causes serious concern ... And suddenly, when you take another blood test, it turns out that you have a changed erythrocyte sedimentation rate (ESR). Should I be worried? How important is the value of this indicator and what should be done in such a situation? Let's figure it out together.

ESR analysis: what is it

ESR (ROE, ESR) - erythrocyte sedimentation rate - is a very important characteristic that can indirectly indicate inflammatory and pathological processes in the body, including those occurring in a latent form. The ESR index is influenced by a number of factors, including: infectious diseases, fever, chronic inflammation. Upon receipt of an ESR analysis result that does not meet the standard values, the doctor will always prescribe an additional examination to identify the cause of the deviation.

To determine the level of ESR, an anticoagulant (a substance that prevents clotting) is added to the blood taken for analysis. Then this composition for one hour is placed in a vertically mounted container. The specific gravity of erythrocytes is higher than the specific gravity of plasma. That is why, under the influence of gravity, erythrocytes settle to the bottom. The blood is divided into 2 layers. Plasma remains in the upper one, and erythrocytes accumulate in the lower one. After that, the height of the top layer is measured. The number corresponding to the border between erythrocytes and plasma on the test tube scale will be the erythrocyte sedimentation rate, measured in millimeters per hour.

Why is a blood test important?
Blood consists of plasma and formed elements: erythrocytes, leukocytes and platelets, the balance of which reflects the state of the patient's body. Many pathological processes develop asymptomatically, so a timely analysis often helps to identify a number of diseases in the early stages, which allows them to be treated in time and avoid many problems.

When is an erythrocyte sedimentation rate test ordered?

Determination of ESR is necessary in the following situations:

  • for diagnostics and preventive examinations;
  • to monitor the patient's condition during treatment;
  • with infectious diseases;
  • with inflammatory diseases;
  • with autoimmune disorders;
  • in the presence of ongoing oncological processes in the body.

Preparing and conducting a blood sampling procedure

An ESR analysis does not require special preparation, but before donating blood, you need to follow a few simple rules.

Firstly, one day before the analysis, you should refrain from drinking alcohol, and 40-60 minutes from smoking. Secondly, you can not eat 4-5 hours before the study, you can only drink non-carbonated water. Thirdly, if you are taking medications, check with your doctor, as it is advisable to stop taking medications before the study. And most importantly - try to avoid any emotional and physical overload before the test.

Analysis Methodology

The determination of the erythrocyte sedimentation rate is carried out in one of two ways: by the Panchenkov method or by the Westergren method.

Panchenkov's method

A 5% solution of sodium citrate (anticoagulant) is poured into a capillary divided into 100 divisions up to the “P” mark. After that, the capillary is filled with blood (the biomaterial is taken from the finger) up to the “K” mark. The contents of the vessel are mixed, then placed strictly vertically. ESR readings are taken after an hour.

Westergren method

For analysis according to Westergren, blood from a vein is needed. It is mixed with sodium citrate 3.8% in a ratio of 4:1. Another option: blood from a vein is mixed with ethylenediaminetetraacetic acid (EDTA), and then diluted with the same sodium citrate or saline in a 4:1 ratio. The analysis is carried out in special tubes with a scale of 200 mm. ESR is determined in an hour.

This method is recognized worldwide. The fundamental difference is in the type of test tubes and the scale used. The results of both methods coincide in standard values. However, the Westergren method is more sensitive to increased erythrocyte sedimentation rate and in this situation the results will be more accurate than the Panchenkov method.

Deciphering the ESR analysis

The results of the erythrocyte sedimentation rate test are usually prepared within one working day, not counting the day of blood donation. However, commercial medical centers with their own laboratory can provide the test result more quickly - within two hours after sampling the biomaterial.

So, you received a form with the result of the analysis for ESR. On the left you will see this abbreviation (either ROE or ESR) and on the right your result in mm/h. To find out how it corresponds to the norm, you should correlate it with the reference (average) values ​​\u200b\u200bcorresponding to your age and gender. The ESR norm indicators for men and women of different ages are as follows:

The ESR norm in women is slightly higher than in men. Also, the indicator changes during pregnancy - this is a natural process. The value may also depend on the time of day. The maximum value of ESR is usually reached around noon.

ESR increased

An increase in the erythrocyte sedimentation rate can be caused by a variety of reasons. Consider the main ones:

  • Infectious diseases - both acute (bacterial) and chronic.
  • Inflammatory processes occurring in different organs and tissues.
  • Connective tissue diseases (rheumatoid arthritis, lupus erythematosus, systemic scleroderma, vasculitis).
  • Oncological diseases of various localizations.
  • Myocardial infarction (damage to the heart muscle occurs, this entails a systemic inflammatory response, resulting in an increased ESR). After a heart attack, ESR peaks about a week later.
  • anemia. In these diseases, there is a decrease in the number of erythrocytes and an acceleration of their sedimentation rate.
  • Burns, injuries.
  • Amyloidosis is a disease associated with the accumulation of abnormal protein in tissues.

However, elevated ESR can also be observed in healthy people. For example, in women during menstruation and pregnancy. Also, some medications affect the result of the analysis, for example, oral contraceptives, theophylline, and the intake of synthesized vitamin A.

note
ESR can be increased in people who are overweight. This is due to high levels of cholesterol in their blood.

ESR lowered

A decrease in the reaction of the erythrocyte sedimentation rate is often noted by doctors in diseases such as erythrocytosis, leukocytosis, DIC, and hepatitis. Also, ESR decreases with polycythemia (an increase in the number of red blood cells) and conditions leading to it, such as chronic heart failure or lung disease.

Another reason for the decrease in ESR is the pathology in which changes in the shape of red blood cells occur. It can be sickle cell anemia or hereditary spherocytosis. These diseases make it difficult for erythrocytes to settle.

In addition, ESR can be lowered in "radical" vegetarians, that is, those who do not eat not only meat, but also any food of animal origin.

It should be remembered that the ESR test is one of the non-specific laboratory blood tests. An increase in the erythrocyte sedimentation rate is observed in a variety of diseases. In addition, this indicator can be increased under certain circumstances and in healthy people. Therefore, based on the results of this study alone, a diagnosis cannot be made. To detail the latter, it is recommended to undergo additional tests, including quantitative analysis of C-reactive protein, leukocyte formula, rheumatoid factor.

Wednesday, 03/28/2018

Editorial opinion

A high erythrocyte sedimentation rate is not a cause for panic. However, to avoid unnecessary anxiety, it is better to consult a doctor and take tests to find out the cause of the deviation from the norm and, if necessary, take action. Careful attention to your health should be mandatory for each of us.

At present, there is no unified theory of the mechanism erythrocyte sedimentation rate (ESR ). It is known that the erythrocyte sedimentation rate is influenced by various physical, physicochemical and biological factors.
According to the electrochemical theory that prevailed for a long time, it was believed that during inflammatory and destructive processes, coarsely dispersed protein fractions with a positive charge enter the blood, which neutralize the negative charge of erythrocytes, as a result of which the latter acquire the ability to assemble into agglomerates and settle faster. Subsequent studies have established that the connection of protein particles with erythrocytes is explained not by electrostatic interaction, but by the so-called adsorption phenomena in the blood (P. A. Podrabinek, 1959). Apparently, erythrocytes, having free surface energy, adsorb protein particles from the plasma, forming agglomerates, which ultimately leads to an acceleration of sedimentation. Studies of blood proteins by electrophoresis undoubtedly confirmed the effect of protein fractions on the erythrocyte sedimentation rate, in particular, the accelerating effect of γ-globulins and fibrinogen. From these positions, an increase in ESR during pregnancy, the use of various protein preparations (tuberculin, serums, vaccines) and blood transfusions, under the influence of various physiotherapeutic procedures and with a sharp change in the diet (rich protein food) is currently regarded.
A particularly sharp increase in ESR is observed in inflammatory-purulent processes, collagenoses, including rheumatism, malignant neoplasms, multiple myeloma and some other diseases. However, at the heart of the increase ESR lie not only shifts in protein fractions, but also a number of other factors, in particular, a decrease in the number of erythrocytes (with severe anemia), an increase in the level of residual nitrogen in the blood (with kidney failure), thyroxine (severe forms of thyrotoxicosis), etc.
Currently studied factors that reduce ESR.
These include:
a decrease in the total amount of blood protein (alimentary and wound dystrophy, debilitating diseases in the terminal period);
increase in the content of CO2 in the blood (cardiac decompensation);
an increase in the number of red blood cells (erythremia);
increase in the content of bile acids (mechanical and parenchymal jaundice);
long-term use of certain drugs (calcium, diuretics, phenobarbital, acetylsalicylic acid).

A slowdown in the rate of erythrocyte sedimentation is also observed in the agonal state.
Thus, a central role in ESR mechanism play adsorption processes (adsorption theory) with the participation of various physico-chemical factors.
G. I. Burchinsky (1962) adheres to the original point of view regarding the ESR mechanism. He considers blood as a complex dispersed medium in which various substances (plasma proteins, salts and some organic compounds) are in complex interaction both with each other and with erythrocytes. In this regard, the author reduces the ESR mechanism to a peculiar form of sedimentation of suspensions.
Different points of view on the mechanism of ESR do not change the general idea that the erythrocyte sedimentation rate is determined not only by the ratio of plasma proteins, but also by the totality of the physicochemical properties of blood. Only in this connection should a clinical assessment of the erythrocyte sedimentation rate be given.

This can be confirmed by several clinical examples.
1. A patient with circulatory failure, developed on the basis of recurrent rheumatic heart disease and mitral heart disease. ESR - 2 mm in 1 hour. In such cases, erythrocyte sedimentation is determined by the relationship of two factors: on the one hand, the presence of an inflammatory process (endomyocarditis), leading to an increase in ESR, and on the other hand, the state of blood circulation, the insufficiency of which leads to a violation of gas exchange in the body with the development of acidosis, which, in turn, inhibits the erythrocyte sedimentation rate. If the second factor exceeds the accelerating effect of the inflammatory process, then ESR is reduced. In the process of treatment, as the activity of the cardiovascular system improves and compensation is restored, the inhibitory effect of CO2 is eliminated, and ESR increases again.
II. With Botkin's disease, erythrocyte sedimentation is slowed down due to the accumulation of bile acids in the blood. An increase in ESR in these cases may be due either to the entry into the blood of products of necrosis and decay of the liver cell (with developing acute liver dystrophy), or the occurrence of an inflammatory process in biliary tract. Of particular diagnostic value is an increase in ESR in the first case, being early symptom toxic dystrophy of the liver.
III. With alimentary dystrophy, there is hypoproteinemia with a predominance of small molecular albumins, as a result of which the ESR is reduced. In this regard, the addition of an inflammatory process (pneumonia, tuberculosis, peritonitis, etc.) usually does not affect the response rates.
It must be emphasized that there is no complete parallelism between ESR, the number of leukocytes in the blood and the nuclear shift of neutrophils. If, for example, there is a favorable ending inflammatory process without an increase in temperature, then in these cases, erythrocyte sedimentation is usually accelerated, while the leukocyte formula may be normal. From this point of view, an acute infection or an exacerbation of a chronic process is better reflected in the hemogram, while chronic, sometimes latent infections, are more easily detected based on changes. ESR, since the leukocyte reaction reflects toxic irritation, and the ESR - absorption processes. Therefore, the leukogram and ESR to a certain extent complement each other.
Reflecting many causes of occurrence and being non-specific, ESR at the same time provides significant assistance in determining the prognosis of the disease and assessing the general condition of the patient.

New methods of diagnosing and determining the causes of diseases appear in modern medicine regularly. However, the definition ESR indicator in human blood is still an effective diagnostic method. It is used for the purpose of diagnosis, both in children and adults. Such a study is prescribed when contacting the doctor of a patient who is concerned about a certain disease, and during preventive examinations.

Any doctor can interpret this test. ESR belongs to the group general blood tests (UAC). If this indicator is increased, it is necessary to determine the cause of this phenomenon.

What is ESR in blood?

Those who are assigned such a study are interested in why to analyze the ESR, and what it is. So, the abbreviation SOE is the capital letters of the term " sedimentation rate of erythrocytes ". Thus, with this test it is possible to accurately determine the settling rate in blood.

red blood cells These are known to be red blood cells. When acting on them anticoagulants over a certain period, they settle at the bottom of the capillary or test tube. The time for which the blood sample taken from the patient is divided into the upper and lower layers is defined as the ESR. He is judged by his height. layer plasma , which is obtained during the study, in millimeters for 1 hour. The ESR indicator is non-specific, however, it has a high sensitivity.

If the rate of ESR in the blood is increased, this may indicate the development of various disorders in the body. So, sometimes it is an indicator of the development of infectious, oncological, rheumatological and other pathologies even before the manifestation of obvious symptoms of diseases. Accordingly, if the ESR level is normal, the doctor, if necessary, prescribes other studies.

The ESR norm for women is 3 to 15 mm / h. But it must be taken into account that this indicator also depends on age - normally it can be different for women under 30 and after 30 years. If necessary, the rate of red blood cells in the blood of women is also determined. In pregnant women, ESR increases from the fourth month. It should be borne in mind that the rate of ESR in pregnant women may vary depending on the period of gestation.

The norm of ESR in men is from 2 to 10 mm / h. In the general blood test, erythrocytes in the blood of men are also determined.

The norm of ESR in the blood in children depends on the age of the patient.

This value in the diagnostic process is important for:

  • differentiation of the diagnosis And , and , and osteoarthritis and etc.);
  • determining the body's response in the process of treating patients, Hodgkin's disease , rheumatoid arthritis and etc.;
  • definition of a disease that is hidden (but it should be borne in mind that even normal ESR values ​​do not exclude the development of a disease or neoplasm in the body).

Sometimes this term is referred to as ROE . The indicator of ROE in the blood and ESR are identical concepts. Speaking of ROE in the blood, we understand what it is erythrocyte sedimentation reaction . Once upon a time, this concept was used in medicine, that is, the rate of ROE in the blood for women, the rate of ROE in the blood for children, etc. were determined. Currently, this concept is considered obsolete, but any doctor understands what ROE is in a blood test, what is ROE in oncology, etc.

Diseases in which there is an increased ESR in the blood

If a patient has an elevated ESR in the blood, what this means is determined by the doctor during the diagnostic process. After all, this indicator, if you suspect the development of a certain disease, is very important for the diagnosis. A qualified doctor in the process of diagnosis takes into account not only the fact that the patient has an increased value, but also determines what the presence of other symptoms indicates. Nevertheless, this indicator is very important in many cases.

An increased ESR in the blood of a child and an adult is observed if bacterial infection - in the acute phase of a bacterial infection.

At the same time, it does not matter where exactly the infections are localized: the picture of peripheral blood will still display the inflammatory reaction.

This value is always increased in an adult if there are viral infectious diseases . From what this indicator rises specifically, the doctor determines in the process of a comprehensive examination.

Thus, we are talking about the development of a certain pathological process, if the ESR is above the norm. What this means depends on the value of the indicator. Very high values ​​- more than 100 mm / h - occur with the development of infectious diseases:

  • at , pneumonia , cold , and etc.;
  • at , and others infections urinary tract ;
  • at fungal infection X, viral hepatitis ;
  • at oncology (high rates can be observed for a long time).

In the course of the development of an infectious disease, this value does not increase rapidly, an increase is observed after 1-2 days. If the patient has recovered, then the ESR will be slightly increased for several more weeks or months. The reasons for the high ESR with normal leukocytes may indicate that the person has recently suffered a viral disease: that is, the content of leukocytes has already returned to normal, but the sedimentation rate of red cells is not yet.

The causes of increased ESR in the blood in women may be associated with pregnancy, therefore, in the process of diagnosis, the doctor must take into account these reasons for the increase in ESR in the blood of women.

An increase in ESR is a typical sign in the following diseases:

  • diseases of the biliary tract and liver;
  • inflammatory diseases of a purulent and septic nature ( reactive arthritis and etc.);
  • blood disorders ( sickle anemia , hemoglobinopathies , anisocytosis );
  • ailments in which tissue destruction And ( , heart attack , tuberculosis , malignant neoplasms);
  • pathology of the endocrine glands and metabolic disorders (, diabetes , cystic fibrosis and etc.);
  • malignant degeneration of the bone marrow, in which red blood cells enter the bloodstream that are not ready to perform direct functions ( myeloma , );
  • autoimmune diseases ( lupus erythematosus , and etc.);
  • acute conditions in which the blood becomes more viscous (, bleeding , vomit , postoperative conditions and etc.).

Normal and pathological indicators of ESR

In medicine, the physiological limits of this indicator are defined, which are the norm for certain groups of people. Normal and maximum indicators are displayed in the table:

ESR during pregnancy

If this value is increased at , it is considered normal. The norm of ESR during pregnancy is up to 45 mm / h. With such values future mother no need to additionally examine and suspect the development of pathology.

Methods by which an ESR blood test is performed

Before a decoding is carried out, which means ESR in a blood test, the doctor uses a certain method for determining this indicator. It should be noted that the results of different methods differ from each other and are not comparable.

It must be taken into account before conducting an ESR blood test that the value obtained depends on several factors. The general analysis should be carried out by a specialist - a laboratory employee, using only high-quality reagents. Analysis in children, women and men is carried out on the condition that the patient has not eaten for at least 4 hours before the procedure.

What does the ESR value show in the analysis? First of all, the presence and intensity of inflammation in the body. Therefore, in the presence of deviations, patients are often prescribed biochemical analysis. Indeed, for a qualitative diagnosis, it is often necessary to find out how much a certain protein is present in the body.

ESR according to Westergren: what is it?

The described method for determining the ESR - Westergren's method — today meets the requirements of the International Committee for the Standardization of Blood Research. This technique is widely used in modern diagnostics. For such an analysis, venous blood is needed, which is mixed with sodium citrate . To measure the ESR, the tripod distance is measured, the measurement is taken from the upper border of the plasma to the upper border of the erythrocytes that have settled. The measurement is taken 1 hour after the components have been mixed.

It should be noted that if the ESR according to Westergren is increased, this means that this result is more indicative for diagnosis, especially if the reaction is accelerated.

ESR according to Wintrob

essence Wintrobe method - a study of undiluted blood that has been mixed with an anticoagulant. You can interpret the desired indicator on the scale of the tube in which the blood is located. However, this method has a significant drawback: if the rate is higher than 60 mm / h, then the results may be unreliable due to the fact that the tube is clogged with settled erythrocytes.

ESR according to Panchenkov

This method involves the study of capillary blood, which is diluted with sodium citrate - 4: 1. Next, the blood is placed in a special capillary with 100 divisions for 1 hour. It should be noted that when using the Westergren and Panchenkov methods, the same results are obtained, but if the speed is increased, then the Westergren method shows higher values. Comparison of indicators - in the table below.

According to Panchenkov (mm/h) Westergren (mm/h)
15 14
16 15
20 18
22 20
30 26
36 30
40 33
49 40

Currently, special automatic counters are also actively used to determine this indicator. To do this, the laboratory assistant no longer needs to dilute blood manually and keep track of the numbers.

ESR in the blood: what do certain values ​​mean?

As mentioned above, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 mm per hour are considered normal indicators of ESR for the body of a healthy man, for women the normal rate is from 2 to 15 mm / h. Therefore, for women, the value of 12, 13, 14, 15 is considered normal. However, indicators in women in adulthood can normally be 16, 17, 18, 19, 20.

If the value exceeds the norm by several units, then the state of the blood can be considered relatively normal. That is, an indicator of 21, 22 in a woman can be considered acceptable, as well as values ​​of 23, 24 mm / h. When a woman is carrying a child, this value is even greater. Therefore, expectant mothers have no reason to believe with an indicator of 25 that this means something unpleasant. During pregnancy, the analysis can show 28, 29. ESR 30, 31, 32, 33, 34, 35, 36, 38 is also not evidence of the development of pathological processes in pregnant women.

This figure increases with age. Therefore, if an ESR value of 40 is noted in elderly patients, a symptom of what disease it is and what it means, the doctor determines by concomitant signs. Normal values ​​for older people are 43, 50, 52, 55 mm/h, etc. However, in young people, values ​​of 40-60 mm/h are possibly evidence of serious disorders. Therefore, after receiving the analysis data, it is necessary to consult in detail about why the ESR is 60, what it might be, and undergo further research.

low value

As a rule, the reasons for the low value of this indicator are associated with the exhaustion of the body, weight loss, taking corticosteroids, hyperhydration, muscle atrophy. Sometimes ESR is lowered in diseases of the heart and blood vessels.

What affects the ESR?

In both women and men, the level of ESR is influenced by a number of different factors, both physiological and pathological. The key factors that most influence this analysis are identified:

  • When determined by various methods - according to Westergren and others - the ESR rate in women in the blood is higher than in men. So, an ESR of 25 in a woman may be the norm. This is due to the physiological characteristics of the blood in women.
  • What is the rate of ESR in the blood of a woman depends on whether she is pregnant. In expectant mothers, the norm is from 20 to 45 mm / h.
  • A higher ESR is observed in women who take contraceptives . Under this condition, a woman can normally have an ESR of 30. What does this mean, whether there is a pathology, or is it a normal physiological indicator, should be determined by the doctor.
  • In the morning, the rate at which red bodies settle is higher than in the afternoon and evening, and here differences in age do not matter.
  • Signs of accelerated sedimentation are noted when exposed to acute phase proteins.
  • If inflammation and an infectious process develops, the values ​​\u200b\u200bchange a day after that. how do you start leukocytosis And hyperthermia . That is, on the first day of the disease, the indicator can be 10, 14, 15 mm / h, after a day it can rise to 17, 18, 20, 27, etc.
  • ESR is increased if there is a chronic focus of inflammation in the body.
  • A lower value is noted at increased blood viscosity .
  • The decrease in the sedimentation rate occurs under the influence of anisocytes and spherocytes, the rate becomes greater under the influence of macrocytes.

Elevated ESR in children

In the case when the ESR norm in children is exceeded, most likely, an infectious inflammatory process develops in the body. But it should be taken into account, when determining the ESR according to Panchenkov, that other indicators of the KLA are increased (or changed) in children ( and etc.). Also, in children with infectious diseases, the general state. In infectious diseases, the ESR is high in a child already on the second or third day. The indicator can be 15, 25, 30 mm / h.

If red blood cells are elevated in a child in the blood, the causes of this condition may be as follows:

  • metabolic disorders ( diabetes , );
  • systemic or autoimmune diseases (, rheumatoid arthritis , lupus );
  • blood diseases , hemoblastosis , anemia ;
  • diseases that cause tissue breakdown tuberculosis , myocardial infarctions , oncological diseases ).

It should be taken into account: if, even after recovery, the erythrocyte sedimentation rate is increased, this means that the process is proceeding normally. It's just that normalization is slow, but about one month after the disease, normal indicators should be restored. But if there are doubts about recovery, then you need to do a second examination.

Parents should understand that if a child has red blood cells above the norm, this means that a pathological process in the body takes place.

But sometimes, if the baby's red blood cells are slightly increased, this means that some relatively "harmless" factors are influencing:

  • in infants, a slight increase in ESR may be associated with a violation of the mother's diet when;
  • teething period;
  • after taking medication ();
  • at lack of vitamins ;
  • at helminthiasis .

Thus, if red blood cells are elevated in the blood, this means that the child develops a certain disease. There is also statistics on the frequency of an increase in this value in various diseases:

  • in 40% of cases, a high value indicates infectious diseases ( disease respiratory tract , tuberculosis , urinary tract diseases , viral hepatitis , fungal diseases );
  • in 23% - oncological processes different organs;
  • in 17% - rheumatism , systemic lupus ;
  • at 8% - , inflammation of the gastrointestinal tract , pelvic organs , anemia, ENT diseases , injury , diabetes , pregnancy ;
  • 3% — kidney disease .

When can an increase in ESR be considered safe?

As you know, an increase in erythrocytes in the blood, as a rule, indicates that a certain inflammatory reaction is developing in the body. But sometimes the reasons for the increase in red blood cells in women and men are not so categorical.

We are talking, first of all, about when an analysis in men and women helps to judge whether anti-allergic treatment is being carried out correctly (fluctuations in the initially elevated ESR should be taken into account). That is, if the clinical effect of the drug takes place, then gradually the norm of ESR in men in the blood, as in women, will be restored.

A hearty breakfast before analysis can also increase this indicator, a strict diet, fasting can also change it.

ESR can change during menstruation, during pregnancy and after the birth of a child.

False positive ESR tests

In medicine, there is also the concept of false positive analysis. Such an analysis on ESR is considered if there are factors on which this value depends:

  • anemia (morphological changes in erythrocytes do not occur);
  • increase in plasma protein concentration , with the exception of fibrinogen ;
  • hypercholesterolemia ;
  • kidney failure ;
  • obesity high degree;
  • pregnancy ;
  • advanced age of a person;
  • introduction dextran ;
  • technically incorrectly conducted research;
  • reception;
  • recent vaccination against hepatitis B .

What if the reasons for the increase are not identified?

If the analysis is carried out normally, but the reasons for the increased erythrocyte sedimentation rate cannot be established, it is important to conduct a detailed diagnosis. Need to exclude oncological diseases , therefore, , GRA, the norm of leukocytes in women and men are determined. In the process of analysis, other indicators are also taken into account - whether the average volume of erythrocytes is increased (what this means - the doctor will explain) or the average volume of erythrocytes is reduced (what this means is also determined by the specialist). Urinalysis and many other studies are also carried out.

But there are cases when high ESR rates are a feature of the body, and it is not possible to reduce them. In this case, experts advise regular medical examinations, and if a certain symptom or syndrome appears, consult a doctor.

How to lower ESR in the blood?

The doctor will tell you in detail about how to lower this indicator with the help of medications after the study. He will prescribe a treatment regimen when the diagnosis is made. It is strongly not recommended to take medications on your own. You can try lowering it. folk remedies, which are mainly aimed at restoring normal function immune system and also for blood purification. Herbal decoctions, teas with raspberries and lemon, beetroot juice, etc. can be considered effective folk remedies. How many times a day to take these funds, how much you need to drink, you should ask a specialist.

Erythrocyte sedimentation is the rate of spontaneous erythrocyte sedimentation in a protected from. The widely used term "erythrocyte sedimentation reaction" (ESR) is inaccurate, as there is no reaction. In the blood stream, red blood cells that carry a negative electrical charge repel each other, which prevents them from sticking together. Outside, for example, in a test tube, due to gravity, they begin to sink, and then combine into groups (agglomeration), which, due to their greater gravity, settle faster. The agglomeration of erythrocytes and, consequently, the acceleration of erythrocyte sedimentation is facilitated by an increase in some protein components of plasma (globulins, and mucopolysaccharides). Acceleration of erythrocyte sedimentation is observed in most inflammatory diseases, infections, tissue breakdown, malignant tumors, collagenosis, nephrosis, etc. Some diseases are characterized by the absence of acceleration of erythrocyte sedimentation at the onset of the disease (epidemic hepatitis) or a slowdown in erythrocyte sedimentation (heart failure, erythremia) .

Erythrocyte sedimentation rarely serves as an independent diagnostic symptom; Basically, it is an indicator of the severity of the process, especially in tuberculosis, collagenoses. Erythrocyte sedimentation does not always change in parallel with other indicators of the activity of the inflammatory process, for example, the acceleration of erythrocyte sedimentation occurs later than leukocytosis and fever in myocardial infarction, appendicitis, and normalizes more slowly than them.

If normal erythrocyte sedimentation is detected, it is impossible to exclude a disease that is characterized by its acceleration. Accelerated erythrocyte sedimentation does not occur in healthy people.

Panchenkov's apparatus. Installation of a capillary.

Research technique. In the USSR, Panchenkov's micromethod was most accepted. A 100 mm graduated Panchenkov capillary is washed by suction with a 5% solution of sodium citrate (dibasic), 50 mm of the same solution is drawn into it and blown onto a watch glass or into a small test tube. After a finger prick, blood is drawn into the same capillary 2 times 100 mm and blown into the reagent, mixed well and the mixture is drawn into the capillary to the “O” mark (with skill, you can draw half the volume of the reagent and blood). Clamping the upper end of the capillary with a finger, it is inserted into the Panchenkov apparatus (Fig.) strictly vertically. Exactly one hour later, the results are noted - the height of the plasma column in millimeters. The norm is 4-10 mm for men, 4-14 mm for women.

Erythrocyte sedimentation - settling of erythrocytes at the bottom of the vessel while maintaining the blood in a non-clotting state. When standing, the blood separates into two layers. Upper (transparent) - plasma, lower - settled erythrocytes connected in lumps (agglomeration). Separation into layers proceeds at different speeds depending on the state of the body and changes in the composition of the blood.

The mechanism of the erythrocyte sedimentation reaction (RSE) is complex and not fully understood. The maintenance of erythrocytes in a suspended state is due to the presence of electrostatic forces in the blood system: similarly (negatively) charged erythrocytes repel each other. Great importance is attached to blood plasma proteins, the ratio between fibrinogen and globulin (especially gamma globulin), on the one hand, and albumins, on the other. As a result of increased cell decay during various pathological processes, this ratio shifts towards large molecular proteins - fibrinogen and globulins. Their particles carry a smaller electric charge than the molecules of finely dispersed albumin, and therefore repel each other less intensively. Red blood cells, in which there is a lot of fibrinogen and globulins, stick together more easily and precipitate. Other factors are also important: the level of mucopolysaccharides and mucoproteins in the blood, lipoids (the value of the lecithin-cholesterol coefficient), bile acids, acid-base balance, blood viscosity, the number of red blood cells in the test blood.

Method of setting the erythrocyte sedimentation reaction. The study of erythrocyte sedimentation rate is carried out by macro- and micromethods. What they have in common is the addition of sodium citrate solution to the blood, which prevents clotting.

In the USSR, the Panchenkov micromethod is the most common. The Panchenkov apparatus consists of a stand in which four pipettes (capillaries) with a diameter of 1 mm, graduated from 0 (top) to 100 (bottom), are placed vertically at the same time. Having previously moistened the pipette to the top with 5% sodium citrate solution, draw it up to the p mark (against dividing 50), and then release it into a test tube or onto a watch glass. An injection is made into the pulp of the finger and the same pipette draws blood twice to the mark k (against dividing 0), immediately mixing it with a solution of sodium citrate (the ratio of blood and sodium citrate solution is 4: 1) in a test tube or on a watch glass. The mixture is drawn into a pipette to the 0 mark, placed in a tripod and through us they look at how many divisions the erythrocytes have dropped (settled) (in mm). The norm is from 4 to 10 mm.

According to the Wastergren method, 1.6 ml of blood is taken from the cubital vein with a syringe, into which 0.4 ml of a 3.8% solution of sodium citrate is preliminarily drawn. Mix in a glass and draw into a pipette 30 cm high with a diameter of 3 mm. The pipette is filled to the zero mark and placed vertically in a special stand. Normally, a column of plasma of 3-7 mm is formed in an hour. This method is considered more accurate, but practically less convenient (taking blood from a vein).

Fractional study of the reaction of erythrocyte sedimentation (FROE) (every 15 minutes for 2 hours, followed by drawing a curve) reflects the activity of the pathological process, according to some authors, to a greater extent than the total number of ROE. In healthy people, subsidence proceeds relatively evenly, and in a number of diseases (tuberculosis, pneumonia), the maximum subsidence, expressed as a bulging of the FROE curve, is noted at the initial moments of the reaction: the curve shifts to the left.

The modified erythrocyte sedimentation reaction proposed by A. M. Efman is based on the addition of various lysates to citrated blood. In this case, the ROE values ​​are obtained, which make it possible to judge which organ is pathologically changed and what the nature of the pathological process is - degenerative or inflammatory.

Sources of errors in the formulation and interpretation of ROE. In addition to the main pathological process, a number of additional factors are reflected in the erythrocyte sedimentation rate - medication intake, physiotherapy procedures and the nature of nutrition. Salicylic drugs, calcium, mercury diuretics, quinine, luminal slow down erythrocyte sedimentation. Sulfur preparations accelerate erythrocyte sedimentation, long-term use sodium bicarbonate (soda), vaccine therapy, serotherapy, blood transfusion. The acceleration of ROE obtained the next day after baths, showers, heliotherapy, massage has no diagnostic value. It is necessary to take into account the air temperature of the laboratory room: fluctuations of 5 ° already have a noticeable effect, so you should not place a stand with pipettes near a window or radiator. Negligence in work affects the erythrocyte sedimentation rate: residues of alcohol or ether in a needle or syringe; insufficient depth of finger prick, mixing of blood with a solution of sodium citrate, shaking the pipette, etc. The accuracy limit of the method should also be taken into account - it is ± 5%.

Physiological fluctuations. In women, ROE is slightly higher than in men (by 3-4 mm). A slight acceleration of ROE is observed during menstruation, more pronounced - during pregnancy. ESR in newborns is slowed down (1-2 mm), in infancy - 4-8-12 mm in 1 hour. In old people, ROE accelerates somewhat, sometimes up to 20 mm per hour. Fluctuations are observed during the day, in the evening ROE is usually higher. Digestion causes (inconsistently) a slight acceleration of the ESR.

clinical significance. ESR is a non-specific reaction of a general nature and, as a clinical test, plays approximately the same role as a change in body temperature or the number of leukocytes. Acceleration of ROE, which depends mainly on protein, colloidal shifts, can be observed in a wide variety of conditions, accompanied by tissue decay or necrosis, inflammatory processes, allergic reactions, immunological changes. The acceleration of ROE in inflammatory processes usually appears later (a day or more) than the rise in temperature, but it lasts for some time after it ends. Significantly greater diagnostic and prognostic value than a single determination have repeated determinations of ESR (in dynamics) in the same patient. Slight accelerations of ROE (especially with a single study) can be observed with asthenia, neurasthenia, hyperthyroidism. ROE is significantly accelerated with severe common diseases(pulmonary tuberculosis, leukemia, prolonged septic endocarditis, etc.). However, in some cases, one should not conclude that high ESR numbers are unfavorable (for example, high ESR is accompanied by lobar pneumonia, rheumatism in the active phase), since the degree of its acceleration does not determine the outcome of the disease. The dynamics of ROE figures is of greater importance. ESR indications should be considered not in isolation, but in connection with the general picture of the disease and its dynamics. Normal ESR does not exclude disease, as it may depend on the unresponsiveness of the body.

Unaccelerated ROE is considered characteristic of certain infections - typhoid fever, influenza, epidemic hepatitis. High ROE numbers are often noted not in the first hours clinical manifestation diseases (for example, with perforated gastric ulcer, acute appendicitis, myocardial infarction, etc.). The slowing down of erythrocyte sedimentation (up to 1-3 mm), which is observed in polycythemia, circulatory failure, pulmonary emphysema, some allergic conditions, and exsicosis in infants, is also of diagnostic value. No direct relationship was found between the rise in temperature, changes in white blood and the degree of acceleration of the ESR. These indicators reflect different aspects of the pathological process and complement each other. Parallelism is noted between accelerated ROE and toxic granularity of neutrophils. In acute diseases, preference should be given to measuring temperature and examining white blood, since ROE does not immediately respond to the pathological process. Erythrocyte sedimentation, being stable, becomes important not in the first, but in the subsequent stages of the disease, as well as in chronic diseases.

Erythrocyte sedimentation reaction in certain diseases. Typical changes in ROE, which are of practical importance, are observed in tuberculosis, rheumatism, myocardial infarction, malignant tumors, malaria and other infections, purulent processes. In pulmonary tuberculosis, the degree of ESR acceleration depends on the severity of the anatomical process, the presence of decay, the degree of activity of the process and its compensation. ESR in tuberculosis has a prognostic value (with high numbers, the prognosis is unfavorable), as well as for monitoring the effectiveness of treatment. With non-tuberculous pneumonia and pleurisy, the acceleration of ESR usually disappears faster and is more correct, cyclic, in nature. ESR naturally and steeply increases with such acute infections as erysipelas, scarlet fever. With typhoid fever, ESR is late for the entire first week of the disease, reaching a maximum in the third week. With malaria, ROE accelerates in the acute stage, after an attack, a relative slowdown occurs. Significant acceleration of ROE is observed in syphilis. In the active stage of rheumatism, especially in articular forms, ROE is sharply accelerated. Sluggish current forms of rheumatic heart disease with decompensated heart disease may not be accompanied by an acceleration of ESR. A pronounced acceleration of ESR is observed in systemic lupus erythematosus (up to 60-80 mm per 1 hour), rheumatoid (infectious non-specific) polyarthritis, to a lesser extent in arthritis of a different etiology, especially metabolic. Protracted septic endocarditis, multiple myeloma, nephrosis, uremic conditions, leukemia, anemia proceed with high numbers of ROE. An important diagnostic value is the acceleration of ESR in myocardial infarction, which appears on the 2-4th day of the disease, as well as in malignant tumors, diabetes. A sharp acceleration of ROE is observed in acute meningitis, encephalitis. In surgical practice, high numbers of ROE are observed in purulent infections, after surgical interventions, suppurative lung diseases, and destructive forms of acute cholecystitis. See also Blood (research methods).