Causes of elevated ESR and level restoration. Elevated ESR in the blood Elevated ESR is at risk

ESR (erythrocyte sedimentation rate) is an indicator that evaluates the rate of separation of blood into plasma and red blood cells. With an increase in ESR, inflammation develops in the patient's body. Therefore, it is important to control the ESR value, which we will discuss in more detail in our material.

ESR (erythrocyte sedimentation rate, ESR) indicates how quickly red blood cells settle in the patient's blood. The normal ESR value among men is 8–12 millimeters per hour (hereinafter referred to as mm/h), and among women – 3–20 mm/h. An excess of ESR indicates either physiological causes or pathological diseases.

It is important to understand that to identify pathology it is not enough to know the value of ESR. The doctor is obliged to take into account other indicators of a general blood test, as well as the results of additional examination of the patient.

Doctors distinguish 4 phases of increasing ESR, such as:

In addition, when deciphering ESR, the doctor takes into account a number of factors, for example:

  • The gender and age of the patient is higher among women than among men.
  • Pregnancy - the normal ESR level increases and does not change until the birth of the child.
  • Time of day – in the morning the ESR value is higher than in the evening.
  • Individual characteristics of the body - 5% of patients have an increased ESR value, which is not a deviation.
  • Recovery period - the ESR level remains elevated for another 2-4 weeks after treatment.

To determine the level of ESR in laboratories, one of 2 methods is used - the Panchenkov or Westergren technique. In the first case, capillary blood is required for analysis, and in the second, venous blood.

Symptoms of increased ESR

Signs of elevated ESR levels depend on the progression of the specific disease. At the same time, at the beginning of the onset of pathology, there are no symptoms.

So, common signs include:


Why does it increase in children and adults?

Doctors distinguish physiological and pathological reasons for increased ESR. So, temporary reasons include:

  1. Poor nutrition (diet, vegetarianism, overeating).
  2. Overheating or hypothermia.
  3. Retirement age.
  4. Allergy.
  5. Hormonal changes (menstruation, pregnancy, menopause).
  6. Incorrect preparation for analysis.
  7. Long-term use of medications or vitamins.
  8. Emotional stress (apathy, stress, depression).

Among the common reasons for increased ESR are:

  • Oncology.
  • Anemia.
  • Cirrhosis of the liver.
  • Intoxication.
  • Myocardial infarction.
  • Diabetes.
  • Tuberculosis.
  • Leukemia.
  • Rheumatoid arthritis.
  • Hepatitis.
  • Pneumonia.
  • Flu, ARVI.
  • Pneumonia.

Important! During pregnancy, the ESR level increases to 45 mm/h. Such a deviation does not require treatment and is not associated with the development of pathologies.

Promotion according to Panchenkov

The most common way to determine ESR is the Panchenkov method. The main advantages are simplicity, high accuracy, low price.

The normal level of ESR according to Panchenkov is (in mm/h):

  1. Infants: 0–2.
  2. 1–5 years: 5–11.
  3. 6–18 years: 4–12.
  4. Women under 30: 8–15.
  5. Women over 30: 10–25.
  6. Ladies over 60 years old: 25–50.
  7. Men under 60 years old: 6–13.
  8. Men over 60 years old: 20–49.

With an increase in ESR according to the Panchenkov method, infections or inflammations develop, which can be obvious or hidden. Therefore, doctors recommend repeating the analysis after 7-10 days to confirm a significant deviation in ESR.

But with a slight increase in ESR, it is important to exclude causes such as: pregnancy; obesity; taking vitamin A or medications; elderly age; hepatitis B vaccination; injury. With a significant increase in ESR, one of the pathologies indicated in the previous chapter develops.

Important! After treatment, the ESR level stabilizes after 3–5 weeks (among children) or after 3–5 days (among adult patients).

But how is the Panchenkov method carried out? For this purpose, blood from a finger is used. So, to obtain a sample, the health worker pricks the ring finger. The sample is then placed in a glass tube, which is placed vertically for 60 minutes. In this case, the nurse first adds sodium citrate to the blood so that the red cells settle to the bottom of the tube. The period during which red blood cells drop indicates the ESR value.

Westergren method

In private clinics, the Westergren method is more common than the Panchenkov method. This technique is carried out similarly to the previous method, but there are a number of differences, namely:

  • Only venous blood is used (Panchenkov method - blood from a finger).
  • A special stand is used to decipher the ESR level.
  • A different test tube and the presence of a calibrated scale of results.
  • The Westergren method is more sensitive to an increase in ESR, therefore, the results will be higher than the Panchenkov method.

An increase in Westergren's ESR is often associated with an increase in protein molecules in the blood, namely firbinogen or paraproteins. Therefore, pathologies that cause such deviations in blood composition are the cause of an increase in ESR.

But it is worth remembering that an increase in ESR is not always associated with the development of pathologies. For example, a deviation in ESR will provoke the use of medications, for example, Paracetamol, Aspirin.

How to normalize ESR?

Treatment of an elevated ESR level depends on 2 basic factors - the cause of the deviation and the ESR indicators.

In the first case, the treatment method depends on the disease, which is determined by the doctor (after a comprehensive examination of the patient). For example, in case of pneumonia, the doctor prescribes medications that help the body cope with the disease.

In the second case, we are talking about the value of ESR. So, in case of minor deviations, it is enough to follow a number of preventive measures, for example:

  1. Rejection of bad habits.
  2. Normalization of nutrition.
  3. Regular exercise or daily walking.
  4. Elimination of stressful situations.
  5. Use of traditional medicine - when ESR increases, it is recommended to use:
  • lemon with honey;
  • beet broth or beet juice (on an empty stomach, once a day for a week);
  • herbal tea made from chamomile, linden or horsetail.

For more information about elevated ESR levels, see the following video:

The conclusion will be as follows: after receiving elevated ESR results, the patient should consult a doctor who will determine the cause of the deviation based on the individual characteristics of the body. But first you need to make sure that such an increase is not associated with physiological reasons.

Erythrocyte sedimentation rate is a test used to detect inflammation in the body.

The sample is placed in an elongated thin tube, red blood cells (erythrocytes) gradually settle to the bottom, and the ESR is a measure of this settling rate.

The test can diagnose many disorders (including cancer) and is a necessary test to confirm many diagnoses.

Let's figure out what it means when the erythrocyte sedimentation rate (ESR) in the general blood test of an adult or child is increased or decreased, should we be afraid of such indicators and why does this happen in men and women?

Women have higher ESR values; pregnancy and the menstrual period can cause short-term deviations from the norm. In pediatrics, this test helps diagnose rheumatoid arthritis in children or.

Normal ranges may vary slightly depending on laboratory facilities. Abnormal results do not diagnose a specific disease.

Many factors such as age or medication use, can affect the final result. Drugs such as dextran, ovidone, silest, theophylline, vitamin A can increase ESR, and aspirin, warfarin, cortisone can reduce it. High/low readings only tell the doctor about the need for further examination.

False promotion

A number of conditions can affect the properties of blood, affecting the ESR value. Therefore, accurate information about the inflammatory process - the reason why the specialist prescribes a test - may be masked by the influence of these conditions.

In this case, the ESR values ​​will be falsely elevated. These complicating factors include:

  • Anemia (low red blood cell count, decreased hemoglobin in serum);
  • Pregnancy (in the third trimester, ESR increases approximately 3 times);
  • Increased concentration of cholesterol (LDL, HDL, triglycerides);
  • Kidney problems (including acute kidney failure).

The specialist will take into account all possible internal factors when interpreting the results of the analysis.

Interpretation of results and possible reasons

What does it mean if the erythrocyte sedimentation rate (ESR) in the blood test of an adult or child is increased or decreased, should we be afraid of indicators that are higher than normal or lower?

High levels in blood test

Inflammation in the body provokes red blood cells to stick together (the weight of the molecule increases), which significantly increases their rate of settling to the bottom of the test tube. Increased sedimentation levels may be caused by the following:

  • Autoimmune diseases – Libman-Sachs disease, giant cell disease, polymyalgia rheumatica, necrotizing vasculitis, rheumatoid arthritis (the immune system is the body’s defense against foreign substances. Against the background of an autoimmune process, it mistakenly attacks healthy cells and destroys body tissue);
  • Cancer (this can be any form of cancer, from lymphoma or multiple myeloma to bowel and liver cancer);
  • Chronic kidney disease (polycystic kidney disease and nephropathy);
  • Infection, such as pneumonia, pelvic inflammatory disease, or appendicitis;
  • Inflammation of joints (polymyalgia rheumatica) and blood vessels (arteritis, diabetic angiopathy of the lower extremities, retinopathy, encephalopathy);
  • Inflammation of the thyroid gland (diffuse toxic goiter, nodular goiter);
  • infections of the joints, bones, skin, or heart valves;
  • Too high serum fibrinogen concentrations or hypofibrinogenemia;
  • Pregnancy and toxicosis;
  • Viral infections (HIV, tuberculosis, syphilis).

Because the ESR is a nonspecific marker of inflammation foci and correlates with other causes, the results of the analysis should be taken into account together with the patient’s health history and the results of other examinations (complete blood count - extended profile, urinalysis, lipid profile).

If the sedimentation rate and the results of other tests coincide, the specialist can confirm or, conversely, exclude the suspected diagnosis.

If the only elevated indicator in the analysis is ESR (against the background of a complete absence of symptoms), the specialist cannot give an accurate answer and make a diagnosis. Besides, a normal result does not exclude disease. Moderately elevated levels may be caused by aging.

Very large numbers usually have good reasons, such as multiple myeloma or giant cell arteritis. People with Waldenström's macroglobulinemia (the presence of abnormal globulins in the serum) have extremely high ESR levels, although there is no inflammation.

This video describes in more detail the norms and deviations of this indicator in the blood:

Low performance

Low sedimentation rates are generally not a problem. But may be associated with such deviations as:

  • A disease or condition that increases red blood cell production;
  • A disease or condition that increases white blood cell production;
  • If a patient is being treated for an inflammatory disease, the degree of sedimentation going down is a good sign and means that the patient is responding to treatment.

Low values ​​can be caused by the following reasons:

  • Elevated glucose levels (in diabetics);
  • Polycythemia (characterized by an increased number of red blood cells);
  • Sickle cell anemia (a genetic disease associated with pathological changes in cell shape);
  • Severe liver diseases.

The reasons for the decline could be any number of factors., For example:

  • Pregnancy (in the 1st and 2nd trimester, ESR levels drop);
  • Anemia;
  • Menstrual period;
  • Medicines. Many medications can falsely lower test results, such as diuretics and medications that contain high calcium levels.

Increased data for diagnosing cardiovascular diseases

In patients with cardiac or myocardial disease, ESR is used as an additional potential indicator of coronary heart disease.

ESR used for diagnostics– (inner layer of the heart). Endocarditis develops due to the migration of bacteria or viruses from any part of the body through the blood to the heart.

If symptoms are ignored, endocarditis destroys the heart valves and leads to life-threatening complications.

To make a diagnosis of endocarditis, a specialist must prescribe a blood test. Along with high levels of sedimentation rates, endocarditis is characterized by a decrease in platelets(lack of healthy red blood cells), the patient is often also diagnosed with anemia.

Against the background of acute bacterial endocarditis, the degree of sedimentation may increase to extreme values(about 75 mm/hour) is an acute inflammatory process characterized by severe infection of the heart valves.

When diagnosing congestive heart failure ESR levels are taken into account. This is a chronic, progressive disease that affects the power of the heart muscles. Unlike regular “heart failure,” congestive heart failure refers to the stage in which excess fluid accumulates around the heart.

To diagnose the disease, in addition to physical tests (echocardiogram, MRI, stress tests), the results of a blood test are taken into account. In this case, analysis for an extended profile may indicate the presence of abnormal cells and infections(sedimentation rate will be higher than 65 mm/hour).

At myocardial infarction An increase in ESR is always provoked. The coronary arteries deliver oxygen in the blood to the heart muscle. If one of these arteries becomes blocked, part of the heart is deprived of oxygen, causing a condition called “myocardial ischemia.”

Against the background of a heart attack, ESR reaches peak values(70 mm/hour and above) for a week. Along with increased sedimentation rates, the lipid profile will show elevated levels of triglycerides, LDL, HDL and cholesterol in the serum.

A significant increase in erythrocyte sedimentation rate is observed against the background acute pericarditis. This, which begins suddenly, causes blood components such as fibrin, red blood cells and white blood cells to enter the pericardial space.

Often the causes of pericarditis are obvious, such as a recent heart attack. Along with elevated ESR levels (above 70 mm/hour), an increase in urea concentration in the blood was noted as a result of renal failure.

Erythrocyte sedimentation rate increases significantly against the background of the presence of an aortic aneurysm or . Together with high ESR values ​​(above 70 mm/hour), blood pressure will be elevated; in patients with an aneurysm, a condition called “thick blood” is often diagnosed.

conclusions

ESR plays an important role in the diagnosis of cardiovascular diseases. The indicator appears to be elevated against the background of many acute and chronic painful conditions characterized by tissue necrosis and inflammation, and is also a sign of blood viscosity.

Elevated levels directly correlate with the risk of myocardial infarction and coronary heart disease. For high subsidence levels and suspected cardiovascular disease the patient is referred for further diagnostics, including an echocardiogram, MRI, electrocardiogram to confirm the diagnosis.

Experts use erythrocyte sedimentation rate to determine foci of inflammation in the body; measuring ESR is a convenient method of monitoring the progress of treatment of diseases accompanied by inflammation.

Accordingly, high sedimentation rates will correlate with greater disease activity and indicate the presence of possible conditions such as chronic kidney disease, infections, thyroid inflammation and even cancer, while low values ​​indicate less active disease development and its regression.

Although sometimes even low levels correlate with the development of some diseases, for example, polycythemia or anemia. In any case, consultation with a specialist is necessary for a correct diagnosis.

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

In clinical practice, the 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 the quantitative determination of 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

The most common reason for 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 albumin content. 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 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 the top. 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 ambient temperature, refrigerated blood samples cannot be used for 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. At higher temperatures, the ESR value increases, and at lower temperatures 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 are equivocal. 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.

The abbreviation “ESR” stands for “erythrocyte sedimentation rate.” This is a nonspecific laboratory indicator that is determined in the patient.

ESR is one of the initial diagnostic methods. Correct interpretation allows you to determine the algorithm for further actions of the doctor.

History and essence of the method

In 1918, it was found that women's ESR changes during pregnancy. Later it turned out that changes in the indicator are observed in inflammatory diseases. One of the methods for determining the indicator, which is still widely used in clinical practice, was developed by Westergren back in 1928.

The density of red blood cells is higher than the density of plasma, and if the blood does not coagulate, the red blood cells gradually sink to the bottom of the laboratory tube under their own weight.

Please note:to prevent blood clotting, an anticoagulant substance, sodium citrate (5% or 3.8% solution), is added to the container before the test.

The leading factor affecting the sedimentation rate is the aggregation of erythrocytes (i.e., their sticking together). The formed indivisible particles known as “coin columns” have a smaller area to volume ratio, so they overcome the resistance of the liquid (plasma) more easily and settle faster. The larger the size and number of aggregates, the higher the ESR.

Aggregation is influenced by the protein composition of plasma and the surface potential of erythrocytes. With the development of pathology of infectious-inflammatory genesis, the electrochemical composition of the blood changes. The main reason for the increase in aggregation is the presence in the blood of the so-called. “acute phase proteins” - immunoglobulins, fibrinogen, ceruloplasmin and C-reactive protein. Agglutination is normally hampered by the negative charge of red blood cells, but it tends to change with the addition of antibodies and acute-phase fibrinogen.

Note:an altered electrical charge and an increased tendency to aggregation are characteristic of atypical forms of erythrocytes.

Minor decreases in albumin content have virtually no effect on the sedimentation rate, but a significant decrease in concentration causes a decrease in serum viscosity and an increase in the rate.

Research using the Panchenkov method

To evaluate ESR using this method, a special laboratory vessel is used - the so-called. Panchenkov capillary. First, sodium citrate is filled into it up to the “P” mark, and the anticoagulant is transferred to the glass. Then the test blood is drawn twice successively to the “K” mark and combined with citrate. Citrate blood is again drawn into the capillary, which is fixed in a vertical position. ESR is determined after 60 minutes. or after 24 hours; the indicator is expressed in millimeters. This method, which doctors in our country most often rely on, provides high accuracy in single studies. Its main disadvantage is that it takes a relatively long time to carry out the analysis.

Study using the Westergren method

The European method is slightly more sensitive to an increase in ESR. To carry out the analysis, Westergren tubes with a diameter of 2.5 mm and a graduation of 200 mm are used. The material for research is venous blood mixed with sodium citrate (3.8%) in a ratio of 4:1. A reagent such as ethylenediaminetetraacetic acid (EDTA) may be added to the blood. The indicator is expressed in mm/hour.

Important:studies according to Panchenkov and Westergren may give different figures, and the higher the ESR, the greater the possible difference. Therefore, the transcript of the analysis must indicate by what method the analysis was done. If you received the results in a laboratory that determines ESR according to international standards, be sure to check whether the results were adjusted to the standards of Panchenkov indicators.

Interpretation of results: normal ESR values ​​in adults and children

Normal ESR values ​​vary depending on gender, age, and some individual characteristics of the subject.

Normal limits for adults:

  • for men – 2-12 mm/hour;
  • for women – 3-20 mm/hour.

Important:with age, the indicator increases, significantly exceeding normal limits. In older people, a speed of 40-50 mm/hour can be detected, and this is not always a sign of infection, inflammation or other pathology. For women over 60 years of age, figures in the range of 2-30 mm/hour are considered normal, and for men of the same age - 2-20 mm/hour.

Normal limits for children of different ages (in mm/hour):

  • newborns – up to 2;
  • from 2 to 12 months – 2-7;
  • from 2 to 5 years – 5-11;
  • from 5 to 12 years – 4-17;
  • boys over 12 years old 2-15;
  • girls over 12 years old – 2-12.

The most common deviations are in the direction of increasing numbers. The inaccuracy of the analysis may be due to violation of the rules of conduct. Blood for ESR must be donated on an empty stomach in the morning. If the subject was hungry the day before or, conversely, had too much dinner, the results are distorted. In such situations, it is recommended to retake the test after 1-2 days. The ESR result is influenced by the storage conditions of biological material before the study.

What does an increase in ESR indicate?

ESR analysis is famous for its simplicity and low cost, but interpretation of the results often presents certain difficulties. Figures within the normal range do not always indicate the absence of an active pathological process.

It has been established that in a number of patients with diagnosed malignant diseases this indicator is less than 20 mm/hour. As for cancer patients, a significant increase in the red cell sedimentation rate is more typical for individuals with solitary tumors than for patients with malignant blood diseases.

In some cases, no disease is detected in subjects with an ESR of 100 mm/hour or higher.

The main reasons for the increase in ESR:

  • acute and chronic bacterial infections (infectious diseases of the respiratory and urinary systems, as well as);
  • viral infections (including);
  • fungal infections (systemic candidiasis);
  • malignant diseases (tumor neoplasms, lymphomas and myeloma);
  • rheumatological diseases;
  • kidney diseases.

An increase in ESR is also typical for some other diseases and conditions, including:

  • anemia;
  • chronic granulomatous periodontitis;
  • inflammation of the pelvic organs (for example, prostate or appendages);
  • enterocolitis;
  • phlebitis;
  • significant injuries (including bruises and);
  • high tension;
  • conditions after operations.

Important:an increase in the erythrocyte sedimentation rate over 100 mm/hour is most often detected during an active infectious process (including), malignant tumors, oncohematological diseases, systemic connective tissue lesions and kidney diseases.

An increased ESR does not necessarily indicate the presence of pathology. It increases within 20-30 mm/hour in pregnant women, during menstruation, and also when taking certain pharmacological drugs - in particular salicylates (acetylsalicylic acid), complexes containing

It happens that when taking a test, an increased ESR level in the blood is detected. Many people panic, not even knowing what it is. Let's figure out what an increase in ESR means, what it means and how it can affect health.

The medical abbreviation ESR stands for erythrocyte sedimentation rate. This indicator characterizes the presence of an inflammatory process in the body.

Red blood cells are blood bodies and are an integral part of it. These are the most basic blood cells. Their quality, quantity and sedimentation rate directly depend on the general state of health, the presence or absence of any diseases, and age, gender, and chronic diseases also play a role in the sedimentation rate of blood bodies.

ESR is of great importance because it diagnoses pathologies in the body. To determine this indicator, you need to take a blood test. Blood consists of two important components. The first is plasma, and the second is blood bodies - erythrocytes, leukocytes and platelets.

In a healthy body, all these indicators should be normal.

If at least one parameter deviates, it is worth undergoing a full diagnosis, since all organs and systems are interconnected and if at least one indicator is violated, changes in others will begin over time, which can lead to various diseases.

An analysis to determine the erythrocyte sedimentation rate is prescribed in the following cases:

  1. routine medical examination
  2. monitoring of health status in hospital during therapy
  3. if infectious diseases are suspected
  4. in the presence of malignant and benign neoplasms

In principle, a blood test can completely reveal the clinical picture of the body’s condition, therefore, when contacting specialists, the analysis is a necessary measure, based on which the doctor sees whether there are diseases and what their nature is. Thanks to this, it is possible to establish a diagnosis and prescribe a course of treatment.

Methods for diagnosing ESR (preparation and procedure)

As mentioned above, ESR is diagnosed by a blood test. To undergo the examination, there are several recommendations, adherence to which will help to establish all the parameters as accurately as possible. Firstly, blood is donated early in the morning, with the exception of critical situations and inpatient care.

Preparing for analysis:

  • On the eve of the test, it is better to avoid heavy, fatty, salty or too sweet foods.
  • It is also better not to smoke for 1-2 hours before taking blood, as tobacco smoke can distort blood counts.
  • It is strictly prohibited to drink alcohol 1-2 days before donating blood.
  • Before diagnosis, it is recommended not to eat or drink tea/coffee.
  • Also, if the patient takes medications or traditional medicine during this period, it is necessary to inform the doctor about this, since some substances can artificially affect the number of platelets, leukocytes or red blood cells.
  • In addition, physical and emotional stress is undesirable on the eve of blood sampling.

In laboratory conditions, blood is placed in a test tube and left for some time. At first it is of uniform consistency and color, but soon the blood is divided into two parts: red blood cells settle to the bottom and it becomes thick and dark, and a clear and light liquid remains on top - this is plasma, which no longer contains red blood cells. Blood cells settle within a certain period of time, this is the ESR indicator. Since the cells settle in the flask, the value is measured in millimeters per hour. This is how the “digit mm/hour” is designated.

More information about ESR can be found in the video:

Red blood cells tend to connect with each other. Due to this, they become heavier and settle. But if there is an inflammatory process or any pathology in the body, then a special substance is released in the blood that accelerates the union of red blood cells. Accordingly, if they settle too quickly, this indicates some health problems.

If, upon receiving the result of a blood test, an abnormality in erythrocyte sedimentation is detected, then additional diagnostics are prescribed to determine the cause. And only then the doctor will be able to establish a diagnosis and recommend a treatment method.

Diagnosis of erythrocyte sedimentation rate can be carried out in several ways:

  1. Westergren's method, in which blood from a vein is mixed with ethylenediaminetetraacetic acid and diluted with saline. In an hour, the analysis result will be ready. This method is considered the most common for checking ESR.
  2. Panchenkov’s method - an anticoagulant is drawn into a special laboratory capillary at 100 divisions, then biological material taken from a finger is added there. The flask is installed in a vertical position. After an hour, the result will be ready.

Normal for age and pregnancy

The erythrocyte sedimentation rate is a purely individual indicator and depends on many factors. On average, the standard value is considered to be from 2 to 15 mm/hour.

But it should be borne in mind that for women, men, children of different ages and for pregnant women, the standard indicators are different:

  • newborn babies – 0-2 mm/h
  • children, 1 month old. – 2-5 mm/h
  • children up to six months – 2-6mm/h
  • children from 6 months to one year – 3-10mm/h
  • from one to 6 years – 5-11mm/h
  • from 6 to 14 years old, girls – 2-15mm/h
  • from 6 to 14 years old, boys – 1-10mm/h
  • women, up to 35 years old – 8-15mm/h
  • women, after 35 years – up to 20 mm/h. considered normal
  • men, up to 60 years old – 2-10mm/h
  • men over 60 years old – up to 15-16 mm/h

In addition, indicators can increase or decrease with poor nutrition, alcohol consumption, and a sedentary lifestyle, which can lead to problems with the cardiovascular system.

In women, regardless of age, during pregnancy, the erythrocyte sedimentation rate can be four to five times higher than the normal norm. This is not a pathology, since many changes occur during pregnancy and ESR is one of them. For a pregnant woman, up to 40-45 mm/h is a normative indicator.

Reasons for increasing ESR

As already written above, an increased level of ESR signals the development of an inflammatory process in the body. But if we look more globally, there can be a lot of reasons for increasing the erythrocyte sedimentation rate, the most common among them:

  1. diabetes
  2. anemia
  3. tuberculosis
  4. cancer

In infants, the causes of increased ESR may be the following:

  • teething, which usually causes increased body temperature
  • violation of the mother's diet during breastfeeding
  • worms
  • lack of vitamins
  • while taking paracetamol

According to statistics, in 40% of cases the cause of an increase in the number of red blood cells is respiratory viral infections, tuberculosis, and infection of the genitourinary system. Also, some medications can affect an increase in ESR, the use of which must be reported to your doctor.

What to do? How to normalize ESR in the blood

If it turns out that the erythrocyte sedimentation rate is increased, the doctor usually prescribes additional diagnostics to find out the exact reasons that violated this indicator. Additional tests and examination will be able to clarify the clinical picture completely.

After this, the doctor prescribes a course of treatment for the detected disease. After treatment, it is recommended to take another blood test to make sure that the therapy was beneficial.

In addition to the medications prescribed by a specialist, you can additionally help yourself at home using traditional medicine. These can be decoctions and syrups, but they are based on immunostimulating components. These include lemon, calendula, rose hips, string, linden, honey and all bee products. To avoid harm, before self-treatment, it is important to make sure that there is no allergic reaction to these components.

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