Blood test for ESR: norm and deviations. ESR (erythrocyte sedimentation rate): concept, norm and deviations - why it increases and decreases. What does ESR 4 mean in a blood test

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 (ESR) - erythrocyte sedimentation rate - is a very important characteristic that can indirectly indicate inflammatory and pathological processes in the body, including those occurring in a latent form. The ESR 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;
• for 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 medications before the study. 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 with their own laboratory can provide test results 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. The normal ESR indicators for men and women of different ages are as follows:

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 of 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 affected by some medications, for example, oral contraceptives, theophylline, and taking synthesized vitamin A.

Please 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 blood tests. An increase in erythrocyte sedimentation rate is observed in a variety of 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 a quantitative analysis of C-reactive protein, leukocyte count, and 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.

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 gluing. 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 in 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 cause of increased 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. Adsorbed on negatively charged erythrocytes, they reduce their surface charge and contribute to 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.
Old 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 non-specificity 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 gender.
Old 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.
Breastfeeding.
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 to one 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 one 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 one 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.

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

Previously, it was called ROE, although some still habitually use this abbreviation; now they call it ESR, but in most cases they apply the neuter gender to it (increased or accelerated ESR). With the permission of the readers, the author will use the modern abbreviation (ESR) and the feminine gender (speed).

1. Acute and chronic inflammatory processes of infectious origin (pneumonia, syphilis, tuberculosis,). Using this laboratory test, one can judge the stage of the disease, the subsidence of the process, and the effectiveness of therapy. The synthesis of “acute phase” proteins in the acute period and the enhanced production of immunoglobulins at the height of “military operations” significantly increase the aggregation abilities 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 polyarthritis).
3. Heart lesions ( – damage to the heart muscle, inflammation, synthesis of “acute phase” proteins, including fibrinogen, increased aggregation of red blood cells, formation of coin columns – increased 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. Injury to organs and tissues (surgeries, wounds 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 sign for oncology, but its increase will one way or another create many questions that will have to be answered.
11. Monoclonal gammopathies (Waldenström's macroglobulinemia, immunoproliferative processes).
12. High cholesterol ().
13. Exposure to certain medications (morphine, dextran, vitamin D, methyldopa).

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

• A very sharp increase in ESR 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 occurs, the rate will quickly creep up.
• In the acute period of infection, the ESR will begin to increase 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 recedes, but the ESR persists.
• It is unlikely that this laboratory test will be able to help on the first day of acute appendicitis, since it will be within normal limits.
• Active rheumatism can proceed for a long time with an increase in ESR, but without frightening numbers, however, its decrease should alert us to the development of heart failure (acidosis).
• Usually, when the infectious process subsides, the total number of leukocytes is the first to return to normal (and remain to complete the reaction), the ESR is somewhat delayed and decreases later.

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

What could a decrease in ESR mean?

The reader will probably agree that we attach little importance to ESR if the numbers are within the normal range, but reducing the indicator, taking into account age and gender, to 1-2 mm/hour will still raise a number of questions for particularly curious patients. For example, a general blood test of a woman of reproductive age, when examined repeatedly, “spoils” the level of erythrocyte sedimentation rate, which does not fit into the 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. Changes in the shape of red blood cells, which, in principle, due to their irregular shape, cannot fit into coin columns (sickling, spherocytosis, etc.);
3. Changes in physical and chemical blood parameters with a shift in pH downward.

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

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

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

It is definitely not possible to determine whether your ESR has increased without a finger prick, but it is quite possible to assume an accelerated result. Increased heart rate (), increased body temperature (fever), and other symptoms indicating the approach of an infectious-inflammatory disease can be indirect signs of changes in many hematological parameters, including the erythrocyte sedimentation rate.

Video: clinical blood test, ESR, Dr. Komarovsky

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

Any doctor can interpret this test. ESR is included in the group general blood tests (UAC). If this indicator is elevated, you need to determine the cause of this phenomenon.

What is ESR in the blood?

Those who are prescribed such a study are interested in why an ESR analysis is performed and what it is. So, the abbreviation ESR is the capital letters of the term “ erythrocyte sedimentation rate " Thus, with the help of this test, the settling rate can be determined accurately in the blood.

Red blood cells – these are, as you know, red blood cells. When acting on them anticoagulants over a certain period they settle at the bottom of the capillary or test tube. The time during which a blood sample taken from a patient is divided into upper and lower layers is defined as ESR. It is rated by height layer plasma , which was obtained during the research process, in millimeters per 1 hour. The ESR indicator is nonspecific, however, it has high sensitivity.

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

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

The norm for ESR in men is from 2 to 10 mm/h. A general blood test also determines red blood cells in the blood of men.

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

This value in the diagnostic process is important for:

• differentiation of diagnosis ( And , and , and osteoarthritis etc.);
• determining the body's response during the treatment of patients, lymphogranulomatosis , rheumatoid arthritis etc.;
• determination of a disease that occurs latently (but it should be borne in mind that even normal ESR values ​​​​do not exclude the development of a disease or neoplasm in the body).

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

Diseases in which there is an increased ESR in the blood

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

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

In this case, it does not matter where exactly the infections are localized: the picture of the peripheral blood will still reflect the inflammatory reaction.

This value is always increased in an adult, if there are viral infectious diseases . What specifically causes this indicator to increase is determined by the doctor during a comprehensive examination.

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

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

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

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

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

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

Normal and pathological ESR values

In medicine, the physiological limits of this indicator are determined, which are the norm for certain groups of people. Normal and maximum values ​​are shown in the table:

ESR during pregnancy

If this value is increased at , this is considered a normal condition. The normal ESR rate during pregnancy is up to 45 mm/h. With such values, the expectant mother does not need to be further examined and the development of pathology is not suspected.

Methods used to test ESR blood

Before deciphering what ESR means in a blood test, the doctor uses a certain method to determine this indicator. It should be noted that the results of different methods differ and are not comparable.

Before performing an ESR blood test, it must be taken into account that the obtained value depends on several factors. The general analysis must be carried out by a specialist - a laboratory employee, and only high-quality reagents are used. The analysis in children, women and men is carried out provided that the patient has not eaten food for at least 4 hours before the procedure.

What does the ESR value show in the analysis? First of all, the presence and intensity of inflammation in the body. Therefore, if there are abnormalities, patients are often prescribed a biochemical analysis. Indeed, for high-quality diagnostics it is often necessary to find out in what quantity a certain protein is present in the body.

ESR according to Westergren: what is it?

The described method for determining ESR is Westergren method — today meets the requirements of the International Committee for Standardization of Blood Research. This technique is widely used in modern diagnostics. This analysis requires venous blood, which is mixed with sodium citrate . To measure ESR, the distance of the stand is measured, the measurement is taken from the upper limit of the plasma to the upper limit of the red blood cells that have settled. The measurement is carried out 1 hour after the components have been mixed.

It should be noted that if Westergren's ESR is elevated, this means that this result is more indicative for diagnosis, especially if the reaction is accelerated.

ESR according to Wintrob

The essence Wintrobe method - examination of undiluted blood that was mixed with an anticoagulant. The desired indicator can be interpreted using the scale of the tube in which the blood is located. However, this method has a significant drawback: if the reading is above 60 mm/h, the results may be unreliable due to the fact that the tube is clogged with settled red blood cells.

ESR according to Panchenkov

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

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

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

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

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

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

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

Low value

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

What affects the ESR indicator?

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

• When determined by different methods - according to Westergren et al. - the norm of ESR in the blood of women is higher than that of men. So, an ESR of 25 in a woman may be normal. This is due to the physiological characteristics of blood in women.
• What is the normal ESR level in a woman’s blood depends on whether she is pregnant. For expectant mothers, the norm is from 20 to 45 mm/h.
• A higher ESR is observed in women who take contraceptives . Under this condition, a woman may have a normal ESR of 30. What this means, whether there is a pathology, or whether we are talking about a normal physiological indicator, must be determined by the doctor.
• In the morning, the rate at which red cells settle is higher than in the afternoon and evening, and differences in age do not matter here.
• Signs of accelerated sedimentation are observed when exposed to acute phase proteins.
• If inflammation and an infectious process develops, the values ​​change a day later. how they begin leukocytosis And hyperthermia . That is, on the first day of the disease the indicator can be 10, 14, 15 mm/h, and a day later it can increase to 17, 18, 20, 27, etc.
• ESR is elevated if there is a chronic source of inflammation in the body.
• A reduced value is observed when increased blood viscosity .
• A decrease in sedimentation rate occurs under the influence of anisocytes and spherocytes; the rate becomes greater under the influence of macrocytes.

Elevated ESR in children

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

If red blood cells are elevated in a child’s blood, the reasons for this condition may be the following:

• metabolic disorder ( diabetes , );
• systemic or autoimmune diseases (, rheumatoid arthritis , lupus );
• blood diseases , hemoblastoses , anemia ;
• diseases in which tissue breakdown occurs ( tuberculosis , myocardial infarction , oncological diseases ).

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

Parents must understand that if a child’s red blood cells are higher than normal, this means that a pathological process is taking place in the body.

But sometimes, if a baby’s red blood cells are slightly elevated, this means that some relatively “harmless” factors are influencing:

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

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

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

When can increasing ESR be considered safe?

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

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

A hearty breakfast before the test can also increase this indicator; a strict diet and fasting can also change it.

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

False-positive ESR tests

In medicine there is also the concept of a false positive analysis. An analysis of ESR is considered such if there are factors on which this value depends:

• anemia (there is no morphological change in red blood cells);
• increase in plasma protein concentration , except fibrinogen ;
• hypercholesterolemia ;
• renal failure ;
• obesity high degree;
• pregnancy ;
• old age of a person;
• introduction dextran ;
• a technically incorrect study;
• reception ;
• recent vaccination against hepatitis B .

What to do if the reasons for the increase are not determined?

If the analysis is normal, but the causes of the increased erythrocyte sedimentation rate cannot be determined, it is important to conduct a detailed diagnosis. Should be excluded oncological diseases Therefore, GRA, the norm of leukocytes in women and men are determined. During the analysis process, other indicators are also taken into account - whether the average volume of erythrocytes is increased (what this means - the doctor will explain) or whether the average volume of erythrocytes is decreased (what this means is also determined by the specialist). Urine tests and many other studies are also carried out.

But there are cases when high ESR levels are a feature of the body, and they cannot be reduced. In this case, experts advise regular medical examinations, and if a certain symptom or syndrome appears, consult a doctor.

How to reduce ESR in the blood?

The doctor will tell you in detail about ways to reduce this indicator with the help of medications after the study. He will prescribe a treatment regimen once the diagnosis has been made. It is strictly not recommended to take medications on your own. You can try to reduce it with folk remedies, which are mainly aimed at restoring normal function immune system , as well as for blood purification. Effective folk remedies can be considered herbal decoctions, teas with raspberries and lemon, beet juice, etc. How many times a day to take these remedies, how much you need to drink, you should find out from a specialist.

An important indicator in a general blood test (CBC) is the erythrocyte sedimentation rate (ESR). The marker evaluates the functioning of a person’s internal systems. 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 unit of marker measurement is mm per hour. Within 60 minutes, rapid precipitation of blood cells is observed.

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

Category of people	ESR values, mm/h
In children
In newborns	From 1 to 2
In infants up to 6 months	From 11 to 17
From 7 months to 3 years	From 3 to 10
From 3 to 13 years	From 4 to 12
In adults
In women
From 13 to 18 years old
From 18 to 30 years old	From 3 to 14
From 30 to 40 years old	From 3 to 21
From 40 to 60 years old	From 0 to 27
Since 61	From 3 to 57
During pregnancy	Does not exceed 45
In men
From 14 to 21 years old
From 21 to 50	Does not exceed 14
After 50	Up to 30

Deviations of 1-3 mm/h are considered an acceptable phenomenon if other important blood markers remain within normal limits.

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 explained by 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

A high level of precipitation rate of blood cells is a clear sign of pathology. It is also called accelerated ESR syndrome. According to ICD 10 (international classification of 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 of the 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;
• old 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 levels are observed in early 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.

The methods differ in the accuracy of the results and the specifics of their implementation, but their essence is the same - the combination of biological material with a special reagent.

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 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 accuracy 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 the functioning of internal organs. Therefore, there is no need to purposefully reduce ESR. The values ​​in the clinical analysis are normalized independently after completing a course of drug therapy for a particular disease.

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

• take vitamin complexes and mineral supplements prescribed by your doctor;
• give up 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 identifying the true cause of deviations in the normal ESR.