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Erythrocyte sedimentation rate 4. Normal ss value for women

Thanks to the achievements of modern medicine, many diseases and disorders can be detected at the very beginning of their development, which increases the chances of a complete recovery of the patient.

Usually, the progression of a disease in the human body is reflected in the composition of the blood, and it is its analysis that helps to determine the cause of various changes. One of the components of a general blood test is the red blood cell sedimentation rate or. If the analysis blood ESR increased, it is important to identify the cause of this condition.

Reasons for increasing ESR

Experts identify several reasons that can cause an increase in ESR in human blood. The main reason for the development of this phenomenon is considered to be an increase in the ratio of protein globulins to albumins in the blood. This pathological condition develops as a result of active life. pathogenic microorganisms entering the human body.

When they enter the body, there is a significant increase in the level of globulins, which perform protective functions. The result of this is an increase in ESR, which indicates the onset of inflammation.

Mostly in the human body, pathologies develop, the localization of which becomes various departments. respiratory tract and urinary tract.

In addition, an increase in ESR can occur for the following reasons:

Progression of oncological diseases in the human body. Most often, an increase in this indicator is observed when diagnosing malignant neoplasms, the localization of which is such organs as:, , , , , bronchi, , nasopharynx.
The development of rheumatological pathologies in the human body, which include: , temporal arthritis,rheumatic polymyalgia.
One of the negative factors that can provoke an increase in ESR are various functional disorders. In addition, ESR may change after surgery and with the development of inflammation of the pancreas and gallbladder.
In some cases, the following reasons may cause an increase in ESR: an increase or decrease in the amount, failures in the process of formation of protein molecules in such an organ as, a change in the ratio of the components of the internal environment of the human body.
Usually, there is an increase in the ESR with intoxication of the body of a different nature and with the loss of a large amount of blood.

False positive analysis

An increase in the ESR in the human body usually indicates the development of some kind of inflammatory process, however, in some cases, an increase in the rate can be completely safe and does not require any therapy.

This usually happens in the following cases:

eating before the event
following a strict diet or fasting
period or after childbirth
menstruation

In addition, there is such a thing as a false positive analysis. An increase in ESR in the body is not a sign of the development of any pathology in the presence of the following factors:

patient taking vitamin A
the development of a vaccine against
the patient is elderly
pregnancy period
high weight
development that does not cause morphological changes in erythrocytes
an increase in the content of all plasma proteins with the exception of fibrinogen
disruption of work
administration of dextran
occurrence of technical errors during diagnostics

Features of treatment with an increase in ESR

With an increase in the rate of sedimentation of red blood cells, treatment is usually not prescribed, since such an indicator is not considered a disease. To confirm the absence of pathology in the body, a complex is prescribed to help confirm possible concerns.

Treatment is prescribed taking into account the cause that caused the deviation from the norm. It is for this reason that only a comprehensive diagnostic examination is able to determine the symptoms of a particular pathology in a patient.

It is possible to normalize elevated ESR in the blood with the help of means traditional medicine and one of the most effective recipes the following recipe is considered:

it is necessary to boil the beets on medium heat for 3 hours, then cool the broth
50 ml of this decoction should be drunk every day before breakfast for one week
after 7 days, a break is made for a week and, if necessary, the treatment is repeated again

It is necessary to use traditional medicine recipes with increased ESR only if any pathology is identified by a specialist.

It is worth paying attention to the treatment of elevated ESR in the blood in children, since the reasons for the development of such pathological condition V early age may be different.

ESR indicators in children can increase with improper nutrition and not getting enough vitamins into the body, as well as with teething. In the event that there are no other significant deviations in indicators, then parents should not worry. In the event that an increase in ESR is combined with the child's complaints about his condition, then a comprehensive examination is prescribed to make a diagnosis.

Most often, an increase in ESR in the body of a child indicates the development of an infectious-inflammatory process, which can be detected not only with the help of analysis. Usually, with the development of the disease in children's body there is a change in other indicators.

In addition, the progression of pathologies of an infectious nature in children is usually accompanied by the appearance of additional symptoms and a deterioration in the general state of health.

Indicators of ESR in the body of a child can also increase with non-communicable diseases:

various failures in metabolic processes
development, hemoblastoses and blood pathologies
progression of pathologies, which are characterized by the process of tissue breakdown
injuries of various nature
development of systemic and autoimmune diseases

It is important to remember that after the complete recovery of the child, the normalization of the process of sedimentation of red blood cells takes a long time. In order to make sure that the inflammatory process has stopped, it is recommended to donate blood for C - reactive protein.

Useful video - ESR in the blood: reasons for the increase

Some quite harmless factors can cause a slight increase in ESR in the body of a child:

increasing the values of baby may be the result of malnutrition of the nursing mother
administration of drug therapy
baby teething
appearance of worms
imbalance of vitamins and minerals

ESR is considered one of the important indicators of a patient's health, because it is he who first begins to respond to various changes and diseases in the human body. It is for this reason that one should not be indifferent to this diagnostic method and neglect it. A blood test for ESR allows you to identify various and failures in the body in the early stages of their development and prescribe effective treatment.

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

In clinical practice, the definition of ESR is accessible, easy to do method to assess the patient's condition and assess the course of the disease when performing the test in dynamics.

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

Erythrocyte sedimentation rate- non-specific 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 leukocytes and an increase in the concentration of C-reactive protein, which is a biochemical non-specific 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 erythrocytes leads to a change in the membrane properties of blood cells, contributing to their gluing. This leads to an increase in ESR.

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

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

The erythrocyte sedimentation rate is estimated from the height of the formed plasma layer in millimeters per 1 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 action of gravity, erythrocytes settle to the bottom.

The process of sedimentation (sedimentation) of erythrocytes can be divided into 3 phases that occur at different rates:
1.erythrocytes slowly settle into individual cells
2.erythrocytes form aggregates - "coin columns", and sedimentation occurs faster
3. a lot of erythrocyte aggregates are formed, their sedimentation first slows down, and then gradually stops

Determination of ESR in dynamics, in combination with other tests, used to monitor the effectiveness of treatment inflammatory and infectious diseases.

FACTORS AFFECTING ESR

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.

During the day, fluctuations are possible, the maximum level is noted in daytime.

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

Elevation of 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 the erythrocyte sedimentation rate is noted 24 hours after the temperature increase and the increase in the number of leukocytes.

For chronic inflammation an 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 erythrocyte aggregation. Macrocytes have a charge corresponding to their mass and settle faster.

With anemia drepanocytes affect ESR so that even with inflammation, ESR does not increase.

The ESR value depends on gender and age:
in newborns, ESR is very slow - about 2 mm, which is associated with a high hematocrit and a low content of globulins
by 4 weeks, ESR is slightly accelerated,
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 the elderly, the normal ESR level ranges from 2 to 38 in men and from 2 to 53 among women.

REASONS FOR CHANGES IN ESR

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

With anemia, accompanied, as you know, 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.

Increasing the value of ESR

Most common cause increase in ESR is an increase in the content of coarse proteins in the plasma (fibrinogen, a- and g-globulins, paraproteins), as well as a decrease in the content of albumins. Coarsely dispersed proteins have a smaller negative charge. Being 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 can be:
infections, inflammatory diseases, tissue destruction.
Other conditions leading to an increase in plasma fibrinogen and globulins, such as malignant tumors, paraproteinemias (eg, macroglobulinemia, multiple myeloma).
Myocardial infarction.
Pneumonia.
Liver diseases - hepatitis, cirrhosis of the liver, cancer, etc., leading to severe dysproteinemia, immune inflammation and necrosis of the liver tissue.
Kidney disease (especially accompanied by nephrotic syndrome (hypoalbuminemia) and others).
collagenoses.
Diseases endocrine system(diabetes).
Anemia (ESR increases depending on the severity), various injuries.
Pregnancy.
Poisoning by chemical agents.
Elderly age
Intoxication.
Trauma, broken bones.
Condition after shock, surgical interventions

Decreased ESR value

Three main factors contribute to the reduction of ESR:
1) blood clots
2) acidosis
3) hyperbilirubinemia

And so, the reason for lowering the ESR value can be:
Polycythemia.
Sickle cell anemia.
Spherocytosis.
Hypofibrinogenemia.
Hyperbilirubinemia.
Starvation, loss of muscle mass.
Taking corticosteroids.
Pregnancy (especially 1st and 2nd semester).
Vegetarian diet.
Hyperhydration.
Myodystrophy.
Severe symptoms of circulatory failure.

REMEMBER!!!

The increase in ESR is very sensitive, But non-specific 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 - multiple 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 THE RESULTS OF THE DETERMINATION OF ESR

The results of determining the ESR can be considered reliable only if, if no other parameters, except for the assumed ones, affect the indicator under study. Too many factors influence the results of the test, and therefore its clinical significance should be reconsidered.

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

There are 3 main factors that affect erythrocyte aggregation:
surface energy of cells
cell charge
dielectric constant

The last indicator is a characteristic of the 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 erythrocytes, leading to agglutination and sticking (formation of columns) of erythrocytes 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 an acute phase marker, 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, except for the presence and severity of the inflammatory process, affect ESR, which casts doubt on the clinical significance of the test.

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

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

Sources of errors when running an analysis:
If the test blood is at room temperature, the ESR should be determined no later than 2 hours after taking the blood. 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 should be warmed to room temperature.
To obtain correct results, the determination of ESR should be performed at 18-25°C. With more high temperatures the value of ESR increases, and at lower values it slows down.
The venous blood must be well mixed prior to analysis to ensure better reproducibility of the results.
Sometimes, more often with regenerative anemia, there is no sharp boundary between the erythrocyte column and plasma. Above the compact mass of erythrocytes, a light "veil" of several millimeters is formed, mainly from 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 evaluation of the degree of correlation with glass capillary pipettes.

Factors distorting the result:
Wrong choice of anticoagulant.
Insufficient mixing of blood with anticoagulant.
Late sending of blood to the laboratory.
Using too thin a needle to puncture a vein.
Hemolysis of a blood sample.
Thickening of the blood 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 erythrocytes to settle at the bottom of the vessel under the influence of gravity.

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

Panchenkov's 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).

Research progress:
A 5% solution of sodium citrate is drawn into Panchenkov's capillary to the mark of 50 (letter P) and blown onto a watch glass. From a finger prick, holding the capillary horizontally, draw blood up to the mark 0 (Letter K). Then blood is blown onto a watch glass with sodium citrate, after which blood is drawn a second time to the 0 mark and released in addition to the first portion. Therefore, on a watch glass there is a ratio of citrate and blood equal to 1:4, i.e. four volumes of blood in one volume of the reagent. Mix the blood with the end of the capillary, draw it up to the 0 mark and place it strictly vertically in the Panchenkov apparatus. An hour later, note the number of millimeters of the plasma column.

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

!!! This is an international method for determining ESR. It differs from the Panchenkov method in the characteristics of the test tubes used and in the scale of results calibrated in accordance with the Westergren method. The results obtained by this method, in the region of normal values, coincide with the results obtained when determining ESR method Panchenkov. But the Westergren method is more sensitive to an increase in ESR, and the results in the zone of elevated 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: 0-10mm/h
adults,<50 лет, М: 0-15 Ж: 0-20 >50 years, M: 0-20 W: 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 erythrocytes. Therefore, poikilocytosis slows down settling; on the other hand, a change in the shape (flattening) of erythrocytes in obstructive liver diseases leads to an acceleration of sedimentation. The sensitivity of ESR to the detection of plasma protein pathology is better in the absence of anemia; in anemia, REZ is preferred. The Wintrobe method is more sensitive in the normal or slightly elevated ranges, while the Westergren method is more sensitive in the elevated ranges. The micromethod can be useful in pediatrics. ESR should not be used as a screening method for disease detection in asymptomatic patients. With the acceleration of ESR, a thorough questioning and physical examination of the patient usually allows us to find out the cause. The test is useful and indicated for the diagnosis and monitoring of patients with temporal arteritis and polymyalgia rheumatica. ESR is of little diagnostic value in RA, but may be useful in monitoring disease activity when clinical manifestations are uncertain. Since the test is often not modified 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.

4. Research method: according to Wintrobe.

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

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

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

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

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

ESR - Erythrocyte sedan - the oldest test for detecting and monitoring the course of infectious and inflammatory processes in the body

Synonym:

ROE - erythrocyte sedimentation reaction

The phenomenon of erythrocyte sedimentation has been known since ancient times. At present, the determination of the rate of such subsidence remains popular. laboratory research presented as part of a complete blood count (CBC). However increased rate ESR in the blood in women is not always associated with the disease. Should ESR be measured? If yes, then why?

ESR - why do erythrocytes settle?

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

When the biochemical composition of blood plasma changes, more often, when the normal balance between its protein fractions is disturbed, 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 rises.

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 in acute inflammatory processes, as well as in response to the destruction and death (necrosis) of tissues.
Globulins (including immunoglobulins) are high molecular weight plasma proteins. Produced in the liver and by the immune system. The concentration of immunoglobulins (antibodies) in the blood increases in response to an 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, eating disorders or diseases associated with an increase in these or other proteins in 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 dysproteinemia, the higher the ESR.

ESR norm women and men are not the same. This is probably due to a smaller number of red blood cells, a large amount of fibrinogen and globulins in women.

ESR - the norm in women by age - table

Reference indicators of ESR - the norm in women

How to calculate the individual rate of ESR in a woman by age

For an approximate calculation of the individual allowable limit of the upper norm of ESR in a woman, depending on her age, use the Miller formula:

ESR mm / hour \u003d (woman's age in years + 5): 2

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

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

ESR is one of the most non-specific laboratory parameters

and that's why:

First: ESR rises in many, very different diseases.

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

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

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

Fifth: ESR is affected by the shape of red blood cells, their number in the blood.

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

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

Pathological causes of increased ESR in the blood in women

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

Diseases that affect ESR

group of diseases flowing from increase in ESR	Description
Infectious-inflammatory	Various inflammatory, suppurative processes of the upper and lower respiratory tract (including tracheitis, bronchitis, pneumonia, tuberculosis), urinary 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 disease	nephrotic syndrome. Pyelonephritis. Glomerulonephritis. and etc.
Liver disease	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, diagnosis atypical forms 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 timely recognize the disease and prescribe the right treatment.

ESR during a heart attack rises after a catastrophe: 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. Peak acceleration is expected about a week after the incident heart attack. 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 may occur periodically in quite healthy women. Such a physiological increase in ESR may be associated with menstruation, pregnancy, dietary errors (high-protein diet, fatty foods, overeating, alcohol), physical overload, overweight, stress, age-related changes in organism…

A slight increase in ESR in women cannot be considered an unconditional marker of inflammation or other pathology.
How do some medicines on ESR

Increased ESR during pregnancy

In pregnant women women ESR accelerates: the longer the gestational age, the higher the ESR.

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

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

What does high ESR in blood mean?

How to assess the situation when, apart from the accelerated ESR, there are no other clinical signs diseases, and the patient does not show 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 / h, determined by the Panchenkov method (see below), can be considered a variant of the norm.

When measuring ESR according to Westergren, such an 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 burrow variant.

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

In other cases, an increase in ESR to 30 mm / h reflects a certain tension in the immune system. All infectious processes or conditions after surgical interventions are associated with the mobilization of immunity and increased production of protective proteins (immunoglobulin antibodies). Moreover, their maximum accumulation occurs by the 10th day from the onset of the disease and is retained 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 it mean?

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

If there are no obvious pathological reasons for the increase in ESR (in history, at present), then complex additional research impractical. It is enough to make a few simple tests (for example, ) or temporarily limit yourself to dynamic observation.

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

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

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

If an infectious or inflammatory process is not detected, then such a significant acceleration of ESR (above 75 mm / h) 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 focus.

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

Very high ESR values are also found in Hodgkin's lymphomas.

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

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

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 history taking and screening tests: (general blood count), OAM (general urinalysis), chest x-ray.

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

2. The outpatient card of the patient 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 carried out for 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 increased ESR is still not found, then it is recommended:

5. ESR control after 1-3 months.

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

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

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

Most often, the diagnosis of the cause of an increase in ESR is carried out according to the plan described above. But sometimes, in order 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
therapy "ex juvantibus"

Method principle: verification of the alleged diagnosis by trial treatment.

1. First, the patient is prescribed antibiotics a wide range actions. If the ESR does not decrease, then the reason for its acceleration is not an infection.

2. Then steroid 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 excluded infection and inflammation, the patient is examined for oncology (malignant neoplasm).

Such a primitively simplified approach in some cases helps to determine the controversial diagnosis.

Methods for determining ESR

ESR according to Panchenkov

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

How do:
Thoroughly mixed with an anticoagulant (sodium citrate) capillary blood is placed in a special graduated vessel "Panchenkov's capillary" with a working scale of 100 mm and left for 1 hour.

The distance from the upper to the lower border of the plasma (to the surface with red blood) formed per hour is taken as the ESR value.

ESR according to Panchenkov - 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:

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

Obviously, Panchenkov's method of measuring ESR, brilliant for its time, is as simple (in execution) as it is inaccurate.

ESR according to Westergren

The principle of measuring ESR by 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 - the norm in women

Determination of ESR by an automatic analyzer

The method consists in calculating the kinetics of erythrocyte aggregation. An automatic hemoanalyzer repeatedly (1000 measurements in 20 seconds) records the optical density of the studied blood. Then, using mathematical algorithms, it converts the results obtained into units of ESR according to Westergren (mm / h).

Any method of measuring ESR has its advantages and disadvantages. For a correct assessment of the analysis, it is necessary to reliably know and take into account all the circumstances that affect its results.

Erythrocytes - red blood cells - are the most important component of the blood, since they carry out several basic functions of the circulatory system- nutritional, respiratory, protective, etc. Therefore, it is necessary to know all their properties. One of these properties is erythrocyte sedimentation rate- ESR, which is determined by a laboratory method, and the data obtained carry information about the state of the human body.

ESR is determined when donating blood for OA. There are several methods for measuring its level in the blood of an adult, but their essence is almost the same. It consists in the fact that a blood sample is taken under certain temperature conditions, mixed with an anticoagulant to prevent blood clotting and placed in a special tube with graduation, which is left upright for an hour.

As a result, after the time has elapsed, the sample is divided into two fractions - erythrocytes will settle on the bottom of the tube, and a transparent plasma solution is formed on top, along the height of which the sedimentation rate is measured for a given period of time (millimeter / hour).

The norm of ESR in the body of a healthy adult differs according to age and gender. In men it is:
2-12 mm/h (up to 20 years);
2-14 mm/h (from 20 to 55 years);
2-38 mm/h (from 55 years and above).

Among women:

2-18 mm/h (up to 20 years);
2-21 mm/h (from 22 to 55 years old);
2-53 mm / h (from 55 and above).

There is an error of the method (no more than 5%), which should be taken into account when determining the ESR.

What causes an increase in ESR

ESR mainly depends on the concentration in the blood albumin(protein) because decrease in its concentration leads to the fact that the speed of erythrocytes change, and hence the speed with which they will settle changes. And this happens precisely during adverse processes in the body, which makes it possible to use the method as an additional one when making a diagnosis.

To others physiological reasons for the increase in ESR include changes in blood pH - this is affected by an increase in blood acidity or its alkalization, which leads to the development of alkalosis (acid-base imbalance), a decrease in blood viscosity, changes in the external shape of red cells, a decrease in their level in the blood, an increase in such blood proteins such as fibrinogen, paraprotein, α-globulin. It is these processes that lead to an increase in ESR, which means that they indicate the presence of pathogenic processes in the body.

What does elevated ESR in adults indicate?

When changing the indicators of ESR, one should understand the initial reason for these changes. But not always the increased value of this indicator indicates the presence of a serious disease. So, temporary and acceptable reasons(false positive), in which you can get overestimated research data, consider:

elderly age;
menstruation;
obesity;
strict diet, starvation;
pregnancy (sometimes it rises to 25 mm / h, as the composition of the blood at the protein level changes, and hemoglobin levels often decrease);
postpartum period;
daytime;
the ingestion of chemicals into the body, which affects the composition and properties of the blood;
influence hormonal drugs;
allergic reaction of the body;
vaccination against hepatitis B;
taking vitamins of group A;
nervous tension.

pathogenic causes. for which an increase in ESR is detected and which require treatment are:

strong inflammatory processes in the body, infection;
tissue destruction;
the presence of malignant cells or blood cancer;
ectopic pregnancy;
tuberculosis disease;
infections of the heart or valves;
problems of the endocrine system;
anemia;
problems with the thyroid gland;
kidney disease;
problems with gallbladder and gallstone diseases.

Do not forget about such a reason as a distorted result of the method - if the conditions for conducting the study are violated, not only an error occurs, but often false positive or false negative results are given.

Diseases associated with ESR above normal

A clinical blood test for ESR is the most accessible, due to which it is actively used and confirms, and sometimes establishes, the diagnosis of many diseases. Increased ESR by 40% cases determines diseases associated with infected processes in the body of an adult - tuberculosis, inflammation of the respiratory tract, viral hepatitis, infections urinary tract, the presence of fungal infections.

In 23% of cases, ESR increases in the presence of cancer cells in the body, both in the blood itself and in any other organ.

17% of people with an increased rate have rheumatism, systemic lupus erythematosus (a disease in which the human immune system recognizes tissue cells as foreign).

In another 8%, an increase in ESR is caused by inflammatory processes in other organs - the intestines, bile excretory organs, ENT organs, and injuries.

And only 3% of the sedimentation rate responds to kidney disease.

With all diseases, the immune system begins to actively fight pathogenic cells, which leads to an increase in the production of antibodies, and at the same time, the erythrocyte sedimentation rate also accelerates.

What to do to lower the ESR

Before starting treatment, you should make sure that the reason for the increased ESR is not a false positive (see above), because some of these reasons are quite safe (pregnancy, menstruation, etc.). Otherwise, it is necessary to find the source of the disease and prescribe treatment. But for correct and accurate treatment, one cannot rely only on the results of determining this indicator. On the contrary, the determination of ESR is additional in nature and is carried out along with a comprehensive examination for initial stage treatment, especially if there are signs of a specific disease.

Basically, ESR is examined and controlled during elevated temperature or to rule out cancer. In 2-5% of people, an increased ESR is not at all associated with the presence of any diseases or false-positive signs - it is associated with the individual characteristics of the organism.

If, nevertheless, its level is greatly increased, you can use folk remedy. To do this, it is necessary to cook beets for 3 hours - washed, but not peeled and with tails. Then every morning on an empty stomach drink 50 ml of this decoction for 7 days. After taking another week break, measure the ESR level again.

Do not forget that even with a full recovery, the level of this indicator may not drop for some time (up to a month, and sometimes up to 6 weeks), so you should not sound the alarm. And you need to donate blood in the early morning and on an empty stomach for more reliable results.

Since ESR in diseases is an indicator of pathogenic processes, it can only be brought back to normal by eliminating the main lesion.

Thus, in medicine, the determination of the erythrocyte sedimentation rate is one of the important analyzes definition of the disease and precise treatment at the initial stage of the disease. What is very important when detecting serious diseases, for example, a malignant tumor on early stage development, due to which the level of ESR increases dramatically, which makes doctors pay attention to the problem. In many countries, this method has ceased to be used due to the mass of false positive reasons, but in Russia it is still widely used.

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

Erythrocyte sedimentation rate is part of a complete blood count

Norm of ESR in the blood - table by age

The erythrocyte sedimentation rate is not a constant value, because it has a close relationship with age, gender and some physiological changes (pregnancy, menstrual cycle). The marker unit is mm per hour. Within 60 minutes, the rapidity of precipitation of blood cells is observed.

Table "The norm of ESR in the blood by age and gender"

Category of people	ESR values, mm/h
In children
In newborns	1 to 2
Infants up to 6 months	11 to 17
From 7 months to 3 years	3 to 10
From 3 to 13 years old	4 to 12
In adults
Among women
From 13 to 18 years old
From 18 to 30 years old	3 to 14
From 30 to 40 years old	3 to 21
From 40 to 60 years	0 to 27
From 61 years old	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 acceptable if other important blood markers remain within the normal range.

Reasons for the deviation of indicators from the norm

In 5% of people on the planet, the rate of sedimentation of blood cells is very different from the norm. This is explained by their physiological characteristics and is not pathological. If disturbances in the KLA are not associated with natural processes in the body, this indicates the development of specific diseases.

ESR above normal

A high rate of precipitation of blood cells is a clear sign of pathology. It is also called accelerated ESR syndrome. According to ICD 10 (International Classification of Diseases), this indicator is allocated to a separate group R70 - accelerated erythrocyte sedimentation and anomalies in blood viscosity.

The causes of this condition may be the following diseases:

inflammation in the 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 with cancer in the last stages);
excess of the permissible amount of cholesterol in the blood against the background of severe obesity or diabetes mellitus;
chronic or acute disorder functioning of the kidneys.

Elevated ESR may indicate an excess of cholesterol

Frequent factors that can affect the level of ESR in the blood are:

shock, stress;
taking hormonal drugs;
the period of gestation or breastfeeding;
elderly age.

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

Decreased ESR

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

Other serious reasons there is no slowdown in ESR, but there are non-pathological factors of weak erythrocyte sedimentation:

low protein nutrition;
fasting partial or complete;
early pregnancy.

Decreased ESR rates are observed in early pregnancy

The use of hormonal drugs (corticosteroids) can also slow down the formation of erythrocyte sediment. After completion of treatment, the tests return to normal.

Methods for testing blood for ESR

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

according to Panchenkov;
according to Westergner.

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

According to Westergner

Taken for research deoxygenated blood. The glass tube is used with an exact division into 200 lines, 1 mm each. The mixing of blood with the reagent takes place in a test tube and is left for 1 hour. After the allotted time, a column of blood plasma is measured without settled erythrocytes.

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 blood test from a finger.

How to conduct:

capillary blood sampling is carried out by puncturing the ring finger with a scarifier;
biological material is removed with a glass tube graduated to 100 divisions;
a specific solution (coagulant) is placed on a special glass of a concave shape and the test blood is added in a ratio of 1 to 4;
lost the ability to thicken, the liquid is drawn into a pipette - Panchenkov's capillary, - set in a standing position and wait 60 minutes, during which erythrocyte sedimentation occurs;
the distance from the beginning of the brightened plasma to the deposit is measured (in mm).

The method of measuring ESR according to Panchenkov is very common in medical practice, but its sensitivity is lower than with a clinical analysis 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.

It is enough to follow a few simple recommendations:

stop eating and any drinks 4-5 hours before the procedure;
avoid stress and anxiety a few 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 testing

Experts do not advise conducting a clinical analysis against the background of severe stress, overwork of the body or taking hormonal drugs. This can distort the results of the study, significantly increasing the rate of sedimentation of blood cells.

ESR in a child - Komarovsky

Fatty foods affect ESR

False-positive results can also occur in women during menstruation, as well as in late pregnancy. Medical error is not ruled out. Therefore, for the reliability of the decoding, before taking blood, you must fulfill all the requirements of a specialist, and, if necessary, retake the analysis again.

How to lower the ESR in the blood

An increase in the erythrocyte sedimentation rate in itself is not a pathology. The index only indicates possible deviations in work internal organs. Therefore, it is not necessary to purposefully reduce the ESR. Values in clinical analysis normalize themselves after completing the course drug therapy one disease or another.

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

use vitamin complexes and mineral supplements prescribed by a doctor;
to refuse from bad habits;
stick to proper nutrition.

Regular consumption of freshly squeezed beetroot juice, citrus juices with honey helps to quickly reduce the level of ESR. It is possible to gradually normalize this indicator by minimizing stressful situations, moderate physical activity and complete sleep.

Beetroot juice well lowers ESR

Accelerated sedimentation of blood cells in biological material is a non-permanent marker that is sensitive to many stimuli. It can increase both during inflammatory and infectious processes in the body, and respond to a person’s lifestyle (insufficient mobility, bad habits medications, temporary physiological changes). Therefore, treatment begins only after identifying the true cause of deviations in the normal ESR.