The erythrocyte sedimentation rate helps to effectively and timely diagnose various inflammations and pathologies in the body. This is part of a general blood test. Consider why the speed is above or below the norm. How is the ESR analysis performed? What measures to take to normalize the speed?

What is ESR in the blood

Red blood cells are the heaviest elements in blood plasma. If a test tube with blood is placed vertically, it will be divided into two parts - a sediment of brown erythrocytes, translucent plasma. Erythrocytes stick together, becoming heavier than the studied mass.

In a blood test, the rate of sediment formation per hour is estimated in millimeters. Slowdown, acceleration in an adult means the development of the disease. The change in speed shows the response to a particular treatment. The study of ESR as part of a general blood test is certainly carried out in adults and children.

Normal and pathological indicators of ESR

The ESR norm depends on age, gender. The table shows what should be the ESR in children and healthy adults by age.

After 50 years in the blood in men, an ESR of 15 mm / h is considered the norm.

When ESR is above normal

A high erythrocyte sedimentation rate (ESR) does not always mean a serious illness. This can be observed as a result of starvation, a rigid diet, lack of water. The same action causes the intake of fatty foods before taking blood for analysis. The rapid precipitation of elements will cause the recent exercise stress taking contraceptives. Physiological reasons also include allergic reactions, incorrect anti-allergic therapy, the period of menstruation, childbearing and postpartum three weeks in women.

ESR increase above 100 mm/h

Exceeding the ESR of more than 100 mm / h from normal means that the composition of the blood, its physico-chemical parameters have changed. This is possible due to the development of inflammatory reactions, rheumatological, oncological diseases, and before the manifestation of other symptoms. In infectious processes, ESR grows within 2-3 days, not all at once. The reason for the erythrocyte sedimentation rate of more than 100 mm / h can be:

• bronchitis;
• SARS;
• sinusitis;
• cystitis;
• flu;
• pyelonephritis;
• viral hepatitis;
• tuberculosis;
• pneumonia;
• fungal infections.

ESR during pregnancy

During pregnancy, ESR depends on the physique of the woman and the period.

• Overweight women in the first half of pregnancy have an indicator in the range of 17-47 mm / h, in the second half - from 31 to 69 mm / h.
• For thin people, it is normal 21-62 and 39-64 mm per hour, respectively, in the first and second periods of the baby's gestation period.

ESR depends on the level of hemoglobin. The average value is up to 45 mm/h. Due to the high level of plasma, globulins, cholesterol in women, ESR during pregnancy reaches 55 mm / h. Normalizes within a month after childbirth.

Methods for determining ESR in the blood

Several methods are used to determine the level of ESR in the blood. The most common laboratory methods are: Panchenkov and Westergren. Methods differ in the method of sampling the material, the accuracy of the results. What is ESR according to Westergren and ESR according to Panchenkov, what other methods are there, the differences between them are presented in the table.

Method	Peculiarities
Panchenkova	Capillary blood is taken from a finger, mixed on a glass with an anticoagulant 1 to 4, sent to a glass tube with markings. The blood doesn't clot anymore. Within an hour, the height of the column of separated plasma without erythrocytes is measured.
Westergren	Adopted by international standards. The scale for measuring this laboratory test is more accurate - with a large number of divisions. Venous blood is taken. The measurement principle is the same as for the Panchenkov method. The biomaterial is mixed with sodium citrate.
Vintrobu	Examine undiluted blood mixed with an anticoagulant. The disadvantage of this method is the low accuracy at values ​​of more than 60 mm/h due to clogging of the tube with precipitated erythrocytes.

As a result of the study, the distance traveled by erythrocytes in 60 minutes is determined. ESR depends on viscosity, plasma density, element diameter. Nowadays, automated counters are often used for blood analysis, where there is no need to manually dilute the biomaterial and track the change in sediment.

Features of preparation for a blood test for ESR

For proper blood sampling for ESR analysis, you should not eat for about 4 hours before the procedure. A serious fatty breakfast will show a false increase in the indicator. Air bubbles must not be allowed to enter the sampled blood. When taking blood from a finger, the puncture should be sufficient to allow blood to flow out without pressure. When squeezing out, most of the red blood cells are destroyed, which leads to unreliable results.

Diseases in which there is an increased ESR in the blood

The most common causes of increased ESR are the development of infectious processes in tissues and organs, inflammatory diseases. The factors leading to high ESR in the blood are:

• bacterial, fungal, viral infections respiratory tract, urinary system, often accompanied by leukocytosis;
• autoimmune diseases that oversaturate blood plasma with immune complexes (lupus erythematosus, vasculitis, rheumatoid and rheumatic arthritis, scleroderma, thrombocytopenic purpura);
• inflammation accompanied by tissue necrosis, when the breakdown products of proteins enter the bloodstream (oncological formations, purulent, septic diseases, myocardial infarction, pulmonary tuberculosis);
• endocrine pathologies that disrupt metabolism ( diabetes thyrotoxicosis, hypothyroidism);
• diseases of the kidneys, liver, intestines, pancreas;
• hemoblastosis (myeloma, leukemia, lymphogranulomatosis);
• oncological degeneration of the bone marrow;
• poisoning with arsenic, lead;
• side effects of drugs;
• past trauma, postoperative period.

What does a low level of ESR in the blood indicate

Low ESR means a decrease in their ability to combine due to a change in the shape of the bodies, high blood viscosity, and a decrease in pH. This condition of the blood is observed in diseases:

• reactive erythrocytosis;
• mechanical jaundice;
• erythremia;
• high bilirubin;
• muscle atrophy;
• sickle cell anemia;
• exhaustion;
• epilepsy;
• hepatitis;
• anemia;
• mercury poisoning, calcium preparations;
• pathology of the heart, blood vessels;
• inadequate circulation.

The ESR value will be low in vegetarians if they refuse to eat meat and animal products.

With a low ESR, the patient may complain of fever, tachycardia, hyperthermia.

How to return ESR to normal

The first task is to identify the cause of the pathology. This may require additional instrumental, laboratory examinations. A specific disease is treated after a diagnosis is made. At physiological reasons(menstruation, pregnancy, lactation) deviations of the analysis value from the norm ESR normalizes after the influence of these factors.

If the ESR in the blood is reduced

Most common causes reducing the erythrocyte sedimentation rate are physiological processes. To bring the indicator back to normal, it is necessary to stop the action of the provoking factor - fasting, vegetarian nutrition, taking corticosteroids, and bring the water-salt balance back to normal.

If the ESR in the blood is increased

Medicines to reduce ESR should be prescribed exclusively by a general practitioner after diagnosing the disease that caused it. With a low level of hemoglobin in the blood, patients are prescribed B vitamins, iron preparations, folic acid. If a rheumatic disease is diagnosed, corticosteroids are indicated.

Folk remedies help improve overall health and blood composition. After agreeing with your doctor, to normalize the erythrocyte sedimentation rate, you can try beetroot juice, honey, tea with lemon or raspberry, infusion of linden, chamomile.

False positive result

In women, the level of ESR may increase as a result of temporary hormonal disruptions. False positive results can be shown in the following cases:

• high cholesterol;
• after vaccination against hepatitis B;
• taking contraceptives, vitamins of group A;
• obesity;
• elderly age.

An erroneous result occurs due to a violation of the blood sampling technique used by a non-sterile capillary. If there is a suspicion of a false positive result, it is recommended to retake the test after 7-10 days.

© Use of site materials only in agreement with the administration.

Previously, it was called ROE, although some still use this abbreviation out of habit, now they call it ESR, but in most cases they apply the middle gender (increased or accelerated ESR) to it. The author, with the permission of readers, will use the modern abbreviation (SOE) and feminine (speed).

1. Acute and chronic inflammatory processes of infectious origin (pneumonia, syphilis, tuberculosis,). According to this laboratory test, one can judge the stage of the disease, the remission of the process, and the effectiveness of therapy. Synthesis of "acute phase" proteins in the acute period and enhanced production of immunoglobulins in the midst of "military operations" significantly increase the aggregation ability of erythrocytes and the formation of coin columns by them. It should be noted that bacterial infections give higher numbers compared to viral lesions.
2. Collagenosis (rheumatoid arthritis).
3. Heart damage (- damage to the heart muscle, inflammation, synthesis of "acute phase" proteins, including fibrinogen, increased aggregation of red blood cells, formation of coin columns - increase in ESR).
4. Diseases of the liver (hepatitis), pancreas (destructive pancreatitis), intestines (Crohn's disease, ulcerative colitis), kidneys (nephrotic syndrome).
5. Endocrine pathology (, thyrotoxicosis).
6. Hematological diseases (,).
7. Trauma to organs and tissues surgical operations, injuries and bone fractures) - any damage increases the ability of red blood cells to aggregate.
8. Lead or arsenic poisoning.
9. Conditions accompanied by severe intoxication.
10. Malignant neoplasms. Of course, it is unlikely that the test can claim to be the main diagnostic feature in oncology, but its increase one way or another will create many questions that will have to be answered.
11. Monoclonal gammopathy (Waldenström's macroglobulinemia, immunoproliferative processes).
12. High cholesterol ().
13. Impact of some medicines(morphine, dextran, vitamin D, methyldopa).

However, at different periods of the same process or at different pathological conditions ESR does not change in the same way:

• A very sharp increase in ESR up to 60-80 mm/hour is typical for myeloma, lymphosarcoma and other tumors.
• Tuberculosis in the initial stages does not change the erythrocyte sedimentation rate, but if it is not stopped or a complication joins, the indicator will quickly creep up.
• In the acute period of infection, the ESR will begin to rise only from 2-3 days, but may not decrease for quite a long time, for example, with lobar pneumonia - the crisis has passed, the disease is receding, and the ESR is holding on.
• This laboratory test is unlikely to help even on the first day. acute appendicitis, since it will be within normal limits.
• Active rheumatism can take a long time with an increase in ESR, but without frightening numbers, however, its decrease should alert in terms of the development of heart failure (, acidosis).
• Usually, when the infectious process subsides, the first to return to normal are total leukocytes (and remain to complete the reaction), ESR is somewhat delayed and decreases later.

Meanwhile, long-term preservation of high values ​​​​of ESR (20-40, or even 75 mm / h and above) with infectious inflammatory diseases of any kind, most likely, will suggest complications, and in the absence of obvious infections, the presence of some hidden and, possibly, very serious diseases. And, although not in all oncological patients, the disease begins with an increase in ESR, however, its high level (70 mm / h and above) in the absence of an inflammatory process most often occurs in oncology, because sooner or later the tumor will cause significant damage to tissues, damage to which will ultimately As a result, the erythrocyte sedimentation rate will increase.

What can a decrease in ESR mean?

Probably, the reader will agree that we attach little importance to the ESR if the numbers are within the normal range, however, a decrease in the indicator, taking into account age and gender, to 1-2 mm / hour will still raise a number of questions from especially curious patients. For example, general analysis blood of a woman of reproductive age, with repeated examination, "spoils" the level of erythrocyte sedimentation rate, which does not fit into physiological parameters. Why is this happening? As in the case of an increase, a decrease in ESR also has its own reasons, due to a decrease or lack of the ability of red blood cells to aggregate and form coin columns.

Factors leading to such deviations include:

1. Increased blood viscosity, which, with an increase in the number of red blood cells (erythremia), can generally stop the sedimentation process;
2. Change in the shape of red blood cells, which, in principle, due to their irregular shape, cannot fit into coin columns (crescent, spherocytosis, etc.);
3. Changes in physical and chemical parameters of blood with a downward shift in pH.

Such changes in the blood are characteristic of the following conditions of the body:

• (hyperbilirubinemia);
• Obstructive jaundice and, as a result, the release of a large amount of bile acids;
• and reactive erythrocytosis;
• sickle cell anemia;
• Chronic circulatory failure;
• Decreased fibrinogen levels (hypofibrinogenemia).

However, clinicians do not consider a decrease in the erythrocyte sedimentation rate to be an important diagnostic indicator, so the data are given specifically for especially inquisitive people. It is clear that in men this decrease is generally not noticeable.

It will definitely not work to determine an increase in ESR without an injection in the finger, but it is quite possible to assume an accelerated result. An increase in heart rate (), an increase in body temperature (fever), and other symptoms indicating the approach of an infectious and inflammatory disease may be indirect signs of a change in many hematological parameters, including the erythrocyte sedimentation rate.

Video: clinical blood test, ESR, Dr. Komarovsky

The erythrocyte sedimentation rate is an analysis used to detect inflammation in the body.

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

The analysis allows the diagnosis of many disorders (including cancer) and is a necessary test to confirm many diagnoses.

Let's see what it means when the erythrocyte sedimentation rate (ESR) in the general blood test of an adult or a 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 abnormalities. In pediatrics, this analysis helps diagnose rheumatoid arthritis in children or.

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

Many factors such as age or drug use may 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 boost

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

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

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

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

Interpretation of results and possible causes

What does it mean if the erythrocyte sedimentation rate (ESR) in the blood test of an adult or a child is increased or decreased, is it worth being afraid of indicators above the norm or below?

High levels in a blood test

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

• Autoimmune diseases - Liebmann-Sachs disease, giant cell disease, polymyalgia rheumatica, necrotizing vasculitis, rheumatoid arthritis ( the immune system is the body's defense against foreign substances. Against the backdrop of an autoimmune process, it mistakenly attacks healthy cells and destroys body tissues);
• Cancer (this can be any form of cancer, from lymphoma or multiple myeloma to colon and liver cancer)
• Chronic kidney disease (polycystic kidney disease and nephropathy);
• Infection, such as pneumonia, pelvic inflammatory disease, or appendicitis;
• Inflammation of the joints (polymyalgia rheumatica) and blood vessels (arteritis, diabetic angiopathy 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 concentrations of fibrinogen in serum or hypofibrinogenemia;
• Pregnancy and toxicosis;
• Viral infections (HIV, tuberculosis, syphilis).

Because the ESR is a non-specific marker of inflammation and correlates with other causes, the results of the analysis should be taken into account together with the patient's medical 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 match, the specialist can confirm or, conversely, exclude the suspected diagnosis.

If the only increased rate in the analysis is the ESR (against the background total absence symptoms), the specialist cannot give an accurate answer and make a diagnosis. Besides, a normal result does not rule out disease. Moderately elevated levels may be due to aging.

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

This video talks more about the norms and deviations of this indicator in the blood:

Low performance

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

• A disease or condition that increases the production of red blood cells;
• A disease or condition that increases the production of white blood cells;
• If a patient is being treated for an inflammatory disease, a downward grade of sedimentation is a good sign and indicates 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 the shape of cells);
• Severe liver disease.

Any factor can be the reason for the downgrade., 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 (diuretics), taking medications that are high in calcium.

Increased data for diagnosing cardiovascular diseases

In patients with comorbidity or myocardium, ESR is used as an additional potential indicator coronary disease hearts.

ESR used for diagnosis- (inner layer of the heart). Endocarditis develops when bacteria or viruses migrate from some 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 necessarily prescribes a blood test. Along with high levels of sedimentation rate, endocarditis is characterized by a decrease in platelets(lack of healthy red blood cells), often the patient is 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 normal "heart failure," congestive refers to the stage in which excess fluid builds up 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, the analysis for an extended profile may indicate the presence of abnormal cells and infections(sedimentation rate will be higher than 65mm/h).

At myocardial infarction always provoked by an increase in ESR. 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, a condition called "myocardial ischemia" begins.

Against the background of a heart attack, ESR reaches peak values(70 mm/h and above) within a week. Along with an increase in the rate of sedimentation, the lipid profile will show elevated levels of triglycerides, LDL, HDL and cholesterol in the blood serum.

A significant increase in the erythrocyte sedimentation rate is observed against the background of acute pericarditis. This, which begins suddenly, causes blood components such as fibrin, erythrocytes, and leukocytes 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/h), an increase in the concentration of urea in the blood as a result of kidney failure.

The erythrocyte sedimentation rate is significantly increased in the presence of an aortic aneurysm or . Together with high values ​​​​of ESR (above 70 mm / h), there will be an increased arterial pressure, patients with an aneurysm are often diagnosed with a condition called "thick blood".

conclusions

ESR plays an important role in the diagnosis of cardiovascular diseases.. The indicator turns out to be increased 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 are directly correlated with the risk of myocardial infarction and coronary heart disease. For high settling levels and suspected cardiovascular disease the patient is referred for further diagnostics, including echocardiogram, MRI, electrocardiogram to confirm the diagnosis.

Experts use the erythrocyte sedimentation rate to determine the foci of inflammation in the body, the measurement of ESR is a convenient method for monitoring the course of treatment of diseases accompanied by inflammation.

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

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

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

ESR analysis: what is it

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

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

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

When is an erythrocyte sedimentation rate test ordered?

Definition of ESR necessary in the following situations:

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

Preparing and conducting a blood sampling procedure

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

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

Analysis Methodology

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

Panchenkov's method

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

Westergren method

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

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

Deciphering the ESR analysis

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

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

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

ESR increased

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

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

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

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

ESR lowered

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

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

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

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

Wednesday, 03/28/2018

Editorial opinion

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

ESR - erythrocyte sedimentation rate

Erythrocyte sedimentation is the property of erythrocytes to settle at the bottom of the vessel while maintaining the blood in a non-clotting state. Initially, unrelated elements settle, then their agglomeration occurs and the settling rate increases.

There are macro- and micromethods for determining the erythrocyte sedimentation rate (ESR). Blood is taken from a vein (the first group of methods) or from a finger (the second group of methods), mixed with a solution of some anticoagulant, usually sodium oxalate or citrate (1 part of the diluting liquid and 4 parts of blood) and, having drawn the mixture into a graduated pipette, install it vertically. When assessing the erythrocyte sedimentation rate, the time (1 hour) is more often taken as a constant value, relative to which the variable value is estimated - sedimentation.

In our country, the micromethod in Panchenkov's modification is widespread. The determination is carried out in special graduated pipettes having a clearance of 1 mm and a length of 100 mm.

Many factors affect the erythrocyte sedimentation rate. The main ones are qualitative and quantitative changes in blood plasma proteins. An increase in the content of coarsely dispersed proteins (globulins, fibrinogen) leads to an increase in ESR, a decrease in their content, an increase in the content of finely dispersed proteins (albumins) - to its decrease. It is believed that fibrinogen and globulins contribute to the agglomeration of red blood cells, thus increasing the ESR.

A change in the normal ratio of albumins and globulins towards globulins can be associated both with an absolute increase in the level of individual fractions of globulins in the blood plasma, and with a relative increase in their content in various hypoalbuminemias. An absolute increase in the content of globulins in the blood, leading to an increase in ESR, may occur due to an increase in the α-globulin fraction, in particular α-macroglobulin or haptoglobin (plasma gluco- and mucoproteins have a significant effect on the increase in ESR), as well as the y-globulin fraction (most of the antibodies belong to γ-globulins), fibrinogen and especially paraproteins (special proteins belonging to the class of immunoglobulins). Hypoalbuminemia with relative hyperglobulinemia can develop as a result of albumin loss, for example, in the urine (massive proteinuria) or through the intestines (exudative enteropathy), as well as due to impaired albumin synthesis by the liver (with organic and functional albumin lesions).

In addition to various dysproteinemias, ESR is influenced by factors such as the ratio of cholesterol and lecithin in blood plasma (with an increase in cholesterol, ESR increases), the content of bile pigments and bile acids in the blood (an increase in their number leads to a decrease in ESR), blood viscosity (with an increase in viscosity of the ESR decreases), the acid-base balance of the blood plasma (a shift towards acidosis reduces, and towards alkalosis increases the ESR), physiochemical properties erythrocytes: their number (with a decrease in the number of erythrocytes, the ESR increases, and with an increase, the ESR decreases), value (an increase in the volume of erythrocytes contributes to their agglomeration and increases the ESR), hemoglobin saturation (hypochromic erythrocytes agglomerate worse).

Clinical Significance

Normal ESR in women is 2-15 mm per hour, in men - 1-10 mm per hour (more high rate ESR in women is explained by a smaller number of red blood cells in women's blood, a high content of fibrinogen and globulins. With amenorrhea, the ESR becomes lower, approaching the norm in men).

An increase in ESR under physiological conditions is noted during pregnancy, due to digestion, during dry eating and starvation (ESR increases along with an increase in the content of fibrinogen and globulins due to the breakdown of tissue protein), after the administration of certain agents (mercury), vaccination (typhoid fever).

ESR changes in pathology:

1) infectious and inflammatory (with acute infections ESR begins to increase from the 2nd day of the disease and reaches a maximum at the end of the disease);

2) septic and purulent processes cause a significant increase in ESR;

3) rheumatism - an increase is especially pronounced in articular forms;

4) collagenoses cause a sharp increase in ESR up to 50-60 mm per hour;

5) kidney disease;

6) parenchymal lesions of the liver;

7) myocardial infarction - an increase in ESR usually occurs after 2-4 days from the onset of the disease. The so-called scissors are characteristic - a crossover of leukocytosis curves that occurs on the first day and then decreases, and a gradual increase in ESR;

8) metabolic diseases - diabetes mellitus, thyrotoxicosis;

9) hemoblastoses - with multiple myeloma, the ESR rises to 80-90 mm per hour;

10) malignant tumors;

11) various anemias - the increase is insignificant.

Low ESR values ​​are more often observed in processes leading to blood clotting, for example, in cardiac decompensation, epilepsy, some neuroses, anaphylactic shock, and erythremia.