Why is ESR elevated in women? Increase in ESR

Looking at the results of a general blood test, any experienced doctor will be able to preliminarily assess the patient’s condition. ESR is an acronym that stands for “erythrocyte sedimentation rate.” This result is included in a general blood test and can indicate the onset or progression of an inflammatory disease in the body. Let's figure it out, if the erythrocyte sedimentation rate is increased, what does this mean?

How do doctors determine ESR?

ESR is determined in laboratory conditions. The following measurement technique is common: fresh blood received for analysis is mixed with an anticoagulant substance, left for an hour, and after the elapsed time, the laboratory assistant measures how many mm the blood has been stratified: red blood cells - red blood cells - settle down, and the remaining components rise to the top.

This technique bears the name of the scientist who invented it - Wintrob.

In some medical institutions, special automatic devices are installed that immediately provide the finished ESR result, without the action of a laboratory assistant.

The rate of sedimentation depends on the viscosity of the blood, and therefore on the temperature. Moreover, ESR depends on both body temperature and ambient temperature. This implies two provisions: 1) the temperature in the room in which the blood test is carried out must be strictly established. 2) even temporary overheating or cooling of the body affects the ESR.

ESR norm

• newborns: 0-2.8 mm/h;
• 1 month–six months: 2-6 mm/h;
• six months to a year: 3-9 mm/h;
• year-5 years: 4-11 mm/h;
• 6-14 years: 5-12 mm/h;
• over 14 years: 2-14 mm/h for girls, 1-11 mm/h for boys;

• up to 30 years: 8-16 mm/h;
• from 30 to 59 years: 8-25 mm/h;
• over 60 years: 10-50 mm/h.

• up to 60 years: 6-12 mm/h;
• over 60 years: 15-20 mm/h.

Increased ESR in the blood: what does it mean?

Erythrocytes are another name for red blood cells; they are responsible for transmitting oxygen to all organs and tissues. Red blood cells of a healthy person have a standard shape, size and deposition rate. If any of these indicators changes, especially significantly, the doctor will refer you for further examination in order to find out what problems in the body’s functioning caused such a defect.

The rate of red blood cell deposition increases in acute illnesses caused by bacteria and infections. However, a high ESR level in the blood can be influenced by many other factors, including both the stressful state of the body and inaccurate laboratory conditions. If the erythrocyte sedimentation rate is slightly increased, you may need to do the analysis again; the second time the rate may return to normal. The ESR indicator can be affected by:

• gender: women have higher ESR than men;
• age: ESR varies depending on age, and there is no direct relationship between them;
• pregnancy: pregnancy can cause an increase in ESR in the blood of women;
• taking contraceptives also increases ESR;
• anemia;
• time of analysis: in the morning the ESR is slightly higher than in the evening. This fact works for all people, therefore, for the accuracy of the result, it is recommended to take a general blood test at an earlier time of day.
• increased blood viscosity slows down the sedimentation rate;
• changes in the shape and size of red blood cells also affect ESR.

If the blood test shows elevated ESR, girls and women should consider the possibility of pregnancy; men should consider some diseases that cause increased ESR, which will be discussed below.

Reasons why high ESR

The most common diseases that cause increased ESR can be divided into several categories:

• gallbladder and liver diseases (stones);
• inflammation;
• purulent processes
• strokes, heart attacks;
• anisocytosis – change in the size of red blood cells or platelets;
• sickle anemia;
• hemoglobinopathy;
• obesity;
• stress;
• postoperative period;
• intestinal obstruction;
• diarrhea;
• lupus erythematosus;
• prostatitis;
• lymphoma;
• diabetes;
• rheumatism;
• tuberculosis;
• fractures, injuries;
• malignant tumors
• multiple myeloma.

Especially often, the cause of increased ESR in a blood test is an inflammatory process, however, if the deviation from the norm is significant (for example, by 40-50 units), oncology is suspected.

Since ESR is a test for red blood cells, it may not be influenced by leukocytes. High ESR in the blood with normal leukocytes can be a characteristic of a previous viral disease, when the level of white blood cells is already normal, and the rate of sedimentation of red cells has not yet returned to normal.

In the case of pregnancy, elevated ESR levels in the blood of women are not uncommon. In this interesting situation, the ESR can reach 45 units, and there is no suspicion of pathology in this case.

If you see an increased ESR in yourself or a loved one in the analysis, do not rush to get upset and engage in self-hypnosis. It must be said that in many developed countries, the analysis of ESR is not considered among the general ones, since there are many factors that change it in one direction or the other. Instead, doctors in these countries examine the PSA. So, knowing only how elevated ESR is in the blood of an adult, one cannot draw any clear conclusions.

Increased ESR and ROE in the general analysis mean the same thing. As we already know, ESR is responsible for the sedimentation rate, and ROE literally means “erythrocyte sedimentation reaction.”
Stay healthy and get your blood tested regularly!

Erythrocyte sedimentation rate (ESR) has been used in laboratory practice since the late 19th and early 20th centuries. Polish physician, pathologist and medical historian Edmund Biernacki proposed using erythrocyte sedimentation as a test. More than 120 years ago, E. Bernatsky published discussions about the possible mechanisms of the phenomenon and observations about the differences in reactions in different types of pathology. The analysis was called by the author the erythrocyte sedimentation reaction (ERS). Often, when receiving ESR analysis results that are higher than normal, what does this mean?

Even in the era of Galen and Hippocrates, doctors actively used bloodletting and noticed that the blood, after standing, “stratified.” The bottom layer is denser and colored, and the top layer is transparent and light. It was noticed that in patients the light layer is more pronounced than the dark one. But until the 20th century, the diagnostic value of ESR was not noted.

In 1918, at a congress in Stockholm, Swedish hematologist R. Fareus reported changes in ESR during gestation, considering this analysis a pregnancy test. Later, ESR was considered an objective test for pathological processes in the body.

The essence of the ESR phenomenon is that red blood cells form a sediment under the influence of gravity. The rate of their settling depends on aggregation (sticking together). In various diseases, red blood cells can form large conglomerates and then the ESR increases.

The formation of large conglomerates is due to an increase in:

• fibrinogen and globulin levels;
• plasma viscosity;
• blood cell size.

ESR is affected by:

• analysis method;
• age and gender characteristics.

To obtain discrete results, it is necessary to take into account factors affecting the accuracy of the indicator. The table shows the reasons for changes in ESR in people, regardless of gender and age:

Factors influencing ESR	Fast	Slow
Red blood cell activity	Anemia	Polycythemia
Taking medications	Oral contraceptives	Nonsteroidal analgesics
Lipid disorders	Increased cholesterol	Increased levels of bile acids in the blood
Violation of the acid-base balance of the blood	Acidosis (“acidification”)	Alkalosis (“alkalinization”)
Ambient air temperature when settling the capillary	>+ 27°С	+22°С
Other factors	Pregnancy	Abnormalities in the size and shape of blood cells

The influence of these factors distorts the result of the analysis and must be taken into account when conducting research.

ESR cannot claim to be the “title” of an analysis that provides a comprehensive result. When prescribing it and deciphering the indicators, the doctor must be aware of the diagnostic limitations of the analysis.

Among women

In women under the age of 60 years, the reference value (norm) of ESR is considered to be 2-12 mm/hour. The indicator varies depending on the condition and amount of the main blood components, as well as on the activity of androgynous hormones. For representatives of both sexes there are indicators of normal ESR in the blood in accordance with age. Thus, for women over 60 years of age, it is considered normal< 20 (30) мм/час.

Changes in hormone levels are also observed during gestation, so there is a special table of reference values ​​depending on the stage of pregnancy. Adaptive mechanisms in preparation for childbirth also include changes in the blood. The normal ESR rate in the second half of pregnancy is 40-50 mm/hour.

Since the reference values ​​are the average, and the upper limit of the norm is valid only for 95% of patients, individual calculations of the norm can be made using the Tarelli, Westergren or simpler Miller formulas.

In children

The normal ESR level in the blood of children reflects the characteristics of their development and improvement of various functions of body systems.

So, for example, ESR in the blood of newborns does not exceed 2 mm/hour, which is due to the characteristics of the blood composition:

• high content of red blood cells (hematocrit);
• low amount of proteins and, in particular, globulins;
• high cholesterol levels (hypocholesterolemia);
• low acidosis.

With age, blood counts in children change, and so do ESR values.

So, for example, the norm for ESR in children is:

• newborns: 1-7 days – 1-2 mm/hour; 8-14 days – 4-17 mm/hour; 2-6 months – 17-20 mm/hour;
• preschoolers – 1-8 mm/hour;
• teenagers: girls – 15-18 mm/hour; boys – 10-12 mm/hour.

In children, all indicators of system functioning are more labile (mobile) than in adults. Therefore, they are greatly influenced by external factors, such as environmental conditions. It has been established that in children and adolescents living in unfavorable conditions, blood characteristics differ from the average norm. Thus, in children living in high latitudes (the European North), gender differences in the content of erythrocytes are increased.

They, compared with adolescents from middle latitudes, have significant differences in ESR:

• in girls – 6-8 mm/hour (versus 5-6 mm/hour);
• in young men – 6-7 mm/hour (versus 4–5 mm/hour).

In adolescents living in the North, the normal ESR readings are significantly higher than the normal ESR in the blood of children of middle latitudes. At the same time, the adaptation of girls to high latitude conditions is more pronounced than that of boys.

In men

The normal ESR level in the blood of men is also subject to age-related metamorphosis:

Insignificant - by 1-2 units, an increase in the indicator compared to the norm may indicate attenuation of the pathological process or a violation of the conditions for preparing for the analysis.

If the result deviates by 15-30 units, a minor inflammatory process characteristic of colds can be suspected.

An increase or decrease in the indicator by > 30 units signals a serious process.

An indicator that differs from the norm by 60 or more units indicates severe violations of the condition.

Since ESR itself is uninformative and nonspecific (it cannot accurately indicate the nature and localization of the pathological process), it is prescribed in conjunction with other studies.

Table of ESR norms for women by age

The chemical and physical composition of blood is influenced by many external and internal factors. Since the female body is more susceptible to changes, including hormonal ones, fluctuations in ESR values ​​depending on age in women are more clearly expressed than in men.

Age-related changes occurring in a woman’s body can be divided into 5 blocks:

1. Formation and development of the body.
2. Beginning of puberty.
3. Puberty is the childbearing period.
4. Beginning of menopause.
5. Climax.

Each of the blocks is characterized by its own ESR rate, and the period of puberty has a more detailed division. Below is presented in table form the norm of ESR in women by age:

Age (years)	ESR rate (mm/hour)
	Bottom line	Upper limit
 13	1-4	12
13-18	3	18
19-30	2	15
31-40	2	20
41-50	0	26
51-60	0	26
>60	2	55

In addition to the factors listed above that affect ESR indicators, in women the test result increases when hormonal levels change, which is caused by:

• menstrual cycle;
• pregnancy;
• condition after childbirth and breastfeeding;
• taking oral contraceptives;
• hormone replacement therapy.

Diet has a significant impact on ESR levels in women. Adolescents and young women's obsession with diets leads to deviations of ESR values ​​from the age norm. There are significant differences from the reference values ​​with an increase or decrease in body mass index.

ESR during pregnancy

Different ESR indicators are observed in women at different stages of gestation:

• I trimester – ~ 13-21 mm/hour;
• II trimester – 25 mm/hour;
• III trimester – 30-45 mm/hour.

After childbirth, elevated ESR persists for some time (3-4 weeks or more). An increased ROE during pregnancy indicates that the fetus is developing.

If a woman's ESR level is higher than normal, what does this mean?

In pregnant women, the ESR level is higher than normal, what does this mean? Pregnancy is accompanied by genetically programmed, adaptive processes.

The degree of their severity depends on:

• gestational age;
• number of fruits;
• individual reserve capabilities of the woman’s body.

Even with a physiologically progressing pregnancy, researchers note the presence of signs of systemic inflammation syndrome.

As the gestational age increases, the ESR rate also increases, which is due to:

• a decrease in the number of red blood cells due to an increase in blood plasma volume;
• an increase in the size of red blood cells;
• increased endogenous intoxication;
• activation of anti-inflammatory cytokines;
• decrease in the amount of total blood protein;
• an increase in the volume of fibrinogen in the blood and an increase in its viscosity.

These adaptive mechanisms lead to an acceleration of erythrocyte sedimentation.

Proteins that lead to red blood cell aggregation are localized on the surface of red blood cells. In addition, the charge on the surface of the red blood cell membrane also changes. If at the beginning of pregnancy potassium ions predominate, then by the second trimester their level decreases, and in the third trimester sodium ions predominate. By the end of pregnancy, the total accumulation of sodium ions reaches maximum values. A change in membrane charge leads to “clumping” of blood cells.

In addition, lipid metabolism changes in pregnant women. The amount of cholesterol, triglycerides and fatty acids in the blood increases, which are the material for the synthesis of steroids necessary for the formation of fetal tissue. All of these changes lead to an acceleration of ESR and are a physiological norm during pregnancy. Therefore, ESR during the gestational period loses its diagnostic value as an indicator of the inflammatory process.

But if the ESR significantly exceeds the upper limit of normal, then this may indicate:

• inflammatory processes in the body;
• infections of the urogenital system;
• pyelonephritis caused by the mechanical impact of a growing fetus;
• late gestosis.

The study of blood parameters, including ESR, is carried out at least 4 times during the entire gestational period. The results obtained help determine the presence of obstetric complications in the early period and develop adequate therapeutic correction of the condition.

Methods for determining ESR

Determination of ESR is carried out using several methods. In our country, the method proposed in 1924 by T.P. is still popular. Panchenkov. And abroad they use the Westergren method, which in 1977 was recognized by the International Committee for Standardization in Hematology (ICSH) as a standard. The Westergren method was refined by the Australian hematologist Wintrobe. In Europe and Israel, preference is given to the Wintrobe method, and in America the Wintrobe method is used. How are these methods different?

ESR according to Panchenkov

This method has been used for more than 90 years to determine ESR. Capillary blood is used for research. It is diluted with sodium citrate and placed in a glass tube with an internal cavity diameter of 1 mm.

The simplicity and low cost of the method does not compensate for its inherent disadvantages:

• impossibility of standardizing the method due to the influence of external factors (capillary cleanliness, dilution errors, quality of sodium citrate);
• technical difficulties in obtaining capillary blood (blood hemolysis when squeezing a finger);
• inability to achieve an ideal internal surface and cleanliness of the capillary during repeated use.

The column used in the analysis has a length of 100 mm and is graduated with a step between marks of 1 mm. Due to the small volume of blood in the capillary, it cannot be stored, which is a big disadvantage during screening examinations. In addition, the accuracy of the result is influenced by too many factors, which does not allow standardization of the method.

ESR according to Westergren

When determining ROE according to Westergren, whole venous blood is used. The length of the capillary also differs – it is 200 mm. In the zone of high ESR values, there are differences in the indicators according to Westergren and Panchenkov. So, for example, 70 mm/hour according to Panchenkov corresponds to approximately 100 mm/hour according to Westergren.

Despite the greater accuracy of the Westergren method, it also has a number of disadvantages:

• the inability to use blood for other tests, since blood for general analysis and ESR studies is prepared differently;
• duration is 1 hour;
• high (18.3%) variability of results;
• impossibility of automating the process.

Taking these shortcomings into account, Wintrobe improved Westergren's method.

ESR according to Wintrob

According to the Wintrobe method, blood is taken from a vein, but its amount is less than in the Westergren method, since the column is not 200 mm, but 100 mm. But this method greatly underestimates the result, both in the area of ​​low indicators and in the area of ​​high indicators. So, for example, the table shows the corresponding indicators of the ESR blood test, the norm on different scales:

Therefore, when indicating ESR indicators, it is necessary to mention the method by which the study was conducted.

If the Panchenkov and Westergren methods are comparable in terms of results within normal limits, then the Wintrobe method gives indicators that are not comparable with the two previous methods.

In the 90s of the last century, automatic analyzers were developed that convert the result of repeated measurements of the optical density of a blood sample in accordance with the Westergreen scale. This method does not have the disadvantages listed above and excludes the influence of the human factor.

Diseases in which there is an increased ESR in the blood

Currently, the diagnostic value of the method for determining ESR in various pathological processes is being reviewed.

But for now, an increased ESR value is an indicator of diseases such as:

1. infections caused by various pathological agents:

• bacteria (tuberculosis, genitourinary tract infections, diseases of the upper and lower respiratory tract);
• viruses (viral hepatitis);
• fungal infections affecting internal organs;

2. malignant diseases:

• malignant blood pathologies;
• malignant neoplasms of various organs;

3. rheumatological diseases (arteritis, rheumatism, rheumatoid arthritis, polymyalgia rheumatica);

4. injuries with suppuration and intoxication;

5. immune diseases and conditions;

6. systemic connective tissue diseases (systemic lupus erythematosus, systemic sclerosis, dermatomyositis);

7. kidney pathologies (glomerulonephritis, pyelonephritis, renal failure, urolithiasis);

8. endocrine diseases (diabetes mellitus, hyper- or hypofunction of the thyroid gland);

9. Other states:

• inflammation: gastrointestinal tract, oral organs, ENT organs, pelvis, veins of the lower extremities;
• conditions after surgery;
• anemia;
• sarcoidosis;
• allergic reaction;
• epilepsy.

But an increased ESR is not always a symptom of a pathological process.

When can increasing ESR be considered safe?

In addition to the physical and physiological factors listed above that affect the ESR rate, the following can distort the indicators:

• human factor (error or incompetence of the laboratory assistant);
• use of low-quality reagents;
• non-compliance with the rules of preparation for analysis:
• eating before blood sampling;
• intense physical activity;
• taking hormonal or other medications;
• prolonged violation of the eating and drinking regime (fasting, strict diets, dehydration);
• changes in blood gas and lipid composition.

In children, an increased ESR is observed when:

• lack of vitamins;
• teething;
• changing diet, for example, when switching from breastfeeding to complementary feeding;
• poor nutrition.

The listed factors are easy to correct and do not have a pathogenic effect on the body.

How to reduce ESR in the blood?

In order to reduce elevated ESR, it is necessary to establish the cause, detect and treat the pathology. In the absence of symptoms of the disease, it makes no sense to reduce the ESR; studies are prescribed, which are repeated after a certain period of time. To regularly monitor the level of ESR in the blood, it is necessary to undergo annual studies, and if the indicator increases, additional tests and in-depth research are prescribed.

• ESR - Erythrocyte sedimentation rate - the oldest test for identifying and monitoring the progress of infectious and inflammatory processes in the body

Synonym:

• ESR - erythrocyte sedimentation reaction

The phenomenon of erythrocyte sedimentation has been known since ancient times. Currently, determination of the rate of such sedimentation remains a popular laboratory test, presented as part of a complete blood count (CBC). However, an increased ESR in the blood of women is not always associated with the disease. Is it necessary to measure ESR? If yes, then for what?

ESR - why do red blood cells settle?

Normally, red blood cells - erythrocytes - carry a negative charge. According to the laws of physics, they, being equally charged, repel each other and “float” in the plasma without sticking together. When, under the influence of gravity, red blood cells “fall” down one by one, their sedimentation rate is low.

When the biochemical composition of blood plasma changes, more often when the normal balance between its protein fractions is disrupted, the negative charge of erythrocytes is neutralized. Positively charged proteins, like “bridges,” connect (aggregate) red blood cells with each other into “coin columns.”

Erythrocyte-protein conglomerates are much heavier than individual cells. Therefore, they settle down at a faster rate and the ESR increases.

Proteins that increase erythrocyte aggregation and accelerate ESR:

• Fibrinogen is a marker of inflammatory and destructive processes. Produced in the liver. Its concentration in the blood increases significantly during acute inflammatory processes, as well as in response to the destruction and death (necrosis) of tissues.
• Globulins (including immunoglobulins) are high molecular weight proteins in blood plasma. Produced in the liver, as well as by the immune system. The concentration of immunoglobulins (antibodies) in the blood increases in response to infection.
• Mixed cryoglobulins - in particular, polyclonal Ig G antibodies and monoclonal antibodies Ig M and Ig G to the Fc fragment of Ig G. The combination of the latter is called rheumatoid factor.

Any physiological conditions, nutritional disorders or diseases associated with an increase in these or other proteins in the plasma are manifested by an increase in ESR.

Dysproteinemia is a violation of the quantitative ratio of proteins in the blood.
ESR is a sign of dysproteinemia.
The more pronounced the dysproteinemia, the higher the ESR.

The ESR norm is not the same for women and men. This is probably due to fewer red blood cells and more fibrinogen and globulins in women.

ESR - norm for women by age - table

Reference indicators of ESR are the norm for women

How to calculate a woman’s individual ESR rate by age

To roughly calculate the individually acceptable limit of the upper norm of ESR in a woman, depending on her age, use the Miller formula:

ESR mm/hour = (woman’s age in years + 5): 2

The upper limit of the ESR norm is equal to the figure obtained by dividing the sum (woman's age plus five) by two.

Example:
(55 years + 5) : 2 = 30
The acceptable ESR limit for a 55-year-old woman is 30 mm/hour.

ESR is one of the most nonspecific laboratory indicators

and that's why:

Firstly: ESR increases in many, very different diseases.

Secondly: In a number of diseases, ESR may remain normal.

Third: With age, ESR gradually (by about 0.8 mm/h every 5 years) increases. Therefore, in elderly patients, the diagnostic values ​​of a moderate increase in ESR have not been established.

Fourth: In 5-10% of healthy people, ESR can remain within 25-30 mm/hour for years (the so-called “soy disease”).

Fifth: ESR is influenced by the shape of red blood cells and their number in the blood.

Sixth: In addition to the protein composition of plasma, ESR depends on many of its other biochemical parameters - the amount of bile acids, electrolyte composition, viscosity, cholesterol-to-lecithin ratio, blood pH, etc.

Finally: The ESR norm is not the same in different measurement methods (read below).

Pathological causes of increased ESR in the blood of women

Despite the difficulty of interpretation, a pathological increase in ESR remains an objective criterion for inflammation, infection and necrosis.

Diseases affecting ESR levels

Group of diseases flowing from increase in ESR	Description
Infectious and inflammatory	Various inflammatory, suppurative processes of the upper and lower respiratory tract (including tracheitis, bronchitis, pneumonia, tuberculosis), genitourinary tract associated with infection. Injuries, burns, suppuration of the wound surface.
Immune	Systemic connective tissue diseases (SLE, rheumatoid arthritis, systemic sclerosis, dermatomyositis, etc.). Systemic vasculitis (periarteritis nodosa, Wegener's granulomatosis, Takayasu's disease, temporal arteritis, Buerger's disease, thrombotic thrombocytopenic purpura, hemorrhagic vasculitis). Immunodeficiencies.
Kidney diseases	Nephrotic syndrome. Pyelonephritis. Glomerulonephritis. and etc.
Liver diseases	Hepatitis. Cirrhosis.
Diseases of the blood system, including malignant	Anemia. Leukemia. Lymphomas. Myeloma.
Necrosis	Myocardial infarction. Heart attacks of the brain, lungs, etc.
Endocrine	Diabetes. Thyrotoxicosis. Hypothyroidism. Thyroiditis.
Malignant diseases	Cancer of the lung, breast, gastrointestinal, genitourinary tract, etc.

ESR in myocardial infarction

In some cases, diagnosing atypical forms of myocardial infarction - necrosis of the heart muscle due to impaired coronary blood flow - causes difficulties. Comprehensive clinical and laboratory studies, including dynamic monitoring of changes in ESR, help the doctor to recognize the disease in a timely manner and prescribe the correct treatment.

ESR during a heart attack increases after the disaster has occurred: 1-2 days after the temperature rises and the development of leukocytosis.

In other words, ESR begins to increase from the 3-4th day of illness. The peak of acceleration is expected approximately a week after the heart attack occurs. The ESR returns to normal gradually over the next few weeks.

What ELSE do ESR indicators in women depend on?

Moderate (up to 40-50 mm/hour) acceleration of ESR can periodically appear in completely healthy women. Such a physiological increase in ESR can be associated with menstruation, pregnancy, errors in diet (high-protein diet, abuse of fatty foods, overeating, alcohol), physical overload, excess body weight, stress, age-related changes in the body...

A slight increase in ESR in women cannot be considered an absolute marker of inflammation or other pathology
How do some medications affect ESR?

Increased ESR during pregnancy

In pregnant women, ESR accelerates: the longer the pregnancy, the higher the ESR.

From the third trimester, ESR can exceed the norm by 3 times and reach 45-50 mm/hour.

After childbirth, the ESR remains accelerated from three months to six months, then gradually decreases and returns to normal on its own.

What does high ESR in the blood mean?

How to assess a situation when, apart from an accelerated ESR, there are no other clinical signs of the disease, and the patient does not make any complaints? Let's look at a few examples:

ESR 20 in women - what does it mean?

An isolated increase in ESR up to 20 mm/hour, determined by the Panchenkov method (see below), can be considered a variant of the norm.

When measuring ESR according to Westergren, this indicator for women is the norm.

ESR 25, 30 in women - what does this mean?

In older women, these values ​​are more often regarded as a variant of the hole.

In young and middle-aged women - they may be a variant of the individual norm or indicate the approach of menstruation or pregnancy.

In other cases, an increase in ESR to 30 mm/hour reflects a certain tension of the immune system. All infectious processes or conditions after surgical interventions are associated with the mobilization of the immune system and increased production of protective proteins (immunoglobulin antibodies). Moreover, their maximum accumulation occurs by the 10th day from the onset of the disease and persists 2 or more weeks after recovery (remission). All this time, the ESR will be increased, although the acute stage of the disease (inflammation) has already resolved.

ESR 40 in women - what does this mean?

This acceleration of ESR is not easy to interpret. The best method for diagnosing a possible disease in this situation is a thorough history taking.

If there are no obvious pathological reasons for the increase in ESR (in history, currently), then it is not advisable to conduct complex additional studies. It is enough to do a few simple tests (for example,) or temporarily limit yourself to dynamic observation.

An ESR above 70-75 in a woman - what does this mean?

Such an increase in ESR already indicates a painful condition associated with inflammation, immune disorders, destruction of connective tissue, necrosis or malignancy:
- tuberculosis;
— subacute bacterial endocarditis (infection of the heart valves);
- polymyalgia rheumatica;
- exacerbation of rheumatoid arthritis;
- Crohn's disease, ulcerative colitis;
- temporal arteritis;
- acute renal or hepatic pathology;
- others

But, as a rule, these diseases are associated not only with high ESR - there are more modern and reliable methods for diagnosing them.

If no infectious or inflammatory process is detected, then such a significant acceleration of ESR (above 75 mm/hour) suggests a malignant tumor.

ESR above 100 mm/h – what to do? What does it indicate?

A significant increase in ESR in cancer patients may indicate metastasis—the spread of the tumor beyond the primary site.

The only case of diagnostic use of accelerated ESR (100 mm/hour and above) in oncology is the detection multiple myeloma(malignant bone marrow disease).

Very high ESR values ​​also occur in Hodgkin lymphomas.

Analysis of ESR in neoplasms is often used not for diagnosis, but for dynamic assessment of the effectiveness of treatment and monitoring the course of the disease.

What to do if the ESR in the blood is elevated?

If, upon detection of an accelerated ESR, the doctor decides to examine the patient in detail, then the following diagnostic tactics are recommended:

1. Careful medical history and screening tests: (complete blood count), UAM (general urinalysis), chest x-ray.

If the initial examination does not produce results, then the search for the cause of high ESR continues further:

2. The patient’s outpatient record is studied, the current ESR indicators are compared with the previous ones. ESR is also re-determined to exclude a false-positive result.

3. A blood test is performed to determine the concentration of proteins in the acute phase of inflammation:
— SRB,
- fibrinogen.

4. To exclude polyclonal gammopathy and myeloma, the concentration of immunoglobulins in the blood is determined (by electrophoresis).

If the cause of the elevated ESR is still not found, then it is recommended:

5. Monitoring ESR after 1-3 months.

6. Dynamic monitoring of the patient to detect (exclude) clinical manifestations of the suspected disease.

How to lower ESR in the blood of women and is it worth lowering?

Obviously, to normalize ESR, it is necessary to determine the source of dysproteinemia and eliminate it (i.e., detect and cure the disease or optimize nutrition and lifestyle). After eliminating the factor that accelerates ESR, blood counts will return to normal on their own.

Most often, the cause of an increase in ESR is diagnosed according to the plan described above. But sometimes, to clarify the nature of the disease and at the same time bring the elevated ESR back to normal, the treatment and diagnostic tactics “ex juvantibus” are used.

Algorithm for bringing ESR back to normal
ex juvantibus therapy

Principle of the method: verification of the suspected diagnosis by trial treatment.

1. First, the patient is prescribed broad-spectrum antibiotics. If the ESR does not decrease, then the reason for its acceleration is not an infection.

2. Then steroidal anti-inflammatory drugs are used (glucocorticoids: prednisolone, dexamethasone, etc.). If there is no positive result, then the reason for the acceleration of ESR is not inflammation (immune, autoimmune).

3. Having ruled out infection and inflammation, the patient is examined for oncology (malignant neoplasm).

This primitive-simplified approach in some cases helps to determine a controversial diagnosis.

Methods for determining ESR

ESR according to Panchenkov

Basis of the method:
The ability of red blood cells to settle to the bottom of a vessel under the influence of gravity.

How to do it:
Capillary blood thoroughly mixed with an anticoagulant (sodium citrate) is placed in a special graduated vessel “Panchenkov capillary” with a working scale of 100 mm and left for 1 hour.

The ESR value is taken to be the distance formed in an hour from the upper to the lower boundary of the plasma (to the surface with red blood).

ESR according to Panchenkov is the norm in women

Disadvantage of the method:
distortion of real results due to many non-specific factors.

What affects the accuracy of measuring ESR according to Panchenkov:

• quality of anticoagulant,
• quality and accuracy of the inner diameter of the glass vessel,
• degree of cleanliness of the capillary vessel,
• adequacy of mixing blood with anticoagulant,
• air temperature in the laboratory,
• the adequacy of obtaining a blood sample from a finger prick,
• position of the rack with blood samples...

It is obvious that Panchenkov’s method of measuring ESR, ingenious for its time, is as simple (in execution) as it is inaccurate.

ESR according to Westergren

The principle of measuring ESR with this method is the same as that of the Panchenkov method. But for the study, pure venous blood and a capillary tube 200 mm long are used.

ESR according to Westergren is the norm in women

Determination of ESR by an automatic analyzer

The method involves calculating the kinetics of erythrocyte aggregation. An automatic hemoanalyzer repeatedly (1000 measurements in 20 seconds) records the optical density of the blood being tested. Then, using mathematical algorithms, it converts the results into Westergren ESR units (mm/hour).

Any method of measuring ESR has its advantages and disadvantages. To correctly evaluate the analysis, one must reliably know and take into account all the circumstances influencing its results.

Elevated ESR in the blood of women is not such a rare case. This circumstance is clarified by a blood test. What are the causes of increased erythrocyte sedimentation rate? And, most importantly, how to correct the situation? This will be discussed in the article.

What does ESR mean and what are its standards?

Blood plays an important role in the human body. With its help, the fight against foreign bodies, microbes and viruses occurs. In addition, blood, or rather red blood cells, supplies organs with oxygen and substances for their functioning.

Red blood cells are the largest in the blood and repel each other due to their negative charge. But in the presence of disease, this process becomes insufficiently powerful, and the red blood cells begin to clump together. As a result, the erythrocyte sedimentation rate changes.

To determine this indicator, a blood test is performed. To prevent it from curdling, various chemical elements are added, most often sodium citrate. Further observation is carried out. The analysis itself lasts one hour, during which the erythrocyte sedimentation rate is determined.

Such an analysis should be carried out in the following cases:

• if there is a suspicion of rheumatic diseases;
• with myocardial infarction, with this disease there is a circulatory disorder;
• when carrying a child. ESR in women in this position is always increased;
• if there is a suspicion of various bacterial infectious diseases.

What are the standards for this indicator? High ESR is quite difficult to accurately determine. The fact is that this indicator can vary greatly depending on various factors. Moreover, an increased ESR, if the analysis is taken from a woman, may appear depending on the menstrual cycles. Even the diet a person follows on a daily basis can have a significant impact.

In order for the analysis to give accurate results, you should adhere to the following recommendations from experts:

1. You need to go to the hospital on an empty stomach.
2. One day before, or better yet a little earlier, you should not drink alcohol.
3. The day before the test, it is better to stop taking any medications.
4. Do not overload the body with unnecessary physical activity.
5. It is not advisable to eat fatty foods a few days before taking the test to determine an elevated ESR.

Only by following these rules can you more or less accurately determine whether the ESR is elevated or not.

The norm itself for men is defined as 1-10 millimeters per hour. In women it ranges from 2 to 15 millimeters per hour. During the period of bearing a child, even an indicator of 45 mm per hour will not be considered as exceeding the norm.

As you can see, this blood characteristic can lie in a fairly wide range. But still, if a woman is not pregnant, then a value of 20-25 mm will be considered a violation and will require closer attention from a doctor.

The ESR indicator may change according to the degree of growth. Knowing what stage the patient’s indicator is at, you can make a more accurate diagnosis.

Experts distinguish the following four stages of ESR growth:

1. First. At this stage, the increase in ESR is insignificant. However, all other indicators are normal.
2. The second stage is growth up to 30 mm. This value indicates the presence of minor infectious diseases (for example, ARVI). It is enough to undergo a course of treatment and the indicator will return to normal within a week.
3. The third stage of growth is if the indicator becomes more than 30 mm. This value indicates the presence of a disease that has a serious impact on the entire body. You need to start treatment immediately.
4. The fourth stage is growth up to 60 or more millimeters per hour. In this case, the disease threatens the entire body, and treatment begins immediately.

But it is worth noting that while pregnant, a woman’s erythrocyte sedimentation rate can reach up to 45 millimeters per hour. In this case, treatment is not required, since this value is considered normal for pregnant women.

Why does ESR increase?

What is the reason for increased ESR? Why does the erythrocyte sedimentation rate increase? As mentioned above, such reasons include various rheumatological diseases.

In addition, the reason why this indicator increases may be one or more of the following diseases:

• infectious, bacterial and fungal nature. Among them there may even be non-dangerous acute respiratory viral infections and acute respiratory infections. But the greatest increase in ESR (up to 100) is observed with influenza, bronchitis, and pneumonia.
• for various tumors. In this case, the number of leukocytes may remain normal;
• various diseases of the urinary tract and kidneys;
• anisocytosis, hemoglobinopathy and other blood diseases;
• food poisoning, vomiting and diarrhea and a number of other serious conditions of the body.

As practice shows, the reasons for an increase in ESR in 20% of cases are rheumatic diseases, as well as poisoning of the body. In such cases, the viscosity of the blood increases, which causes the red cells to settle more slowly.

The highest growth occurs when there is an infection in the body. In this case, the ESR may remain normal during the first two days after the onset of the disease. After complete recovery, the ESR value returns to normal, but this happens quite slowly, sometimes it takes a month for normalization.

Sometimes an elevated ESR does not indicate the presence of a disease in the body. This manifestation can be caused by taking certain medications (especially those containing hormones), unhealthy diet, excessive use of vitamin complexes (especially vitamin A), vaccination against hepatitis, and so on. In addition, almost five percent of the population has an individual feature - a constantly elevated ESR. In this case, there is no talk of any disease.

Elevated ESR is also observed in children aged 4 to 12 years. During this period, the formation of the body occurs, which entails such a deviation from the norm. This situation happens especially often in boys.

Women also have their own characteristics that affect changes in ESR. For example, as already mentioned, pregnancy leads to a significant increase in this indicator. Changes begin already in the tenth week of pregnancy. The highest erythrocyte sedimentation rate is observed in the third trimester. The indicator returns to normal after one to two months after the birth of the baby.

Also, the erythrocyte sedimentation rate is affected by menstrual cycles, or rather their beginning. Even the diet that women often use to maintain their figure affects this indicator. The same applies to poor nutrition and overeating.

Treatment

An elevated ESR in itself is not a disease. Therefore, it is necessary to treat the underlying ailment, which led to the change in the indicator. In some cases, no treatment is given at all. For example, the erythrocyte sedimentation rate will not change until a wound heals or a broken bone heals. Also, treatment is not required if the elevated ESR is a consequence of a woman carrying a child.

To find out the reason for the increase in this indicator, it is necessary to conduct a comprehensive examination. As a result, the doctor will identify the presence of the disease and the necessary treatment will be prescribed. Only by defeating the underlying disease can an elevated ESR be normalized.

Women should pay special attention to their health during pregnancy. During this period, she is responsible for the fetus. And as you know, any change in the mother’s body inevitably affects the development of the unborn child. If during pregnancy a woman experiences an increased ESR, then it is necessary to try to prevent anemia. To do this, you must strictly follow the correct diet. Also during this period, your doctor may prescribe medications that improve the body's absorption of iron.

If the cause of the increased erythrocyte sedimentation rate is an infectious disease, then a course of antibiotics is prescribed. However, it cannot be interrupted, as this will lead to the neglect of the disease.

For women carrying a child, taking antibiotics is undesirable. But here the lesser of evils is chosen.

Some infectious diseases, if left untreated, can affect the development (both physical and mental) of the fetus. In this case, it is better to take a course of antibiotics under the supervision of a doctor than to harm the child’s health.

Often the reason for a slight increase in the value of this indicator is poor nutrition. With an increased content of fatty foods in the diet, the ESR value may increase. In this case, a balanced diet will help return it to normal. She will also be able to correct the situation if the increase in ESR was caused by a lack of a number of vitamins in the body. The doctor prescribes a course of medications or prepares a diet.

Any treatment should only be carried out in consultation with a specialist. Of course, if the increase in ESR is caused by a simple cold, then you can use those medications that help you. But in the absence of acute respiratory viral infections and acute respiratory infections and with an increased ESR, it is better to consult a doctor and follow all his instructions.

It is worth remembering that some infectious diseases can cause significant harm to the body. This is especially true for women while pregnant. Infection and other illnesses can harm the development of the fetus, so treatment should begin immediately.

ESR or erythrocyte sedimentation rate is an integral part of a general clinical blood test, which shows how many red blood cells will undergo agglomeration per hour and settle to the bottom of the test tube. This analysis cannot be called specific, since it does not indicate any specific disease; at the same time, ESR has great diagnostic value due to the fact that its increase can indicate pathological processes at the very beginning of their development.

Red blood cells settle most quickly in women, the lowest rate in children, which is determined by the physiological characteristics of protein metabolism, the structure of blood elements and a number of other indicators.

Physiological limits of normal ESR:

• Children under 12 years of age – 0-2 mm/h;
• Girls and women – 3-16;
• Boys and men – 2-11.

Immediate causes of increased ESR

To understand under what circumstances red blood cells begin to stick together and settle faster, you need to understand what factors influence the loss of bioelectric potential by the red blood cell membrane and increase the rate of their gluing. First of all, it should be taken into account that blood is an independent tissue containing a variety of cells, substances and liquids that maintain constant interaction. Among the reasons that can affect the adhesion of red blood cells are the following:

• An increase in the amount of bile pigments and acids in the blood, which occurs in a number of diseases of the liver, gall bladder and its ducts;
• Acidosis or a change in blood pH to the acidic side, which is observed in most inflammatory diseases, as well as in cases of serious errors in the diet;
• Changes in blood viscosity, which are usually caused by bleeding, diarrhea and debilitating vomiting, as well as some types of cancer;
• Changes in the ratio between protein fractions of the blood, the predominance of albumins, as well as immunoglobulins of class G and E - such biochemical indicators are characteristic of the development of inflammatory processes in the body;
• An increase in the number of red blood cells is a typical symptom of respiratory failure, which is noted in pathologies of the heart and lungs;
• The appearance in the blood of immature forms of red blood cells that are not able to perform their functions, as a result of which their agglomeration and sedimentation can be characterized as a protective mechanism.

What disease can an increased ESR indicate?

The most common reason for an increase in ESR is the development of inflammatory processes in organs and tissues, which is why many perceive this reaction as specific. However, this is not the case. Based on immediate, biochemical reasons, it should be concluded that the rate of red blood cells clumping into piles can indicate a wide variety of diseases. For example, an increase in the level of bile pigments and acids in the blood is detected not only with hepatitis and cholecystitis, but also with protein, fatty hepatosis, cirrhosis and liver cancer.

In general, the following groups of diseases can be distinguished in which the sedimentation rate of red blood cells increases:

• Diseases of the liver and biliary tract;
• Inflammatory, purulent and septic diseases;
• Processes accompanied by tissue destruction and necrosis, for example, heart attacks and strokes, tuberculosis and malignant tumors;
• Blood diseases - sickle anemia, anisocytosis, hemoglobinopathies;
• Metabolic diseases and pathologies of the endocrine glands - thyrotoxicosis, diabetes mellitus and others;
• Malignant degeneration of the bone marrow, in which red blood cells enter the blood without being ready to perform their functions;
• Acute conditions that increase blood viscosity - bleeding, diarrhea, vomiting, intestinal obstruction;
• Autoimmune diseases - lupus erythematosus, rheumatism, scleroderma and others.

In addition, an increase in ESR to 20-25 mm/h is often observed in women during pregnancy and after menstruation, which is primarily associated with iron consumption and, as a consequence, iron deficiency anemia.