The erythrocyte sedimentation rate (ESR) in the blood is one of the main signs that doctors monitor when studying laboratory analysis this material. Such close attention to this indicator is due to the fact that it can serve as a sign of the presence of an inflammatory process in the body.
Normal ESR values
The rate of erythrocyte sedimentation rate in the blood directly depends on the gender and age of the person whose blood is being tested. Thus, the highest ESR rate is usually observed in infants: it ranges from 12 to 17 millimeters per hour. Normal indicator ESR for women is 3-15 mm/hour, - 1-10 mm/hour, for children - 0-2 mm/hour. In older people, the ESR rate is usually higher: it can be up to 38 mm/hour and up to 53 mm/hour in women. Therefore, if your results obtained as a result of the analysis differ significantly from these figures, you should consult a doctor to figure out what is the cause of the elevated ESR level.ESR indicators
Preliminary conclusions about what problems may indicate increased level ESR in your blood, you can do it yourself. Thus, a deviation of the result from the norm by several units is most often due to the specific characteristics of your body and may not be a sign of the presence of any serious dysfunction. However, in order to make sure that the result is normal for you, it is recommended to consult a physician for advice.If the deviation from the norm is 15-30 mm/hour, this usually indicates the presence of an inflammatory process in the body. In some cases, its presence may be obvious to you, for example, if this moment you're leaking colds. However, the existing disease may also be hidden, for example, if the liver or organs are affected gastrointestinal tract. Therefore, in this case, you should definitely consult a doctor who can prescribe you additional tests. They will allow you to determine the nature of the disease and prescribe adequate treatment.
Even more serious is the excess of ESR compared to normal level by 30 units or more. In this case, specialists usually begin to suspect the presence of a progressive destructive process in the body. One of the common examples of diseases that can accompany such a significant increase in ESR levels is oncological manifestations. In such a situation, you must immediately visit a doctor who can prescribe complex treatment taking into account the nature, specificity and intensity of your disease.
A routine blood test reveals many indicators. One of them is ESR. This term used to indicate speed Some patients who do not understand medical concepts, may hear the word “soy” instead of “ESR”. There are cases when “soy” in the blood is increased or decreased.
What could cause such changes? Let's try to understand this issue.
How is the analysis carried out?
An anti-clotting agent is added to the blood in the test tube. In this state, the material for research is left in a dark place for one hour. Under the influence of gravity, red blood cells gradually settle to the very bottom. An hour later, the laboratory assistant measures the height of the resulting plasma column in the upper part of this tube. The following indicators are considered normal: 1-10 mm/hour in men and 2-15 mm/hour in women. This analysis plays an important role in the diagnosis of a number of pathologies.
Increased rate
So, why there are quite a lot of reasons causing this change. First of all, these are inflammatory processes, especially infectious or purulent diseases. The next reason is ailments associated with improper metabolism, as well as tumors, syphilis, rheumatism, tonsillitis, tuberculosis, thrombosis and cirrhosis of the liver. "soy" in the blood is also observed in anemia. As the course of the disease worsens, as a rule, this indicator only increases. Therefore, it is very important to observe the increase (or decrease) of ESR over time.
The only exception may be pregnancy. In young women during the period of bearing a baby, as a rule, “soy” in the blood is increased several times. And this is the norm. An increase in this indicator can also be caused by non-inflammatory diseases, such as anemia, various pathologies kidneys and liver, as well as malignant tumors, heart attack or stroke, frequent or even vaccine therapy. Fractures and bone injuries, intoxication, post-shock condition, collagenosis, hyperfibrinogenemia can also cause changes in this laboratory indicator.
Decrease in ESR
A slowdown in sedimentation rate usually occurs with certain liver diseases and stomach pathologies. Also this sign may indicate a condition such as erythrocytosis. With this disease, there is an increased content of red cells in the blood, which leads to its excessive viscosity.
Children
If the “soy” in the blood of children is increased by 20-30 units, this indicates the severity of the inflammatory processes.
In this case, it is imperative to conduct a thorough examination of the child. In children under two years old, the norm is 5-7 mm/h, after 2 years - 8 mm/h. In older children, this figure is 12-15 mm/h. After past illness The ESR level does not return to normal immediately.
As a rule, it may take a month to a month and a half for red blood cells to recover. Therefore, after thirty days you should take a repeat test. Thanks to this, more accurate conclusions can be made regarding the degree of development of the disease. Various non-infectious factors can also cause a condition in a child in which “soy” in the blood will be elevated. These include helminthiasis, vitamin deficiency, teething, taking drugs based on paracetamol, etc.
Currently, medicine has ample opportunities, however, for a separate type Diagnostic research methods developed almost a century ago have still not lost their relevance. The indicator ESR (erythrocyte sedimentation rate), formerly called ROE (erythrocyte sedimentation reaction), has been known since 1918. Methods for measuring it have been defined since 1926 (according to Westergren) and 1935 according to Winthrop (or Wintrob) and are used to this day. A change in ESR (ROE) helps to suspect pathological process at its very beginning, identify the cause and begin early treatment. The indicator is extremely important for assessing the health of patients. In the article, we will consider situations when people are diagnosed with elevated ESR.
ESR - what is it?
Erythrocyte sedimentation rate is really a measurement of the movement of red blood cells under certain conditions, calculated in millimeters per hour. The test requires a small amount of the patient's blood - the count is included in the general analysis. It is estimated by the size of the layer of plasma (the main component of blood) remaining on top of the measuring vessel. For the reliability of the results, it is necessary to create conditions under which only the force of gravity (gravity) will influence the red blood cells. It is also necessary to prevent blood clotting. In the laboratory this is done using anticoagulants.
The process of erythrocyte sedimentation can be divided into 3 stages:
- Slow subsidence;
- Acceleration of sedimentation (due to the formation of erythrocyte columns formed during the process of gluing together individual erythrocyte cells);
- Slowing down subsidence and stopping the process completely.
Most often, it is the first phase that matters, but in some cases it is necessary to evaluate the result a day after blood sampling. This is done already at the second and third stages.
Why does the parameter value increase?
The ESR level cannot directly indicate a pathogenic process, since the reasons for an increase in ESR are varied and are not a specific sign of the disease. In addition, the indicator does not always change during the course of the disease. There are several physiological processes, at which ROE increases. Why then is analysis still widely used in medicine? The fact is that a change in ROE is observed with the slightest pathology at the very beginning of its manifestation. This allows us to accept emergency measures to normalize the condition before the disease seriously undermines human health. In addition, the analysis is very informative in assessing the body’s response to:
- Conducted drug treatment, (use of antibiotics);
- If myocardial infarction is suspected;
- Appendicitis in the acute phase;
- Angina pectoris;
- Ectopic pregnancy.
Pathological increase in indicator
| An increased ESR in the blood is observed when following groups diseases: |
|---|
| Infectious pathologies, often of a bacterial nature. An increase in ESR may indicate an acute process or chronic course diseases |
| Inflammatory processes, including purulent and septic lesions. For any localization of diseases, a blood test will reveal an increase in ESR |
| Connective tissue diseases. ROE is high in SCS - systemic lupus erythematosus, vasculitis, rheumatoid arthritis, systemic scleroderma and other similar diseases |
| Inflammation localized in the intestines with ulcerative colitis, Crohn's disease |
| Malignant formations. The rate rises highest in myeloma, leukemia, lymphoma (the analysis determines an increase in ESR in bone marrow pathology - immature red blood cells enter the bloodstream, which are not able to perform their functions) or cancer Stage 4 (with metastases). Measuring ROE helps evaluate the effectiveness of treatment for Hodgkin's disease (cancer of the lymph nodes) |
| Diseases accompanied by tissue necrosis (myocardial infarction, stroke, tuberculosis). About a week after tissue damage, the ROE indicator increases to its maximum |
| Blood diseases: anemia, anisocytosis, hemoglobinopathy |
| Diseases and pathologies accompanied by an increase in blood viscosity. For example, heavy blood loss, intestinal obstruction, prolonged vomiting, diarrhea, postoperative recovery period |
| Diseases of the biliary tract and liver |
| Diseases metabolic processes And endocrine system(cystic fibrosis, obesity, diabetes, thyrotoxicosis and others) |
| Trauma, extensive skin damage, burns |
| Poisonings ( food products, waste products of bacteria, chemicals etc.) |
Increase above 100 mm/h
The indicator exceeds the level of 100 m/h in acute infectious processes:
- ARVI;
- Sinusitis;
- Flu;
- Pneumonia;
- Tuberculosis;
- Bronchitis;
- Cystitis;
- Pyelonephritis;
- Viral hepatitis;
- Fungal infections;
- Malignant formations.
A significant increase in the norm does not occur overnight; ESR increases for 2–3 days before reaching a level of 100 mm/h.
When an increase in ESR is not a pathology
There is no need to sound the alarm if a blood test shows an increase in the sedimentation rate of red blood cells. Why? It is important to know that the result must be assessed over time (compared with earlier blood tests) and take into account some factors that may increase the significance of the results. In addition, accelerated erythrocyte sedimentation syndrome may be a hereditary feature.
ESR is always elevated:
- During menstrual bleeding in women;
- When pregnancy occurs (the indicator can exceed the norm by 2 or even 3 times - the syndrome persists for some time after childbirth, before returning to normal);
- When consumed by women oral contraceptives (birth control pills for oral administration);
- In the morning. There are known fluctuations in the ESR value during the day (in the morning it is higher than in the afternoon or in the evening and at night);
- At chronic inflammation(even if it’s a simple runny nose), the presence of pimples, boils, splinters, etc., the syndrome of increased ESR can be diagnosed;
- Some time after completion of treatment for a disease that can cause an increase in the indicator (often the syndrome persists for several weeks or even months);
- After eating spicy and fatty foods;
- In stressful situations immediately before the test or the day before;
- For allergies;
- Some medications can give such a reaction from the blood;
- Lack of vitamins from food.
Increased ESR level in a child
In children, the ESR may increase for the same reasons as in adults, however, the list above can be supplemented with the following factors:
- At breastfeeding(neglect of the mother’s diet can cause accelerated red blood cell sedimentation syndrome);
- Helminthiases;
- The period of teething (the syndrome persists for some time before and after it);
- Fear of taking the test.
Methods for determining results
There are 3 methods for manually calculating ESR:
- According to Westergren. For the study, blood is taken from a vein and mixed in a certain proportion with sodium citrate. The measurement is carried out according to the distance of the tripod: from upper limit liquid to the border of red blood cells that have settled in 1 hour;
- According to Wintrobe (Winthrop). The blood is mixed with an anticoagulant and placed in a tube with markings on it. At a high sedimentation rate of red blood cells (more than 60 mm/h), the internal cavity of the tube quickly becomes clogged, which can distort the results;
- According to Panchenkov. For the study, blood from the capillaries is required (taken from a finger), 4 parts of it are combined with a part of sodium citrate and placed in a capillary graduated by 100 divisions.
It should be noted that analyzes carried out using different methods cannot be compared with each other. When increased rate The first method of calculation turns out to be the most informative and accurate.
Currently, laboratories are equipped with special devices for automated calculation of ESR. Why has automatic counting become widespread? This option is the most effective because it eliminates the human factor.
When making a diagnosis, it is necessary to evaluate the blood test as a whole, in particular great importance given to leukocytes. With normal leukocytes, an increase in ROE may indicate residual effects after an illness; if low - on the viral nature of the pathology; and if it is elevated, it is bacterial.
If a person doubts the correctness of the blood tests performed, then you can always double-check the result in paid clinic. Currently, there is a technique that determines the level of CRP - C-reactive protein; it excludes the influence of external factors and indicates the human body’s response to the disease. Why hasn't it become widespread? The study is a very costly undertaking; it is impossible for the country’s budget to implement it in all public medical institutions, but in European countries they have almost completely replaced the measurement of ESR with the determination of PSA.
IS HIGH ESR IN THE BLOOD DANGEROUS?ESR - erythrocyte sedimentation rate!
The popularity of the blood test for ESR was facilitated by the technical simplicity and low cost of this test, as well as the general confidence in its reliability. However, the interpretation of ESR results is fraught with certain difficulties. For example, if a patient's ESR is normal, can we assume that he does not have active disease? And if there is only an increase in ESR, but there are no other signs of the disease, does this mean that the person is sick?
Usually both doctors and patients calm down when they see normal result samples, and an increase in ESR is perceived as a reason for further examination.
Unfortunately, a normal ESR result does not always mean the absence of disease. According to the literature, a significant number of patients with potentially curable malignant diseases have an ESR of less than 20 mm/hour.
On the other hand, sometimes even with a strongly elevated ESR (100 mm/hour or more) it is not possible to detect signs of the disease.
Table 4 presents the results of a number of studies, the inclusion criterion for which was an extreme increase in ESR from 100 mm/h and above. The sum of the percentages does not equal 100 because some patients had several diseases at once.
Table 4. Disease groups with a significant increase in ESR
| Absolute number | Percent | |
|---|---|---|
| Number of observations | 1666 | 100% |
| Infection | 651 | 39% |
| Malignant diseases | 390 | 23% |
| Systemic diseases connective tissue | 280 | 17% |
| Kidney diseases | 54 | 3% |
| Others | 292 | 18% |
| No reasons found | 39 | 2% |
Thus, an increase in ESR in most cases is caused by one or more diseases from the four most common groups:
- Infections. An increase in ESR most often accompanies infectious processes.
- Malignant diseases. Among oncological pathologies, an increase in ESR is more common in solitary tumors than in oncohematological diseases.
- Rheumatological diseases.
- Kidney pathology.
The list of diseases accompanied by an increase in ESR is presented in Table 5.
Table 5. Reasons for increasing ESR
| 1. Infections | |
| 1.1. Majority bacterial infections(mostly spicy) | Infections of the upper and lower respiratory tract Infections urinary tract Pulmonary and extrapulmonary tuberculosis |
| 1.2. Viral infections | Viral hepatitis |
| 1.3. Systemic fungal infections | |
| 2. Malignant diseases | |
| 2.1. Oncohematological diseases | Leukemia, lymphoma Waldenström's macroglobulinemia Plasmacytoma, myeloma |
| 2.2. Malignant tumors | Lung, bronchi, nasopharynx Breast, ovaries, uterus Kidney, prostate gland Pancreas, colon Other localization |
| 3. Rheumatological diseases | Temporal arteritis Rheumatism Polymyalgia rheumatica Rheumatoid arthritis Systemic lupus erythematosus Other diseases |
| 4. Kidney diseases | Glomerulonephritis Nephrotic syndrome Pyelonephritis Other diseases |
| 5. Other conditions | Anemia Inflammatory pathology of the pelvic organs (adnexitis, prostatitis, etc.) Inflammatory pathology of the large intestine, gallbladder, pancreas Dental granulomas ENT pathology: sinusitis, tonsillitis, otitis Sarcoidosis Conditions after surgical interventions Phlebitis with varicose veins of the lower extremities |
It takes a certain time for plasma proteins to change, and ESR needs a “running start” (on average 24-48 hours). Therefore, in the first days of the infectious process, ESR is delayed compared to leukocytosis and fever.
And since changes in blood proteins due to various inflammatory processes persist for a long time, after the end of the disease, an increased ESR is often observed (sometimes for several months). This phenomenon should be remembered. The increase in ESR in these cases simply reflects the period of recovery.
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 the general blood test and can indicate the beginning or progress of inflammatory disease in 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 technician 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 temperature environment. 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 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 sedimentation of red blood cells increases with acute diseases 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 test 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 taking the analysis: in the morning the ESR is slightly higher than in the morning evening time. 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 inflammatory process, however, if the deviation from the norm is significant (for example, by 40-50 units), there is a suspicion of oncology.
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, but the deposition rate 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 that interesting position ESR can reach 45 units, and there is no suspicion of pathology in this case.
If you see in yourself or loved one the analysis shows an increased ESR, 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 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!
