The erythrocyte sedimentation rate (ESR) test is accepted in medicine all over the world as mandatory when conducting a general blood test. It is carried out during preventive examination, clinical examination and diagnosis of diseases.

The normal ESR level in the patient’s blood indicates the absence of a pronounced inflammatory reaction in organs and tissues. However, the ESR indicator is not considered the only and unique indicator in making a diagnosis. Correct interpretation is possible only together with other analysis results: the total number of leukocytes, leukocyte formula of blood, c-reactive protein are taken into account. The ESR indicator can also be affected by the number of red blood cells and their qualitative composition. Let's look at how laboratory analysis is carried out.

Method for determining ESR

In Russia they use the famous Panchenkov method.

The essence of the method: if you mix blood with sodium citrate, it does not clot, but is divided into two layers. The lower layer is formed by red blood cells, the upper layer is made up of transparent plasma. The process of erythrocyte sedimentation is associated with the chemical and physical properties of blood.

There are three stages in the formation of sediment:

• in the first ten minutes, vertical clusters of cells are formed, which are called “coin columns”;
• then it takes forty minutes to settle;
• for another ten minutes the red blood cells stick together and become denser.

This means that the entire reaction requires a maximum of 60 minutes.

These capillaries collect blood to determine ESR.

For the study, take a drop of blood from a finger and blow it into a special recess on the plate, where a 5% sodium citrate solution has previously been added. After mixing, the diluted blood is drawn into thin glass graduated capillary tubes to the upper mark and placed strictly vertically in a special stand. In order not to confuse the tests, a note with the patient’s name is pierced with the lower end of the capillary. Time is recorded by a special laboratory clock with an alarm. Exactly one hour later, the results are taken into account based on the height of the red blood cell column. The answer is recorded in mm per hour (mm/h).

Despite the simplicity of the technique, there are instructions that must be followed when performing the test:

• take blood only on an empty stomach;
• inject the flesh of the finger deep enough so that the blood does not have to be squeezed out (pressure destroys red blood cells);
• use fresh reagent, dry washed capillaries;
• fill the capillary with blood without air bubbles;
• maintain the correct ratio between sodium citrate solution and blood (1:4) when stirring;
• carry out the determination of ESR at an ambient temperature of 18-22 degrees.

Any violations in the analysis may lead to unreliable results. The reasons for an erroneous result should be sought in violation of the technique and inexperience of the laboratory assistant.

Normal level

Under normal conditions, red blood cells settle slowly, which means that the rate after an hour will be quite low. With various diseases, an increased amount of proteins and fibrin appears in the blood. They make red blood cells settle faster. The ESR value increases.

Norms of ESR in the blood depend on age and physiological state (pregnancy). They are different for women, men and children. There is evidence that they are even slightly different among residents of different territories.

To determine the exact standard, mass surveys were carried out. The average value obtained is considered normal.

The norm of ESR in a child depending on age is presented in the table.

In women during pregnancy, a connection between the norm and body type was revealed.

In addition, there is a dependence of the erythrocyte sedimentation rate on the level of hemoglobin in a pregnant woman.

ESR norms in adults also change with age.

Interpretation of the analysis

Decoding such an indicator as ESR in the analysis is very non-specific. A more specific indication of the type of disease is obtained by taking into account the ESR level and the number of leukocytes together. These indicators are studied by the doctor over time by days of illness.

For example, in acute myocardial infarction, the number of leukocytes increases in the first hours of the disease, while the ESR remains normal. On the fifth day, a “scissors” symptom is expected, when the level of leukocytes drops, and the ESR, on the contrary, rises and remains above normal for a long time. In the future, leukocytes remain normal, and the erythrocyte sedimentation rate is used to judge the scarring of the heart muscle and the effectiveness of the treatment.

The combination of a high leukocyte count and accelerated ESR allows the doctor to continue the diagnosis in terms of searching for the source of the inflammatory reaction.

The ESR value is significantly increased in allergic processes in the body, especially in diseases associated with an erroneous autoallergic reaction to one’s own cells. These include systemic diseases: lupus erythematosus and rheumatoid polyarthritis.

Deciphering high numbers of erythrocyte sedimentation rate makes it possible to identify tumor diseases, blood diseases (acute leukemia, myeloma), and is important for diagnosing various anemias (anemia), the degree of blood loss during injuries, surgical interventions, kidney diseases, and renal failure.

An increased level of ESR is determined in infectious diseases: rheumatism, tuberculosis, any viral infection complicated by bacterial inflammation (paranasal sinuses with influenza, measles and scarlet fever in children). The erythrocyte reaction signals how long the inflammation lasts.

A decrease in ESR is noted with damage to red blood cells (erythremia, sickle cell anemia), extensive burns that increase blood viscosity, cholera due to fluid loss, congenital heart defects with chronic heart failure, liver and kidney diseases with a decrease in protein in the blood.

Once an unusual analysis has been detected, it must be repeated to rule out the influence of various factors. A persistent increase in ESR is a serious reason for an in-depth examination.

You can find out exactly what reason caused the increase in erythrocyte sedimentation rate in a particular case after diagnosis, taking into account checking other objective symptoms of the disease. Clinical examination allows you to detect the disease at the stage of absence of clinical manifestations.

Erythrocyte sedimentation rate is a test used to detect inflammation in the body.

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

The test can diagnose many disorders (including cancer) and is a necessary test to confirm many diagnoses.

Let's figure out what it means when the erythrocyte sedimentation rate (ESR) in the general blood test of an adult or child is increased or decreased, should we be afraid of such indicators and why does this happen in men and women?

Women have higher ESR values; pregnancy and the menstrual period can cause short-term deviations from the norm. In pediatrics, this test helps diagnose rheumatoid arthritis in children or.

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

Many factors such as age or medication use, can affect the final result. Drugs such as dextran, ovidone, silest, theophylline, vitamin A can increase ESR, and aspirin, warfarin, cortisone can reduce it. High/low readings only tell the doctor about the need for further examination.

False promotion

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

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

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

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

Interpretation of results and possible reasons

What does it mean if the erythrocyte sedimentation rate (ESR) in the blood test of an adult or child is increased or decreased, should we be afraid of indicators that are higher than normal or lower?

High levels in blood test

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

• Autoimmune diseases – Libman-Sachs disease, giant cell disease, polymyalgia rheumatica, necrotizing vasculitis, rheumatoid arthritis (the immune system is the body’s defense against foreign substances. Against the background of an autoimmune process, it mistakenly attacks healthy cells and destroys body tissue);
• Cancer (this can be any form of cancer, from lymphoma or multiple myeloma to bowel and liver cancer);
• Chronic kidney disease (polycystic kidney disease and nephropathy);
• Infection, such as pneumonia, pelvic inflammatory disease, or appendicitis;
• Inflammation of joints (polymyalgia rheumatica) and blood vessels (arteritis, diabetic angiopathy of the lower extremities, retinopathy, encephalopathy);
• Inflammation of the thyroid gland (diffuse toxic goiter, nodular goiter);
• infections of the joints, bones, skin, or heart valves;
• Too high serum fibrinogen concentrations or hypofibrinogenemia;
• Pregnancy and toxicosis;
• Viral infections (HIV, tuberculosis, syphilis).

Since ESR is a nonspecific marker of inflammation foci and correlates with other causes, the results of the analysis should be taken into account together with the patient’s health history and the results of other examinations (complete blood count - extended profile, urinalysis, lipid profile).

If the sedimentation rate and the results of other tests coincide, the specialist can confirm or, conversely, exclude the suspected diagnosis.

If the only elevated indicator in the analysis is ESR (against the background of a complete absence of symptoms), the specialist cannot give an accurate answer and make a diagnosis. Besides, a normal result does not exclude disease. Moderately elevated levels may be caused by aging.

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

This video explains in more detail the norms and deviations of this indicator in the blood:

Low performance

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

• A disease or condition that increases red blood cell production;
• A disease or condition that increases white blood cell production;
• If a patient is being treated for an inflammatory disease, the degree of sedimentation going down is a good sign and means that the patient is responding to treatment.

Low values ​​can be caused by the following reasons:

• Elevated glucose levels (in diabetics);
• Polycythemia (characterized by an increased number of red blood cells);
• Sickle cell anemia (a genetic disease associated with pathological changes in cell shape);
• Severe liver diseases.

The reasons for the decline could be any number of factors., For example:

• Pregnancy (ESR levels drop in the 1st and 2nd trimester);
• Anemia;
• Menstrual period;
• Medicines. Many medications can falsely lower test results, such as diuretics and medications that contain high calcium levels.

Increased data for diagnosing cardiovascular diseases

In patients with cardiac or myocardial disease, ESR is used as an additional potential indicator of coronary heart disease.

ESR used for diagnosis– (inner layer of the heart). Endocarditis develops due to the migration of bacteria or viruses from any part of the body through the blood to the heart.

If symptoms are ignored, endocarditis destroys the heart valves and leads to life-threatening complications.

To make a diagnosis of endocarditis, a specialist must prescribe a blood test. Along with high levels of sedimentation rates, endocarditis is characterized by a decrease in platelets(lack of healthy red blood cells), the patient is often also diagnosed with anemia.

Against the background of acute bacterial endocarditis, the degree of sedimentation may increase to extreme values(about 75 mm/hour) is an acute inflammatory process characterized by severe infection of the heart valves.

When diagnosing congestive heart failure ESR levels are taken into account. This is a chronic, progressive disease that affects the power of the heart muscles. Unlike regular “heart failure,” congestive heart failure refers to the stage in which excess fluid accumulates around the heart.

To diagnose the disease, in addition to physical tests (echocardiogram, MRI, stress tests), the results of a blood test are taken into account. In this case, analysis for an extended profile may indicate the presence of abnormal cells and infections(sedimentation rate will be higher than 65 mm/hour).

At myocardial infarction An increase in ESR is always provoked. The coronary arteries deliver oxygen in the blood to the heart muscle. If one of these arteries becomes blocked, part of the heart is deprived of oxygen, causing a condition called “myocardial ischemia.”

Against the background of a heart attack, ESR reaches peak values(70 mm/hour and above) for a week. Along with increased sedimentation rates, the lipid profile will show elevated levels of triglycerides, LDL, HDL and cholesterol in the serum.

A significant increase in erythrocyte sedimentation rate is observed against the background acute pericarditis. This, which begins suddenly, causes blood components such as fibrin, red blood cells and white blood cells to enter the pericardial space.

Often the causes of pericarditis are obvious, such as a recent heart attack. Along with elevated ESR levels (above 70 mm/hour), an increase in urea concentration in the blood was noted as a result of renal failure.

Erythrocyte sedimentation rate increases significantly against the background of the presence of an aortic aneurysm or . Together with high ESR values ​​(above 70 mm/hour), blood pressure will be elevated; in patients with an aneurysm, a condition called “thick blood” is often diagnosed.

Conclusions

ESR plays an important role in the diagnosis of cardiovascular diseases. The indicator appears to be elevated against the background of many acute and chronic painful conditions characterized by tissue necrosis and inflammation, and is also a sign of blood viscosity.

Elevated levels directly correlate with the risk of myocardial infarction and coronary heart disease. For high subsidence levels and suspected cardiovascular disease the patient is referred for further diagnostics, including an echocardiogram, MRI, electrocardiogram to confirm the diagnosis.

Experts use erythrocyte sedimentation rate to determine foci of inflammation in the body; measuring ESR is a convenient method of monitoring the progress of treatment of diseases accompanied by inflammation.

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

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

(ESR) is an indirect method for detecting inflammatory, autoimmune or cancer diseases. It is performed on a sample of venous or capillary blood, to which a substance has been added that allows it not to clot (anticoagulant). When analyzing ESR using the Panchenkov method, blood is placed in a thin glass or plastic tube and monitored for an hour. At this time, erythrocytes (red blood cells), as having a large specific gravity, settle, leaving a column of transparent plasma above them. The ESR is calculated based on the distance from the upper boundary of the plasma to the red blood cells. Normally, red blood cells settle slowly, leaving very little pure plasma. For this method, a Panchenkov apparatus is used, consisting of a tripod and capillary pipettes with a 100 mm scale.

For capillary photometry (automatic analyzers ROLLER, TEST1), the kinetic “stopped jet” method is used. At the beginning of the ESR analysis, programmed mixing of the sample occurs in order to disaggregate the red blood cells. Ineffective disaggregation or the presence of microclots can affect the final result, since the analyzer actually measures the kinetics of red blood cell aggregation. In this case, the measurement occurs in the range from 2 to 120 mm/h. The results of measuring ESR by this method have a high correlation with the Westergren method, which is the standard for determining ESR in the blood, and have identical reference values.

The results obtained using the capillary photometry method in the region of normal values ​​coincide with the results obtained when determining ESR using the Panchenkov method. However, the capillary photometry method is more sensitive to an increase in ESR, and the results in the zone of increased values ​​are higher than the results obtained by the Panchenkov method.

An increase in the level of pathological proteins found in the liquid part of the blood, as well as some other proteins (the so-called acute-phase proteins that appear during inflammation), contributes to the “gluing” of red blood cells. Because of this, they settle faster and the ESR increases. It turns out that any acute or chronic inflammation can lead to an increase in ESR in the blood.

The fewer red blood cells, the faster they settle, which is why women have a higher ESR than men. The ESR norm varies depending on gender and age.

What is the research used for?

• For the diagnosis of diseases associated with acute or chronic inflammation, including infections, cancer and autoimmune diseases. Determining ESR is sensitive, but one of the least specific laboratory tests, since an increase in ESR in the blood itself does not allow determining the source of inflammation, in addition, it can occur not only due to inflammation. That is why analysis of ESR is usually used in combination with other studies.

When is the study scheduled?

• When conducting diagnostics and monitoring:
  • inflammatory diseases,
  • infectious diseases,
  • oncological diseases,
  • autoimmune diseases.
• When conducting preventive examinations in conjunction with other studies (

Erythrocyte sedimentation rate (ESR) is an indicator that determines the speed and intensity of red blood cell gluing in certain pathological processes. This analysis is one of the mandatory values ​​of a general blood test; previously the analysis was called ROE and determined the erythrocyte sedimentation reaction.

Changes and deviations from the norm indicate inflammation and the development of the disease. That is why, in order to stabilize the ESR, the disease is initially treated, rather than trying to achieve the norm artificially with the help of drugs.

As a rule, exceeding the norm indicates a violation of the electrochemical structure of the blood, as a result of which pathological proteins (fibrinogens) attach to red blood cells. The appearance of such elements occurs against the background of bacterial, viral, infectious and fungal lesions, and inflammatory processes.

Indications

Important! ESR is a nonspecific indicator. This means that, in isolation from other data, it is impossible to make a diagnosis based on ESR alone. Deviations in erythrocyte sedimentation rate only indicate the presence of pathological changes.

Analysis of ESR is a necessary stage in diagnosing the structure of the blood, which at the earliest stages of the disease makes it possible to determine the presence of inflammatory processes in the body.

That is why ESR is prescribed for suspected pathologies of various nature:

• inflammatory diseases;
• infectious;
• benign and malignant formations.

Additionally, screening is carried out during annual medical examinations.

ESR is used in a complex of clinical (general) analysis. After this, it is necessary to additionally use other diagnostic methods.

Even minor deviations from the norm should be considered conditionally pathological, requiring additional examination.

If a pathology of the hematopoietic system is suspected, the analysis of ESR acquires the main diagnostic value.

ESR standards

The erythrocyte sedimentation rate is measured in mm per hour.

ESR according to Westergren, ESR using the micromethod - venous blood is examined

ESR according to Panchenkov - capillary blood is examined (from a finger)

Depending on the type, form of progression (acute, chronic, recurrent) and stage of development of the disease, ESR can change dramatically. To obtain a complete picture, a repeat study is carried out after 5 days.

ESR is higher than normal

Important! A physiological increase in ESR can be observed in women during menstruation, pregnancy and the postpartum period.

As a rule, the erythrocyte sedimentation rate exceeds the norm in the following diseases:

• inflammatory processes of various etiologies. The indicator increases as a result of increased production of globulins and fibrinogens during the acute phase of inflammation;
• decay, tissue death, necrotic processes in cells. As a result of breakdown, protein products enter the bloodstream, causing sepsis and purulent processes. This group includes oncological pathologies, tuberculosis, heart attacks (brain, myocardium, lungs, intestines), etc.;
• metabolic disorders - hypo- and hyperthyroidism, diabetes at all stages, etc.;
• nephrotic syndrome and hypoalbuminemia, liver pathologies, serious blood loss, exhaustion;
• anemia (anemia), hemolysis, blood loss and other pathologies of the circulatory system. As a result of the disease, the number of red blood cells in the body is reduced.;
• vasculitis, connective tissue diseases: arthritis, periarteritis, scleroderma, rheumatism, lupus and many others;
• hemoblastoses of all types (leukemia, Waldenström's disease, lymphogranulomatosis and others);
• periodic hormonal changes in the female body (menstruation, pregnancy and childbirth, the onset of menopause).

ESR is below normal

Registered in the following cases:

• disorders of the circulatory system associated with the production of red blood cells (erythremia, erythrocytosis, etc.), changes in their shape (hemoglobinopathy, spherocytosis, sickle cell anemia and others);
• prolonged fasting, dehydration;
• congenital or hereditary circulatory failure;
• nervous system disorders: epilepsy, stress, neuroses, as well as mental disorders;
• Regular use of certain medications: calcium chloride, salicylates, drugs containing mercury.

When you receive the ESR results, you need to contact a therapist, who will decipher them and refer them to a highly specialized doctor (infectious disease specialist, hematologist, oncologist, immunologist and others).

Self-medication and an attempt to artificially stabilize the ESR level will not yield results, but will blur the picture for further research and competent therapy.

How to prepare for the procedure

A general blood test (which detects ESR) is performed in the morning on an empty stomach. That is, about 8-10 hours should pass between the last snack and the blood sampling procedure.

1-2 days before donating blood, you must give up alcohol, “heavy” foods (fried, fatty, smoked), and hot spices.

A couple of hours before the procedure, you should refrain from smoking (cigarettes, hookah, pipes, electronic cigarettes, etc.).

Severe stress, psychological stress, physical activity (running, climbing stairs, carrying heavy objects) can also affect the level of red blood cells. Immediately before the manipulations, you need to rest for 30-60 minutes.

You should also tell your doctor about all medications you take regularly or on demand. Their active substances may affect the test result.

Keep in mind that each laboratory uses different ESR testing methods and units of measurement. Therefore, it is necessary to do the analysis, undergo further (repeated) examination and treatment in the same hospital.