Normal erythrocyte sedimentation rate. Normal ESR for a person, high ESR, low ESR What does ESR mean 4

An important indicator in a general blood test (CBC) is the erythrocyte sedimentation rate (ESR). Marker evaluates work internal systems person. If the norm of ESR in the blood does not correspond to acceptable values ​​(increased or greatly reduced), we can talk about pathological processes in the body of a different nature.

Erythrocyte sedimentation rate is part of the complete blood count

Normal ESR in the blood - table by age

The erythrocyte sedimentation rate is not a constant value because it is closely related to age, gender and some physiological changes (pregnancy, menstrual cycle). The marker unit is mm per hour. Within 60 minutes, rapid precipitation of blood cells is observed.

Table “Norms of ESR in blood by age and gender”

Reasons for deviations from the norm

In 5% of people on the planet, the rate of blood cell sedimentation is very different from the norm. This is due to their physiological characteristics and is not a pathology. If disturbances in the CBC are not associated with natural processes in the body, this indicates the development of specific diseases.

ESR is higher than normal

High level the rate of precipitation of blood cells is a clear sign of pathology. It is also called accelerated ESR syndrome. According to ICD 10 ( international classification diseases) this indicator is allocated to a separate group R70 - accelerated erythrocyte sedimentation and blood viscosity abnormalities.

The following diseases may be the causes of this condition:

• inflammation in internal organs - hepatitis, cystitis, pneumonia, colds, tuberculosis, purulent lesions (sepsis), meningitis;
• infectious processes respiratory tract;
• condition after surgery;
• anemia;
• oncology (usually ESR goes off scale in late stages of cancer);
• exceeding the permissible amount of cholesterol in the blood due to severe obesity or diabetes;
• chronic or acute renal dysfunction.

An increased ESR may indicate an excess of cholesterol

Common factors that can influence the level of ESR in the blood are:

• shock, stress;
• taking hormonal medications;
• period of gestation or breastfeeding;
• elderly age.

With accelerated erythrocyte sedimentation syndrome, symptoms of the disease may not appear. In this case, only an increased ESR in the CBC can indicate abnormal abnormalities in the body.

Reduced ESR level

A decrease in the sedimentation rate of blood cells is considered a pathology if the patient has severe muscle tissue dystrophy or problems in water-salt synthesis.

There are no other serious reasons for the slowing of ESR, but there are non-pathological factors of weak erythrocyte sedimentation:

• low protein nutrition;
• partial or complete fasting;
• early stages of pregnancy.

Reduced ESR indicators observed on early stages pregnancy

The use of hormonal medications (corticosteroids) can also slow down the formation of red blood cell sediment. After completion of treatment, tests return to normal.

Methods of blood testing for ESR

The level of blood cell sedimentation rate is studied in two main ways:

• according to Panchenkov;
• according to Westerner.

According to Westerner

Venous blood is taken for examination. The glass tube is used with precise division into 200 lines, 1 mm each. The blood is mixed with the reagent in a test tube and left for 1 hour. After the allotted time, a column of blood plasma without sedimented red blood cells is measured.

The study of biological material according to Westergner is a very sensitive analysis, the reliability of which is quite high, which is recognized in the international medical practice.

The reliability of ESR according to Westergner is very high

According to Panchenkov

The Panchenkov method is a well-known finger blood test.

How to do it:

• Capillary blood is collected by puncturing the ring finger with a scarifier;
• biological material is extracted using a glass tube graduated into 100 divisions;
• a specific solution (coagulant) is placed on a special concave glass and the blood being tested is added in a ratio of 1 to 4;
• Having lost the ability to thicken, the liquid is drawn into a pipette - a Panchenkov capillary - placed in a standing position and waited for 60 minutes, during which the red blood cells settle;
• The distance from the beginning of the brightened plasma to the sediment is measured (in mm).

The Panchenkov method of measuring ESR is very common in medical practice, but its sensitivity is lower than that of a clinical test of blood from a vein.

According to the Panchenkov method, blood and coagulant are first placed on a special glass

How to prepare for a blood draw

A blood test to detect ESR does not require special preparation for the patient.

All you need to do is follow a few simple recommendations:

• Stop eating and any drinks 4-5 hours before the procedure;
• avoid stress and anxiety several hours before donating blood;
• 30–40 minutes before sampling, refrain from smoking;
• Do not overdo it with physical activity on the eve of the test.

Do not smoke before taking tests

Experts do not recommend conducting a clinical analysis against the background of severe stress, overwork of the body, or taking hormonal medications. This may skew the test results by significantly increasing the blood cell sedimentation rate.

ESR in a child – Komarovsky

Fatty foods affect ESR levels

False-positive results can also occur in women during menstruation, as well as in late pregnancy. Medical error cannot be ruled out. Therefore, to ensure the reliability of the interpretation, before taking blood, you need to fulfill all the requirements of the specialist, and, if necessary, retake the test again.

How to lower ESR in the blood

An increase in erythrocyte sedimentation rate in itself is not a pathology. The indicator only indicates possible deviations in work internal organs. Therefore, there is no need to purposefully reduce ESR. The values ​​in the clinical analysis are normalized independently after completing the course drug therapy one disease or another.

If the rate of precipitation of blood cells is observed in a healthy person, experts recommend:

• use vitamin complexes and mineral supplements prescribed by the doctor;
• to refuse from bad habits;
• adhere to proper nutrition.

Regular consumption of freshly squeezed beet juice, citrus juices with honey helps to quickly reduce the ESR level. This indicator can be gradually normalized by minimizing stressful situations, moderate physical activity and good sleep.

Beet juice is good for lowering ESR levels

Accelerated sedimentation of blood cells in biological material is a variable marker that is sensitive to many stimuli. It can increase both during inflammatory and infectious processes in the body, and in response to a person’s lifestyle (lack of mobility, bad habits, taking medications, temporary physiological changes). Therefore, treatment begins only after identification the real reason deviations in the normal ESR.

Erythrocyte sedimentation rate is a biological parameter that determines the ratio of proteins and blood elements. ESR is an important parameter of a general blood test, since sedimentation rates change in some diseases and specific conditions of the body.

When infectious and inflammatory reactions occur in the body, a large number of protein compounds are released into the blood (proteins of the acute phase of inflammation). In progress laboratory research red blood cells stick together under the influence of proteins and then settle to the bottom of the tube.

The essence of the study is to measure the sedimentation rate: the more proteins there are in the plasma (markers of inflammatory processes in the body), the faster the red blood cells form fractions and settle.

Methods for determining ESR

There are several methods for determining the erythrocyte sedimentation rate: according to Panchenkov, according to Westergren, according to Wintrobe, microESR. These laboratory research methods differ in the method of blood sampling, the technique of conducting laboratory research and the dimensional scale of the results.

Panchenkov method

This method used in public hospital laboratories and included in general analysis blood, biological material for which is taken from a finger.

During the study, a Panchenkov apparatus is used, which consists of a tripod into which special capillaries (thin tubes) with size marks are inserted.

After drawing blood from a finger, a reagent (sodium citrate solution) is added to the laboratory capillary to prevent coagulation (formation of a dense clot). Next, the biological material is placed in a capillary with a measuring scale of 100 divisions.

After an hour, the laboratory assistant determines how many millimeters the fractions of clumped red blood cells drop in 1 hour.

Westergen method

The Westergen determination method is used for more accurate diagnosis of inflammatory processes and is international laboratory method research.

The collection of biological material for the method of determining ESR according to Westergen is carried out from a vein on an empty stomach. The biological material is added to a test tube with a reagent (sodium citrate) that prevents clotting.

There are 200 divisions on the test tube using the Westergen method, which allows for a more accurate determination of ESR. The units of measurement for this indicator are similar in both versions of the study - millimeters per hour (mm/h).

There are factors that affect the accuracy of the analysis results, namely:

• temperature in the laboratory where the research is being carried out (at a temperature of more than 25 degrees Celsius, the ESR value increases, and if it is less than 18 degrees, a low erythrocyte sedimentation rate is detected);
• storage time (if biological material is stored for more than 4 hours before laboratory analysis);
• reagent used;
• degree of dilution and quality of mixing of biological material with the reagent;
• correct installation of the capillary in the tripod;
• using a plastic capillary instead of a glass one.

Taking into account possible errors, if the low rates ESR for no apparent reason, it is necessary to re-take the test to confirm the pathology.

Norm of ESR in the blood of women by age (table)

The ESR parameter is relatively stable in healthy men, but in women the sedimentation rate may differ, depending on many factors:

• age (after 50 the ESR level increases);
• physique (in women who are overweight and have high cholesterol levels, ESR increases);
• hormonal background;
• pregnancy;
• taking hormonal contraceptives.

Also, physiological reasons for changes in the ESR parameter include diet: eating protein foods increases the ESR rate regardless of gender and age.

Determining ESR is important diagnostic study, which shows the presence of an inflammatory process in the body, but does not reveal the nature and location of the source of infection.

When is it appointed?

A general (biochemical) blood test with ESR measurement is prescribed in several cases:

• during preventive examination, as a method for determining the degree of health of the body;
• for the diagnosis of diseases accompanied by inflammatory processes (infections, tumors, etc.), erythermia, acidosis, etc.

The determination of ESR is fundamental for identifying pathological processes in the body during the diagnosis of infectious diseases of the respiratory tract, namely:

• sinusitis, sinusitis;
• angina;
• inflammation of the pharynx, larynx and trachea;
• bronchitis;
• pneumonia;
• ARVI;
• flu.

After drug treatment For these diseases, a control clinical blood test is performed for ESR, which returns to normal within 7-10 days after recovery.

How to prepare for analysis

Preparing for blood collection for analysis is not difficult. It is necessary to follow some recommendations that contribute to the most realistic analysis results:

• biological material is collected on an empty stomach, 10-12 hours after the last meal;
• on the eve of the procedure you should refrain from large quantity protein foods, do not drink alcoholic beverages at all;
• the day before the analysis, intensive physical exercise and stressful situations.

The procedure for removing material for analysis of erythrocyte sedimentation rate cannot be carried out after certain medical studies that can lead to a temporary disruption of the normal composition of the blood, namely:

• X-ray;
• probing of internal organs;
• physiotherapeutic procedures;
• treatment with heparin, dextran, corticotropin, fluorides, oxalates, cortisone;
• taking vitamin A;
• introduction of hepatitis B vaccine.

If it is necessary to analyze ESR, stop taking certain types of medications 3-5 days before the procedure (glucocorticosteroids, hormonal drugs, etc.).

Reasons for increasing ESR

The development of an acute or chronic inflammatory reaction in the body is accompanied by an increased content of coarse proteins in the blood (globulins, fibrinogens, paraproteins), which contribute to the rapid adhesion of red blood cells and an increase in ESR values. Manifests itself in the following diseases:

• diseases of the upper respiratory tract (ARVI, influenza, bronchitis, pneumonia, sinusitis);
• infections genitourinary system(cystitis, urethritis, pyelonephritis);
• rheumatism;
• rheumatic and bacterial endocarditis;
• infectious polyarthritis;
• cholecystitis;
• tuberculosis;
• pneumonia;
• abscess, gangrene of the lungs;
• pancreatitis;
• pleurisy, etc.

Also, the erythrocyte sedimentation rate can be increased in other pathologies, during which the amount of albumin in the blood decreases, namely:

• illnesses gastrointestinal tract with impaired absorption of nutrients;
• parenchymal hepatitis;
• neoplasms in the liver;
• thyrotoxicosis;
• nephrotic syndrome.

An increase in ESR depends on indicators such as cholesterol, lecithin, bile acids and pigments that may deviate from the norm in such diseases:

• poisoning;
• injuries;
• prolonged bleeding;
• heart attack, heart failure;
• pulmonary infarction;
• nephritis, renal failure;
• some types of anemia.

An increase in the erythrocyte sedimentation rate in women when taking hormonal drugs with estrogen, during pregnancy, during menstruation, as well as during fasting and a strict diet is not dangerous.

The main symptoms of elevated ESR, which may appear along with signs of the underlying disease, are as follows:

• migraines, prolonged headaches, dizziness;
• fast fatiguability;
• nausea;
• abdominal pain, sometimes intestinal upset;
• cardiopalmus;
• pale skin.

Reasons for low ESR levels

In some cases, the ESR level is determined to be too low. There are three main reasons that influence the decrease in erythrocyte sedimentation rate:

• blood thickening - increasing plasma viscosity due to increased red blood cell content;
• hyperbilirubinemia - increased bilirubin levels;
• acidosis is a violation of the alkaline-acid balance in the body.

As a rule, these pathologies occur with the following diseases:

• heart pathologies and circulatory system with congestion;
• simultaneous malfunctions of the liver and biliary tract;
• lack of nutrients;
• long-term vegetarian diet;
• starvation;
• vegetarian diet;
• excessive fluid intake;
• use of corticosteroid drugs,
• frequent use of aspirin.

The main manifestations of a reduced erythrocyte sedimentation rate depend on pathological processes in the body and can be as follows:

• shortness of breath, dry cough;
• weakness, dizziness;
• increased breathing;
• nausea and vomiting;
• weight loss;
• formation of hematomas with minor injuries;
• frequent nosebleeds.

During pregnancy

During pregnancy, ESR testing is carried out four times:

• at the beginning of pregnancy until the 12th week;
• at 20-21 weeks;
• at 28-30 weeks of pregnancy;
• before childbirth.

Due to hormonal changes that occur throughout pregnancy, a woman's erythrocyte sedimentation rate changes significantly during the 9 months of pregnancy, as well as for some time after childbirth.

1st trimester. The norm of ESR in the blood in the first months of pregnancy is very wide: depending on the body type and individual characteristics, this indicator can be either low (13 mm/h) or excessively high (up to 45 mm/h).

2nd trimester. At this time, the woman’s condition stabilizes somewhat and the erythrocyte sedimentation rate is approximately 20-30 mm/h.

3rd trimester. The last stages of pregnancy are characterized by a significant increase in the permissible norm of ESR - from 30 to 45 mm/h. Such a sharp increase indicates rapid fetal development and does not require treatment.

After childbirth, the erythrocyte sedimentation rate in women remains elevated because a woman may lose a lot of blood during labor. For 2-3 months after birth, ESR can reach 30 mm/h. When hormonal processes return to normal, a woman’s ESR level decreases to 0-15 mm/h.

During menopause

The climacteric period of a woman's life is characterized by strong hormonal changes, which significantly affects chemical composition blood. During menopause, the ESR rate in the blood, as a rule, increases significantly and can reach up to 50 millimeters per hour.

In women over 50 years of age, the ESR level can be quite high (up to 30 mm/hour), which is normal if other blood parameters do not exceed the permissible norm.

However, after the onset of menopause, an ESR in the blood of women greater than 50 mm/hour can signal the following diseases:

• illnesses thyroid gland(hyperthyroidism, hypothyroidism), occurring in 50-60% of women after 50 years of age;
• chronic infections;
• tumor growth;
• active rheumatological processes;
• kidney disease;
• allergic reactions;
• fractures.

A reduced level of ESR in women during menopause and in the postmenstrual period always indicates pathological processes in the body. A reduced erythrocyte sedimentation rate (below 15-12 mm/hour) can be caused by the following diseases:

• diseases of the gastrointestinal tract (duodenitis, gastritis, stomach ulcer);
• leukocytosis - an increase in the number of leukocytes that occurs during many inflammatory and oncological processes (meningitis, peritonitis, pyelonephritis, malignant tumors);
• erythrocytosis, manifested in polycythemia vera, diseases respiratory system(pulmonary pleurisy, lung tumors), etc.;
• hepatitis;
• blood clotting disorder.

It should be remembered that the ESR level drops below normal after taking aspirin.

For cancer

Suspicion of oncological processes in the body arises if the ESR value is higher than normal, despite long-term treatment with anti-inflammatory drugs (up to 70 mm/s). At the same time, the hemoglobin level decreases from 120-130 units to 70-80 units, and the level of leukocytes also increases.

A prolonged increase in the red blood cell sedimentation rate may indicate the formation of malignant tumors:

• intestinal tumors;
• cancerous tumors of the breast, cervix and ovaries in women;
• oncological processes in the bone marrow;
• brain tumors.

An increase in the ESR level also occurs during development benign tumors, namely:

• myeloma;
• polyps;
• papillomas;
• fibroids;
• lymphangiomas, etc.

Laboratory analysis of the ESR norm in women is not a direct indicator of the presence of cancer processes in the body, therefore, after determining the erythrocyte sedimentation rate of more than 70-80 mm/hour, a additional examination to confirm the diagnosis (ultrasound examination, magnetic resonance imaging, etc.).

How to reduce ESR using folk remedies

In order to reduce the ESR level to normal, you can use effective folk remedies: beets, honey, garlic, lemons, herbal infusion, etc. Action folk recipes is aimed at cleansing the blood, relieving inflammatory processes in the body and strengthening the immune system.

Beetroot decoction. Red beets have many beneficial properties that can improve health, namely:

• Due to B vitamins, metabolism can be normalized;
• with the help of vitamin C and beta-carotene, the functioning of the immune system improves;
• contains quartz, which strengthens vascular system and helps cleanse the body;
• removes toxins;
• normalizes plasma levels.

To prepare the decoction you will need 3 small beets, which must be thoroughly washed and cooked unpeeled. There is no need to trim the beet tails.

Cook the beets over low heat for 3 hours, making sure that the water does not boil away. The broth is cooled and stored in the refrigerator.

You need to take 50 grams of the decoction on an empty stomach in the morning, without getting out of bed. After taking the medicine, you should lie down for another 10-15 minutes. Treatment lasts 7 days, followed by a week break, and the course of treatment is repeated.

Infusion medicinal herbs . To reduce the erythrocyte sedimentation rate, the following are used: effective herbs, like chamomile, linden flowers, coltsfoot, which have anti-inflammatory, disinfectant, cleansing properties.

Take dried crushed leaves (0.5 teaspoon) of each plant, pour a glass of boiling water and leave for 30 minutes. The infusion is filtered and drunk 2 times a day after meals. The course of treatment is 20 days.

ESR(Erythrocyte sedimentation rate) - a nonspecific indicator of inflammation of various origins(in a vertically placed test tube).

IN clinical practice definition of ESR is accessible, easy to implement method to assess the patient’s condition and assess the course of the disease when performing the test over time.

Main indications for use:
preventive examinations(screening study)
diseases occurring with inflammatory processes- heart attack, tumors, infections, connective tissue diseases and many other diseases

Erythrocyte sedimentation rate- nonspecific indicator , reflecting the course of inflammatory processes of various etiologies.

An increase in ESR often, but not always, correlates with an increase in the number of white blood cells and an increase in the concentration of C-reactive protein, which is a biochemical nonspecific indicator of inflammation.
An increase in the formation of acute phase proteins during inflammation (C-reactive protein and many others), a change in the number and shape of red blood cells leads to a change in the membrane properties of blood cells, promoting their adhesion. This leads to an increase in ESR.

!!! It is currently believed that the most specific, sensitive and therefore preferable indicator of inflammation and necrosis compared to the determination of ESR is quantitation C-reactive protein.

ESR is an indicator of the rate of separation of blood in a test tube with an added anticoagulant into 2 layers:
top - transparent plasma
lower - settled red blood cells

The erythrocyte sedimentation rate is estimated by the height of the formed plasma layer in millimeters per hour (mm/h).

The specific gravity of erythrocytes is higher than the specific gravity of plasma, therefore, in a test tube, in the presence of an anticoagulant (sodium citrate), under the influence of gravity, erythrocytes settle to the bottom.

The process of erythrocyte sedimentation can be divided into 3 phases, which occur at different rates:
1. red blood cells slowly settle into individual cells
2. red blood cells form aggregates - “coin columns”, and sedimentation occurs faster
3. a lot of red blood cell aggregates are formed, their sedimentation first slows down and then gradually stops

Determination of ESR over time, in combination with other tests, used in monitoring the effectiveness of treatment inflammatory and infectious diseases.

FACTORS AFFECTING ESR INDICATOR

The ESR indicator varies depending on many physiological and pathological factors.

ESR values slightly higher in women than in men.
Changes in the protein composition of the blood during pregnancy lead to an increase in ESR during this period.

Values ​​may fluctuate during the day, the maximum level is observed in the daytime.

The main factor influencing the formation of “coin columns” during erythrocyte sedimentation is the protein composition of the blood plasma. Acute-phase proteins, adsorbed on the surface of erythrocytes, reduce their charge and repulsion from each other, promote the formation of coin columns and accelerated sedimentation of erythrocytes.

Increased acute phase proteins, for example, C-reactive protein, haptoglobin, alpha-1-antitrypsin, in acute inflammation leads to an increase in ESR.

In acute inflammatory and infectious processes a change in erythrocyte sedimentation rate is observed 24 hours after an increase in temperature and an increase in the number of leukocytes.

For chronic inflammation the increase in ESR is due to an increase in the concentration of fibrinogen and immunoglobulins.

Some morphological variants of erythrocytes may also affect ESR. Anisocytosis and spherocytosis inhibit red blood cell aggregation. Macrocytes have a charge corresponding to their mass and settle faster.

For anemia drepanocytes influence ESR so that even with inflammation, the ESR does not increase.

The ESR value depends on gender and age:
in newborns, the ESR is very slow - about 2 mm, which is associated with a high hematocrit and low globulin content
by 4 weeks the ESR accelerates slightly,
by 2 years it reaches 4-17 mm
in adults and children over 10 years of age ESR ranges from 2 to 10 mm for men and from 2 to 15 mm for women, which may be explained by different levels of androgenic steroids
in older people, the normal ESR level ranges from 2 to 38 in men and from 2 to 53 among women.

REASONS FOR CHANGES IN ESR INDICATORS

Blood viscosity and the total number of red blood cells also have a significant impact on this indicator.

With anemia, which is known to be accompanied by a significant decrease in blood viscosity, an increase in ESR is observed, and with erythrocytosis, an increase in viscosity and a decrease in ESR.

Increase in ESR value

Most common cause An increase in ESR is an increase in the plasma content of coarse proteins (fibrinogen, a- and g-globulins, paraproteins), as well as a decrease in the content of albumin. Coarse proteins have less negative charge. By adsorbing on negatively charged erythrocytes, they reduce their surface charge and promote the convergence of erythrocytes and their faster agglomeration.

And so, the reason for the increase in ESR may be:
Infections, inflammatory diseases, tissue destruction.
Other conditions leading to increased levels of fibrinogen and globulins in plasma, such as malignant tumors, paraproteinemia (for example, macroglobulinemia, multiple myeloma).
Myocardial infarction.
Pneumonia.
Liver diseases - hepatitis, liver cirrhosis, cancer, etc., leading to severe dysproteinemia, immune inflammation and necrosis of liver tissue.
Kidney diseases(especially those accompanied by nephrotic syndrome (hypoalbuminemia) and others).
Collagenoses.
Diseases of the endocrine system (diabetes).
Anemia (ESR increases depending on severity), various injuries.
Pregnancy.
Poisoning by chemical agents.
Elderly age
Intoxication.
Injuries, bone fractures.
Condition after shock, surgical interventions

Decrease in ESR value

Three main factors contribute to a decrease in ESR:
1) blood thickening
2) acidosis
3) hyperbilirubinemia

And so, the reason for the decrease in ESR value may be:
Polycythemia.
Sickle cell anemia.
Spherocytosis.
Hypofibrinogenemia.
Hyperbilirubinemia.
Fasting, decreased muscle mass.
Taking corticosteroids.
Pregnancy (especially 1st and 2nd semester).
Vegetarian diet.
Overhydration.
Myodystrophies.
Severe symptoms of circulatory failure.

REMEMBER!!!

An increase in ESR is very sensitive, But nonspecific hematological indicator of various pathological processes.

The most significant increase in ESR (up to 50–80 mm/h) is most often observed with:
paraproteinemic hemoblastoses - myeloma, Waldenström's disease
connective tissue diseases and systemic vasculitis - systemic lupus erythematosus, periarteritis nodosa, scleroderma, etc.

The most common cause of a significant decrease in ESR is an increase in blood viscosity in diseases and syndromes accompanied by an increase in the number of red blood cells (erythremia, secondary erythrocytosis).

RELIABILITY OF ESR DETERMINATION RESULTS

The results of determining ESR can be considered reliable only if, if no other parameters, except those expected, affect the indicator being studied. Too many factors influence the results of the test, and therefore its clinical significance should be reconsidered.

The main influence on the sedimentation rate of erythrocytes suspended in plasma is degree of their aggregation.

There are 3 main factors influencing erythrocyte aggregation:
cell surface energy
cell charge
dielectric constant

The latter indicator is a characteristic of plasma associated with the concentration of asymmetric molecules. An increase in the content of these proteins leads to an increase in the strength of the bonds between red blood cells, leading to agglutination and clumping (formation of columns) of red blood cells and a higher sedimentation rate.

A moderate increase in the concentration of plasma proteins of classes 1 and 2 can cause an increase in ESR:
extremely asymmetric proteins- fibrinogen
or
moderately asymmetric proteins- immunoglobulins

Due to the fact that fibrinogen is a marker of the acute phase, an increase in the level of this protein indicates the presence of infection, inflammation or the appearance of tumor cells in the blood, leading to an increase in ESR during these processes.

!!! Despite the recognized nonspecificity of the method for determining ESR, it is often not taken into account that most other factors, in addition to the presence and severity of the inflammatory process, affect ESR, which casts doubt on the clinical significance of the test.

Reasons for a false-positive increase in ESR:
Anemia with normal erythrocyte morphology. This effect is explained by a change in the ratio of erythrocytes to plasma, which promotes the formation of columns of erythrocytes, regardless of the concentration of fibrinogen.
An increase in plasma concentrations of all proteins except fibrinogen (M-protein, macroglobulins and erythrocyte agglutinins).
Kidney failure. In compensated patients, renal failure may be associated with an increase in plasma fibrinogen levels.
Heparin. Sodium citrate dihydrate and EDTA do not affect ESR.
Hypercholesterolemia.
Extreme obesity. An increase in ESR may be associated with an increase in fibrinogen levels.
Pregnancy (ESR determination was initially used to establish pregnancy).
Female.
Elderly age. According to rough estimates, for men the upper level of normal ESR is the figure obtained by dividing age by 2, for women - age plus 10, and divided by 2.
Technical errors. Deviation of the tube from the vertical position to the sides increases the ESR. Red blood cells settle at the bottom of the tube, and plasma rises to top part. Accordingly, the inhibitory effect of plasma weakens. An angle of 3° from the vertical line can lead to an increase in ESR of up to 30 units.
Administration of dextran.
Vaccination against hepatitis B.
Use of oral contraceptives.
Taking vitamin A.

Reasons for a false-positive decrease in ESR:
Morphological changes in red blood cells. The most common forms of red blood cells can lead to changes in the aggregation properties of red blood cells, which, in turn, will affect the ESR. Abnormally or unusually shaped red blood cells, such as sickle-shaped ones, with a shape that prevents the formation of columns, lead to a decrease in ESR. Spherocytes, anisocytes and poikilocytes also affect erythrocyte aggregation, reducing ESR.
Polycythemia. It has an effect opposite to that which anemia has on erythrocyte aggregation.
Significant increase in leukocyte levels.
DIC syndrome (due to hypofibrinogenemia).
Dysfibrinogenemia and afibrinogenemia.
A significant increase in the level of bile salts in the blood plasma (due to changes in the properties of the erythrocyte membrane).
Congestive heart failure.
Valproic acid.
Low molecular weight dextran.
Cachexia.
Lactation.
Technical errors. Due to the fact that ESR increases with increasing temperature environment, refrigerated blood samples cannot be used during the test. If the samples were frozen, before determining the ESR, it is necessary to warm the test tube with blood to room temperature. It is equally important that the ESR determination is made using blood samples obtained 2 hours before the test. If a tube of blood is left on the laboratory bench for a long time, the red blood cells take on a spherical shape, which leads to a decrease in the ability to form columns.
Use at the time of determining ESR: corticotropin, cortisone, cyclophosphamide, fluorides, glucose, oxalates, quinine.

Sources of error when performing analysis:
If the blood being tested is at room temperature, ESR should be determined no later than 2 hours after blood collection. If the blood is at +4°C, the ESR should be determined within no more than 6 hours, but before performing the method, the blood must be warmed to room temperature.
To obtain correct results, ESR determination should be performed at 18-25°C. With more high temperatures the ESR value increases, and at lower values ​​it slows down.
Before performing the analysis, it is necessary to mix the venous blood well, which will ensure better reproducibility of the results.
Sometimes, more often with regenerative anemia, there is no sharp boundary between the erythrocyte column and plasma. A light “veil” of several millimeters is formed above the compact mass of red blood cells, mainly of reticulocytes. In this case, the boundary of the compact layer is determined, and the erythrocyte veil is assigned to the plasma column.
Some plastics (polypropyl, polycarbonate) can replace glass capillary pipettes. Not all plastics have these properties and require testing and assessing the degree of correlation with glass capillary pipettes.

Factors distorting the result:
Wrong choice of anticoagulant.
Insufficient mixing of blood with the anticoagulant.
Late delivery of blood to the laboratory.
Using a needle that is too thin to puncture a vein.
Hemolysis of a blood sample.
Blood thickening due to prolonged squeezing of the arm with a tourniquet.

METHODS FOR DETERMINING ESR

1. The most common method for determining ESR in our country is the micromethod of T. P. Panchenkov , based on the property of red blood cells to settle at the bottom of a vessel under the influence of gravity.

Equipment and reagents:
1. Panchenkov apparatus.
2. Panchenkov's capillaries.
3. 5% sodium citrate solution (freshly prepared).
4. Watch glass.
5. Frank's needle or scarifier.
6. Vata.
7. Alcohol.

Panchenkov apparatus consists of a stand with capillaries (12 pcs.) 1 mm wide, on the wall of which divisions from 0 (top) to 100 (bottom) are marked. At level 0 there is the letter K (blood), and in the middle of the pipette, near the 50 mark, there is the letter P (reagent).

Progress of the study:
A 5% solution of sodium citrate is taken into a Panchenkov capillary to the 50 mark (letter P) and blown onto a watch glass. From a finger prick, holding the capillary horizontally, draw blood to the 0 mark (Letter K). Then the blood is blown onto a watch glass with sodium citrate, after which the blood is drawn a second time to the 0 mark and released in addition to the first portion. Consequently, on the watch glass there is a ratio of citrate and blood equal to 1:4, i.e. four volumes of blood per volume of reagent. The blood is mixed with the end of the capillary, drawn up to the 0 mark and placed in the Panchenkov apparatus strictly vertically. After an hour, the number of millimeters of the plasma column is noted.

2. Research method: according to Westergren, modified (recommended by the ICG).

!!! This is an international method for determining ESR. It differs from the Panchenkov method in the characteristics of the test tubes used and the scale of results, calibrated in accordance with the Westergren method. The results obtained by this method, in the range of normal values, coincide with the results obtained when determining ESR by the Panchenkov method. But the Westergren method is more sensitive to an increase in ESR, and the results in the zone of increased values ​​obtained by the Westergren method are higher than the results obtained by the Panchenkov method.

Sample requirements:
Whole blood (Na citrate).

Reference limits:
Children: 0-10 mm/h
Adults,<50 лет, М: 0-15 Ж: 0-20 >50 years old, M: 0-20 F: 0-30

Notes:

3. Research method: microESR.

Sample requirements:
Capillary blood (EDTA).

Notes:
ESR correlates well with plasma fibrinogen levels and depends on the formation of a column of red blood cells. Therefore, poikilocytosis slows sedimentation; on the other hand, a change in the shape (flattening) of red blood cells in obstructive liver diseases leads to accelerated sedimentation. The sensitivity of ESR to detect plasma protein pathology is better in the absence of anemia; in case of anemia, POS is preferable. The Wintrobe method is more sensitive in the normal or slightly elevated range, whereas the Westergren method is more sensitive in the elevated range. The micromethod can be useful in pediatrics. ESR should not be used as a screening method for disease detection in asymptomatic patients. When the ESR accelerates, a thorough interview and physical examination of the patient usually allows us to find out the cause. The test is useful and indicated for the diagnosis and monitoring of patients with temporal arteritis and polymyalgia rheumatica. ESR has little diagnostic value in RA, but may be useful for monitoring disease activity when clinical manifestations doubtful. Since the test is often unchanged in patients with malignant tumors, infections and connective tissue diseases, determination of ESR cannot be used to exclude these diseases in patients with unclear complaints.

4. Research method: according to Wintrobe.

Sample requirements:
Whole blood (EDTA).
Do not use heparin.

Reference limits:
Children: 0-13 mm/h
Adults, M: 0-9 F: 0-20

Notes:
ESR correlates well with plasma fibrinogen levels and depends on the formation of a column of red blood cells. Therefore, poikilocytosis slows sedimentation; on the other hand, a change in the shape (flattening) of red blood cells in obstructive liver diseases leads to accelerated sedimentation. The sensitivity of ESR to detect plasma protein pathology is better in the absence of anemia; in case of anemia, POS is preferable. The Wintrobe method is more sensitive in the normal or slightly elevated range, whereas the Westergren method is more sensitive in the elevated range. The micromethod can be useful in pediatrics. ESR should not be used as a screening method for disease detection in asymptomatic patients. When the ESR accelerates, a thorough interview and physical examination of the patient usually allows us to find out the cause. The test is useful and indicated for the diagnosis and monitoring of patients with temporal arteritis and polymyalgia rheumatica. ESR has little diagnostic value in RA, but may be useful for monitoring disease activity when clinical manifestations are equivocal. Since the test is often unchanged in patients with malignant tumors, infections and connective tissue diseases, the determination of ESR cannot be used to exclude these diseases in patients with unclear complaints

5. Research method: POS (deposition index Zeta).

Sample requirements:
Whole blood (EDTA).
Stable for 2 hours at 250C, 12 hours at 40C.

Notes:
Unlike the Westergren and Wintrobe methods, POSITION is not affected by anemia. Determination of POS requires special equipment.

You feel fine, nothing causes serious concern... And suddenly, when you take your next blood test, it turns out that your erythrocyte sedimentation rate (ESR) has changed. Should I worry? 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, including those occurring in a latent form. The ESR indicator is influenced by a number of factors, including: infectious diseases, fever, chronic inflammation. If you receive 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 is placed in a vertically mounted container for one hour. The specific gravity of red blood cells is higher than the specific gravity of plasma. That is why, under the influence of gravity, red blood cells settle to the bottom. The blood is divided into 2 layers. Plasma remains in the upper one, and red blood cells accumulate in the lower one. After this, the height of the top layer is measured. The number corresponding to the boundary between red blood cells 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: red blood cells, 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 begin to treat them on time and avoid many problems.

When is an erythrocyte sedimentation rate test prescribed?

Determination of ESR is necessary in the following situations:

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

Preparing and carrying out the blood sampling procedure

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

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

Methodology for performing analysis

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

Panchenkov method

A five percent solution of sodium citrate (anticoagulant) is poured into a capillary divided into 100 divisions to the “P” mark. After this, the capillary is filled with blood (biomaterial is taken from a finger) 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 the Westergren test, 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 test tubes with a scale of 200 mm. ESR is determined after an hour.

This method is recognized in worldwide practice. The fundamental difference is the type of tubes and 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 compared to the Panchenkov method.

Decoding the ESR analysis

Erythrocyte sedimentation rate test results are usually available within one business day, not including the day of blood donation. However, commercial medical centers, having own laboratory, can provide the test result more quickly - within two hours after collecting the biomaterial.

So, you have received a form with the result of the ESR analysis. On the left you will see this abbreviation (either ROE or ESR), and on the right - your result, indicated in mm/h. To find out how much it corresponds to the norm, you should correlate it with the reference (average) values ​​​​corresponding to your age and gender. ESR norm indicators for men and women of different ages look like this:

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

ESR is increased

An increase in erythrocyte sedimentation rate can be caused by a variety of reasons. Let's look at the main ones:

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

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

note
The ESR may be increased in people who are overweight. This is due to increased cholesterol levels in their blood.

ESR is reduced

Doctors often note a decrease in the erythrocyte sedimentation rate reaction in diseases such as erythrocytosis, leukocytosis, disseminated intravascular coagulation syndrome, and hepatitis. ESR also decreases with polycythemia (an increase in the number of red blood cells) and conditions leading to it, such as chronic heart failure or lung diseases.

Another reason for a decrease in ESR is pathologies in which changes in the shape of red blood cells occur. This may 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 consume not only meat, but also any food of animal origin.

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

Wednesday, 03/28/2018

Editorial opinion

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