What does soe indicate. ESR in the blood: the norm by age, the reasons for the increase or decrease

Diagnosis of the patient begins with laboratory examinations, and a complete blood count (CBC) is mandatory on the list. It allows you to determine the number of red blood cells and their main characteristics.

ESR (this indicator stands for erythrocyte sedimentation rate) is a basic parameter, it allows you to diagnose the presence or absence of an inflammatory process, and after a course of therapy to check how effective it turned out to be.

Along with it, the term ROE is used in medicine - the reaction of erythrocyte sedimentation. These concepts are identical. Gravity acts on the blood, which, after being taken from a patient, is placed in a test tube or a high capillary.

Under this influence, it is divided into several layers. Heavy and large red blood cells settle to the very bottom. If this happens quickly, inflammation occurs in the body. It changes in millimeters per hour (mm/h).

Important: Constantly elevated rates are a consequence of chronic inflammation. But sometimes with acute inflammation, an increase is not observed.

Determination of the erythrocyte sedimentation rate is a mandatory parameter of the general blood test. Although the ESR will not help determine the exact diagnosis, it will give some hints - especially when combined with the results of other studies.

What value of ESR is considered normal?

The ESR norm has differences in people of different sex, age and even physique.

For women, due to the characteristics of the body, this rate is higher than for men - it is associated with more frequent blood renewal, as well as a number of hormonal changes that the female body regularly undergoes.

Normal and not requiring additional diagnostics is an increase in ESR in pregnant women from a 4-month period.

This table illustrates the normal amount of ESR in the blood of an adult.

The definition of indicators and their interpretation should also be carried out taking into account the age of the patient.

In pregnant women, there is a dependence of the acceleration of red blood cells on the physique.

In thin people in the first half of pregnancy, the ROE reaches 21-62 mm / h, in the second - 40-65 mm / h.

For full ones - 18-48 mm / h and 30-70 mm / h, respectively. The norm is any indicator in the specified range.

Important: In women taking oral hormonal contraceptives, the erythrocyte sedimentation rate is always higher.

In infants, the change in this indicator depends on teething, the mother's diet (when breastfeeding), the presence of helminths, vitamin deficiency, and also when taking certain medications.

Below are the average rates of erythrocyte sedimentation rate for children.

If the ESR level is increased by 2-3 units, this is a variant of the norm. An additional examination is required if the indicator exceeds the norm by 10 or more units.

Important: In the morning, the ESR is always higher - this is important to consider when interpreting the results of the analysis.

When does the ESR increase?

With inflammation, the level of proteins in the blood increases, so red blood cells settle faster. If all indicators are normal, except for the erythrocyte sedimentation reaction, then there is no serious cause for concern. After a few days, you can retake blood, and compare the results.

The most likely reasons for the increase in ESR:

• Inflammation of the respiratory organs, genitourinary system (including sexually transmitted diseases), fungal infections - almost 40% of cases;
• Oncological processes - about 23%;
• Rheumatic and autoimmune diseases, including allergies - 17%;
• Endocrine and gastroenterological diseases - 8%;
• Kidney disease - 3%.

Important: An increase in ESR to 38-40 mm / h in children and up to 100 mm / h in adults is critical. This value of ESR indicates serious inflammation, kidney problems, and the occurrence of oncology. Such a patient needs an additional examination - special tests of urine, blood, ultrasound or MRI, consultations of several specialized specialists.

Diseases in which ESR increases

A temporary increase is observed after acute conditions, accompanied by a large loss of fluid and an increase in blood viscosity (diarrhea, vomiting, severe blood loss).

For a longer time, the value of ROE grows in some diseases:

• Pathologies of the endocrine system - diabetes, cystic fibrosis, obesity;
• Diseases of the liver and biliary tract, including hepatitis, cholecystitis;
• Diseases that are accompanied by tissue destruction;
• With a heart attack and stroke (increases a few days after the onset of the disease);
• blood diseases;
• Infectious of any etiology.

Important: Bacterial infections cause an increase in ESR by 2-10 times. With viral increases slightly - by several units. In a 31-year-old man, an increase of up to 17-20 mm/h indicates the viral nature of the disease, and up to 58-60 - a bacterial one.

When the reasons for the increase are not established

In this case, the patient needs a more thorough examination. More detailed blood tests are prescribed, during which the average volume of erythrocytes, the number of leukocytes and lymphocytes, and the leukocyte formula are determined.

It is also worth taking a blood test for tumor markers, a urine test.

During these examinations, it is important to consider the initial state of the body:

• Previously diagnosed infections;
• The presence of chronic diseases.

What does a low ESR mean?

The decrease is typical for such conditions:

• exhaustion;
• blood viscosity;
• Muscular atrophy;
• Epilepsy and some nervous diseases;
• Erythrocytosis;
• Hepatitis;
• Long-term use of drugs based on calcium, mercury;
• With some types of anemia.

It is important to consider how low the ESR is. A value of 4 mm / h is the norm for a small child, but for a woman over the age of 20, this is an alarming symptom.

Important: Low speed is the norm for those who adhere to a vegetarian (no meat) and vegan (no animal products) diet.

False positive ESR tests

A false-positive is a temporary increase that does not depend on pathological processes in the body, provoked by certain drugs, age-related or metabolic features.

When the result is false positive:

• In elderly patients;
• In the presence of excess body weight;
• After vaccination against hepatitis B;
• With anemia;
• If the patient has disorders in the work of the kidneys, diseases of the urinary system;
• Against the background of taking vitamin A;
• In case of violation of the algorithm of blood sampling and analysis, as well as in case of violation of the purity of the used capillary.

If you suspect a false positive result, you should retake the test again after 7-10 days.

In cases where the result of the analysis is false positive, the patient does not require additional examination and treatment.

Methods for determining ESR in the blood

There are several techniques for conducting research, the results of which differ by 1-3 units. The most common is the analysis by the Panchenkov method. Westergren method - the technique is the same as the previous method, only a higher capillary is used. This method is more accurate.

Wintrobe analysis is used with anticoagulants. A portion of blood is mixed with an anticoagulant and placed in a special tube.

This technique is effective for readings below 60-66 mm/h.

At a higher speed, it clogs and gives an unreliable result.

Features of preparation for analysis

For maximum reliability of the result, blood sampling must be carried out correctly:

1. The patient should not eat at least 4 hours before the procedure - after a rich and fatty breakfast, the ESR will be falsely elevated.
2. It is necessary to make a deep puncture (when taking blood from a finger) so that you do not have to squeeze out the blood - when pressed, a significant part of the red blood cells is destroyed.
3. Make sure that no air bubbles get into the blood.

How to lower ESR in the blood?

You should not take drugs to lower this indicator on your own. If necessary, they will be prescribed by the attending physician. It is important to remember that simply reducing the indicator does not eliminate the root cause of its increase.

Since often such test results are associated with a low level of hemoglobin, a weakened state, the patient is prescribed iron supplements, B vitamins, and folic acid.

In the presence of rheumatic disease, corticosteroids are prescribed.

On his own, the patient can use folk methods to strengthen the immune system and purify the blood from the waste products of pathogens. This will improve the general condition, support the body and improve blood composition.

For this purpose, the following are used:

• Beetroot juice (100-150 ml on an empty stomach before breakfast);
• Tea with lemon;
• Honey (1-2 teaspoons per day, diluted in a glass of warm tea or water);
• Infusions of chamomile and linden (1 tablespoon per glass of boiling water, drink this volume during the day in several doses).

The measurement of erythrocyte sedimentation rate (ESR) and the use of this indicator as a method of medical diagnosis was proposed back in 1918 by the Swedish researcher Faro. First, he was able to establish that the ESR in pregnant women is significantly higher than in non-pregnant women, and then he found that an increase in ESR indicates many diseases.

But this indicator entered the medical protocols for blood tests only decades later. First Westergren in 1926 and then Winthrop in 1935 developed methods for measuring the erythrocyte sedimentation rate, which are widely used in medicine today.

Laboratory characteristic of ESR

The erythrocyte sedimentation rate shows the ratio of plasma protein fractions. Due to the fact that the density of erythrocytes is higher than the density of plasma, they slowly settle to the bottom under the influence of gravity in the test tube. At the same time, the very speed of this process is determined by the degree of aggregation of red blood cells: the higher the level of aggregation of blood cells, the lower their resistance to friction and the higher the settling rate. As a result, a thick burgundy precipitate of erythrocytes appears in the test tube or in the capillary at the bottom, and a translucent liquid remains in the upper part.

Interestingly, in addition to the red blood cells themselves, other chemicals that make up the blood also affect the erythrocyte sedimentation rate. In particular, globulins, albumins and fibrinogen are able to change the surface charge of erythrocytes, increasing their tendency to "stick together" with each other, thereby increasing the ESR.

At the same time, ESR is a non-specific laboratory indicator, by which it is impossible to unambiguously judge the reasons for its change relative to the norm. At the same time, its high sensitivity is appreciated by physicians, who, when the erythrocyte sedimentation rate changes, have a clear signal for further examination of the patient.
The ESR is measured in millimeters per hour.

In addition to methods for measuring the erythrocyte sedimentation rate of Westergren and Winthrop, Panchenkov's method is also used in modern medicine. Despite some differences in these methods, the results they show are approximately the same. Let's consider all three methods of studying ESR in more detail.

The Westergren method is the most common in the world and it is he who is approved by the International Committee for the Standardization of Blood Research. This method involves the sampling of venous blood, which is combined for analysis in a ratio of 4 to 1 with sodium citrate. The diluted blood is placed in a capillary 15 centimeters long with a measuring scale on its walls, and an hour later the distance from the upper boundary of the settled erythrocytes to the upper boundary of the plasma is measured. The results of the ESR study using the Westergren method are considered as objective as possible.

The Winthrop ESR method differs in that the blood is combined with an anticoagulant (it inhibits the blood's ability to clot) and placed in a tube with a scale on which the ESR is measured. At the same time, this technique is considered indicative for high rates of erythrocyte sedimentation rate (more than 60 mm / h), since in this case the tube becomes clogged with settled blood cells.

According to Panchenkov, the study of ESR is as similar as possible to Westergren's methodology. Blood diluted with sodium citrate is placed for settling in a capillary with division into 100 units. An hour later, the ESR is measured.

At the same time, the results according to the methods of Westergren and Panchenkov are the same only in the normal state, and with an increase in ESR, the first method fixes higher rates. In modern medicine, with an increase in ESR, it is the Westergren method that is considered more accurate. Recently, automatic devices for measuring the ESR index have also appeared in modern laboratories, the operation of which actually does not require human intervention. The function of a laboratory employee is only to decipher the results.

Norms of erythrocyte sedimentation rate

The ESR indicator in the norm varies quite seriously depending on the sex and age of the person. The gradations of this standard for a healthy person are specifically indicated and for clarity we present them in the form of a table:

In some gradations of ESR norms for people aged 60 years and over, not a specific indicator is used, but a formula. In this case, in older men, the upper limit of normal is equal to age divided by two, and in women, age plus "10" divided by two. This technique is used quite rarely and only by individual laboratories. The values ​​​​of the maximum ESR norm for it can reach 36-44 mm / h and even higher rates, which by most doctors is already considered a signal of the presence of pathology and the need for medical research.

It is worth noting once again the fact that the ESR norm in a pregnant woman can seriously differ from the indicators given in the table above. In anticipation of a child, the erythrocyte sedimentation rate can reach 40-50 mm / h, which in no way indicates a disease or pathology and is not a prerequisite for any further research.

Reasons for the growth of ESR

The growth of ESR can indicate dozens of different diseases and abnormalities in the body, so it is always used in combination with other laboratory studies. But at the same time, in medicine there is a certain list of groups of diseases in which the erythrocyte sedimentation rate invariably increases:

• blood diseases (in particular, with sickle cell anemia, the irregular shape of erythrocytes provokes an increase in the erythrocyte sedimentation rate, which differs significantly from the normative indicators);
• infarctions and (in this case, acute-phase inflammatory proteins are adsorbed on the surface of blood cells, reducing their electrical charge);
• diseases associated with metabolic disorders (diabetes mellitus, cystic fibrosis, obesity);
• diseases of the liver and biliary tract;
• leukemia, lymphoma, myeloma (with myeloma, the erythrocyte sedimentation rate in almost all cases exceeds 90 mm / h and can reach 150 mm / h);
• malignant neoplasms.

In addition, an increase in ESR is observed in most inflammatory processes in the body, with anemia and with various infections.
Modern statistics of laboratory studies have collected enough data on the reasons for the increase in ESR, which made it possible to create a kind of "rating". The absolute leader causing the growth of ESR are infectious diseases. They account for 40 percent of the facts of detection of excess ESR. Oncological diseases and rheumatism took the second and third places of this list with results of 23 and 17 percent. In eight percent of cases of fixation of a high erythrocyte sedimentation rate, it was caused by anemia, inflammatory processes in the digestive tract and pelvic area, diabetes mellitus, injuries and diseases of the upper respiratory tract, and in three percent of cases, increased ESR was a signal of kidney disease.

Despite the fact that the collected statistics are quite eloquent, you should not self-diagnose yourself in terms of ESR. This can only be done by a doctor, using several laboratory tests in combination. The ESR indicator can increase very seriously, up to 90-100 mm / h, regardless of the type of disease, but in terms of the result of the study, the erythrocyte sedimentation rate cannot serve as a marker for a specific cause.

There are also prerequisites under which the growth of ESR does not reflect the development of any disease. In particular, a sharp increase in the indicator is observed in pregnant women, and a slight increase in ESR is possible with allergic reactions and even on the type of food: diet or fasting lead to changes in the blood test and to some extent affect the ESR. In medicine, this group of factors is called the causes of a false positive ESR analysis and they are tried to be excluded even before the examination.
In a separate paragraph, it is worth mentioning the cases when even in-depth studies do not show the reasons for the increase in ESR. Very rarely, a constant overestimation of this indicator can be a feature of the body that has neither prerequisites nor consequences. This feature is typical for every twentieth inhabitant of the planet. But even in this case, it is recommended to be regularly examined by a doctor so as not to miss the development of any pathology.

It is also important that in most diseases, the growth of ESR does not begin immediately, but after a day, and after recovery, the restoration of this indicator to normal can take up to four weeks. This fact should be remembered by every doctor, so that after the completion of the course of treatment, the person should not be subjected to additional studies due to a residual increase in the ESR.

Reasons for the growth of ESR in a child

The body of children traditionally differs from the adult in terms of laboratory results. The erythrocyte sedimentation rate is no exception, the growth of which in a child is provoked by a slightly modified list of prerequisites.

In most cases, an increased ESR in the blood of a child indicates the presence of an infectious-inflammatory process in the body. This is often confirmed by other results in the general blood test, which, together with ESR, almost immediately form a picture of the child's condition. At the same time, in a small patient, an increase in this indicator is often accompanied by a visual deterioration of the condition: weakness, apathy, lack of appetite - a classic picture of an infectious disease with the presence of an inflammatory process.

Of the non-communicable diseases that most often provoke an increased ESR in a child, the following should be highlighted:

• pulmonary and extrapulmonary forms of tuberculosis;
• anemia and blood diseases;
• diseases associated with metabolic disorders;
• injury.

However, if an increased ESR is found in a child, the reasons can be quite harmless. In particular, going beyond the norm of this indicator can be triggered by taking paracetamol, one of the most popular antipyretic drugs, teething in infants, the presence of worms (helminthiasis), and vitamin deficiency in the body. All these factors are also false positive and must be taken into account even at the stage of preparation for the delivery of a laboratory blood test.

Causes of an underestimated ESR

A low relative to the norm erythrocyte sedimentation rate is quite rare. In most cases, this situation is provoked by violations of hyperhydration (water-salt metabolism) in the body. In addition, low ESR may be a consequence of developing muscle dystrophy and liver failure. Among the non-pathological causes of low ESR, there are corticosteroids, smoking, vegetarianism, prolonged fasting and early pregnancy, but there is practically no consistency in these prerequisites.
Finally, let's summarize all the information about the ESR:

• this is a non-specific indicator. Only on it it is impossible to diagnose the disease;
• an increase in ESR is not a reason for panic, but is a reason for in-depth analysis. The reasons can be both very harmless and quite serious;
• ESR is one of the few laboratory studies that is based on mechanical action, and not on a chemical reaction;
• until recently, automatic systems for measuring ESR made laboratory technician error the most common cause of false erythrocyte sedimentation rate analysis.

In modern medicine, the erythrocyte sedimentation rate continues to be perhaps the most popular laboratory blood test. The high sensitivity of the analysis allows doctors to clearly determine the presence of problems in the patient and prescribe further examination. The only serious drawback of this study is the strong dependence of the result on the correctness of the actions of the laboratory assistant, but with the advent of automatic systems for determining ESR, the human factor can be eliminated.

Sedimentation rate of erythrocytes is one of the mandatory laboratory blood tests, which allows you to estimate how quickly blood cells are separated from the plasma. This indicator characterizes the state of human health, and also shows the presence and degree of the inflammatory process. How the ESR is determined, and what indicators are normal, we will find out further.

In order to determine the ESR and get more accurate results, prepare for research.