2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-17 02:10
Blood test for ESR: norm and deviations
The erythrocyte sedimentation rate (ESR) is a non-specific laboratory blood index reflecting the ratio of plasma protein fractions.
A change in the results of this test up or down from the norm is an indirect sign of a pathological or inflammatory process in the human body.
Another name for the indicator is "erythrocyte sedimentation reaction" or ROE. The subsidence reaction occurs in the blood, which is deprived of the ability to fold, under the influence of the force of gravity.
Content:
- ESR in the blood test
- Preparation for the procedure and blood sampling
- How is ESR determined?
- ESR analysis methods
- ESR rate depends on gender and age
- ESR above normal - what does it mean?
- What can a decrease in ESR mean?
- How to return ESR to normal
- Editorial opinion
ESR in the blood test
The essence of blood testing for ESR is that erythrocytes are the heaviest elements in blood plasma. If you set a test tube with blood vertically for some time, it will be divided into fractions - a thick brown red blood cell sediment at the bottom, and a translucent blood plasma with the rest of the blood elements at the top. This separation occurs under the influence of gravity.
Erythrocytes have a peculiarity - under certain conditions, they "stick" together, forming cell complexes. Since their mass is much greater than the mass of individual erythrocytes, they settle to the bottom of the test tube faster. With an inflammatory process in the body, the rate of unification of erythrocytes increases, or, conversely, decreases. Respectively, the ESR increases or decreases.
The accuracy of blood testing depends on the following factors:
- Correct preparation for the analysis;
- Qualifications of the laboratory assistant conducting the research;
- The quality of the reagents used.
If all the requirements are met, you can be sure of the objectivity of the research result.
Preparation for the procedure and blood sampling
Indications for the determination of ESR are control over the appearance and intensity of the inflammatory process in various diseases and in their prevention. Deviations from the norm indicate the need for a biochemical blood test to clarify the level of certain proteins. Based on a single ESR test, it is impossible to make a specific diagnosis.
The analysis takes 5 to 10 minutes. Before donating blood for ESR determination, do not eat for 4 hours. This completes the preparation for donating blood.
Capillary blood sampling sequence:
- Rub the third or fourth finger of the left hand with alcohol.
- A shallow incision (2-3 mm) is made on the fingertip with a special tool.
- Remove the protruding drop of blood with a sterile napkin.
- Biomaterial is collected.
- Disinfect the puncture site.
- A cotton swab moistened with ether is applied to the pad of the finger, and asked to press the finger to the palm of the hand to stop bleeding as soon as possible.
The sequence of venous blood sampling:
- The patient's forearm is tied with a rubber band.
- The puncture site is disinfected with alcohol, a needle is inserted into the vein of the elbow.
- Collect the required amount of blood in a test tube.
- Remove the needle from the vein.
- The puncture site is disinfected with cotton wool and alcohol.
- The arm is bent at the elbow until the bleeding stops.
The blood taken for analysis is examined to determine ESR.
How is ESR determined?
The test tube containing the biomaterial with the anticoagulant is placed in a vertical position. After a while, the blood will be divided into fractions - red blood cells will appear at the bottom, transparent plasma with a yellowish tint at the top.
The erythrocyte sedimentation rate is the distance covered by them in 1 hour.
ESR depends on plasma density, its viscosity and the radius of erythrocytes. The calculation formula is quite complicated.
Procedure for determining ESR according to Panchenkov:
- Blood from a finger or vein is placed in a “capillary” (a special glass tube).
- Then it is placed on a glass slide, then sent back to the "capillary".
- The tube is placed in Panchenkov's tripod.
- An hour later, the result is recorded - the value of the plasma column following the erythrocytes (mm / hour).
The method of such a study of ESR is adopted in Russia and in the countries of the post-Soviet space.
ESR analysis methods
There are two methods for laboratory testing of blood for ESR. They have a common feature - before the study, the blood is mixed with an anticoagulant so that the blood does not clot. The methods differ in the type of the studied biomaterial and in the accuracy of the results obtained.
Panchenkov's method
For research using this method, capillary blood taken from the patient's finger is used. ESR is analyzed using a Panchenkov capillary, which is a thin glass tube with 100 divisions applied to it.
The blood is mixed with an anticoagulant on a special glass in a ratio of 1: 4. After that, the biomaterial will no longer coagulate, it is placed in a capillary. After an hour, the height of the column of blood plasma, separated from the erythrocytes, is measured. The unit of measurement is millimeter per hour (mm / hour).
Westergren's method
A study using this method is an international standard for measuring ESR. To carry it out, a more accurate 200-division scale is used, graduated in millimeters.
Venous blood is mixed in a test tube with an anticoagulant, ESR is measured after an hour. The units are the same - mm / hour.
ESR rate depends on gender and age
The gender and age of the subjects affects the ESR indicators, taken as the norm.
- In healthy newborns - 1-2 mm / hour. Reasons for deviations from the standard indicators - acidosis, hypercholesterolemia, high hematocrit;
- in children 1-6 months - 12-17 mm / hour;
- in children of preschool age - 1-8 mm / hour (equal to that of adult men);
- For men - no more than 1-10 mm / hour;
- In women - 2-15 mm / hour, these values differ depending on the level of androgen, from 4 months of pregnancy, the soe grows, reaching 55 mm / hour, after childbirth, it returns to normal in 3 weeks. The reason for the increase in soe is an increased level of plasma volume in pregnant women, cholesterol levels, and globulins.
An increase in indicators does not always indicate pathology, the reason for this may be:
- The use of contraceptives, high molecular weight dextrans;
- Fasting, use of diets, lack of fluid, leading to the breakdown of tissue proteins. A recent meal has a similar effect, so blood is taken on an empty stomach for ESR determination.
- Exercise-induced metabolic increase.
Change in ESR depending on age and gender
Age | ESR rate (mm / hour) |
Newborn babies | 0-2 |
Babies up to 6 months | 12-17 |
Children and adolescents | 2-8 |
Women under 60 | 2-12 |
Women in the 2nd half of pregnancy | 40-50 |
Women over 60 | Up to 20 |
Men under 60 | 1-8 |
Men over 60 | Up to 15 |
The acceleration of ESR occurs due to an increase in the level of globulins and fibrinogen. Such a shift in the protein content indicates necrosis, malignant transformation of tissues, inflammation and destruction of connective tissue, and impaired immunity. A prolonged increase in ESR over 40 mm / h requires other hematological studies to determine the cause of the pathology.
Table of ESR rates in women by age
Indicators found in 95% of healthy people are considered the norm in medicine. Since a blood test for ESR is a non-specific study, its indicators are used in diagnostics in conjunction with other tests.
Age | Rate (mm / hour) |
Girls under 13 | 7-10 |
Teenage girls | 15-18 |
Women of reproductive age | 2-15 |
Women over 50 | 15-20 |
According to the standards of Russian medicine, the norm for women is 2-15 mm / hour, abroad - 0-20 mm / hour.
The values of the norm for a woman fluctuate depending on changes in her body.
Indications for a blood test for ESR in women:
- Anemia,
- Lack of appetite,
- Neck pain, shoulder pain, headache,
- Pain in the pelvic area,
- Joint pain,
- Unreasonable weight loss.
ESR rate in pregnant women, depending on completeness
Body type | ESR rate (mm / hour) in the 1st half of pregnancy | ESR rate (mm / hour) in the 2nd half of pregnancy |
Overweight women | 18-48 | 30-70 |
Skinny women | 21-62 | 40-65 |
ESR in pregnant women depends directly on the level of hemoglobin.
ESR rate in blood in children
Age | ESR rate (mm / hour) |
At birth | 1-2 |
Day 8 | |
Day 14 | 17 |
Older than 2 weeks | About 20 |
In preschool children | 1-8 mm / hour |
ESR above normal - what does it mean?
The main reasons that accelerate the rate of erythrocyte sedimentation are changes in the composition of the blood and its physicochemical parameters. For the implementation of erythrocyte sedimentation, the plasma proteins are agglomerins.
The reasons for the increase in ESR:
- Infectious diseases that provoke inflammatory processes - syphilis, pneumonia, tuberculosis, rheumatism, blood poisoning. Based on the results of ESR, a conclusion is made about the stage of the inflammatory process, and the effectiveness of treatment is monitored. In bacterial infections, ESR values are higher than in diseases caused by viruses.
- Endocrine diseases - thyrotoxicosis, diabetes mellitus.
- Rheumatoid arthritis.
- Inflammatory lesions of the myocardium, heart attack.
- Pathologies of the liver, intestines, pancreas, kidneys.
- Intoxication with lead, arsenic.
- Malignant lesions.
- Hematological pathologies - anemia, myeloma, lymphogranulomatosis.
- Injuries, fractures, conditions after surgery.
- High cholesterol.
- Side effects of drugs (morphine, Dextran, Methyldorf, vitamin B).
The dynamics of changes in ESR can vary depending on the stage of the disease:
- In the initial stage of tuberculosis, the level of ESR does not deviate from the norm, but increases with the development of the disease and with complications.
- The development of myeloma, sarcoma, and other tumors increases the ESR up to 60-80 mm / hour.
- On the first day of the development of acute appendicitis, ESR is within normal limits.
- An acute infection increases the ESR in the first 2-3 days of the development of the disease, but sometimes the indicators can differ from the norm for a long time (with croupous pneumonia).
- Rheumatism in the active stage does not increase ESR indicators, but their decrease may indicate heart failure (acidosis, erythremia).
- When the infection is stopped, the content of leukocytes in the blood first decreases, then ROE returns to normal.
A prolonged increase in ESR indicators up to 20-40 or even 75 mm / h in infections, most likely, indicates the appearance of complications. If there is no infection, and the numbers remain high, there is a latent pathology, an oncological process.
What can a decrease in ESR mean?
With reduced ESR indices, there is a decrease or absence of the ability of red blood cells to unite and form erythrocyte "columns".
The reasons leading to a decrease in ESR:
- Change in the shape of erythrocytes, which does not allow them to fold into "coin columns" (spherocytosis, sickle).
- Increased blood viscosity, which prevents erythrocyte sedimentation, especially with severe erythremia (an increase in the number of red blood cells).
- Change in the acid-base balance of the blood towards a decrease in pH.
Diseases and conditions leading to changes in blood counts:
- The release of bile acids is a consequence of obstructive jaundice;
- Sickle cell anemia;
- High bilirubin levels;
- Insufficient fibrinogen levels;
- Reactive erythrocytosis;
- Chronic circulatory failure;
- Erythremia.
In men, ESR below the norm is almost impossible to notice. In addition, such an indicator is not of great importance for diagnosis. Symptoms of a decrease in ESR are hyperthermia, tachycardia, fever. They can be precursors of an infectious disease or inflammatory process, or signs of a change in hematological characteristics.
How to return ESR to normal
To normalize the indicators of laboratory testing of ESR, you should find the reason for such changes. Most likely, you will have to undergo a course of treatment prescribed by a doctor, additional laboratory and instrumental studies. An accurately diagnosed diagnosis and optimal therapy of the disease will help to normalize the ESR indicators. Adults will need 2-4 weeks for this, children up to one and a half months.
With iron deficiency anemia, the ESR reaction will return to normal when a sufficient amount of foods containing iron and protein are consumed. If the reason for the deviation from the norm was a passion for diets, fasting, or such physiological conditions as pregnancy, breastfeeding, menstruation, ESR will return to normal after the normalization of health.
If ESR is increased
With an elevated level of ESR, natural physiological reasons should first be excluded: old age in women and men, menstruation, pregnancy, postpartum in women.
Attention! 5% of the inhabitants of the Earth have a congenital feature - their ROE indices differ from the norm without any reason and pathological processes.
If there are no physiological reasons, there are the following reasons for the increase in ESR:
- Anemia,
- Inflammatory process,
- Malignant tumors
- Intoxication,
- Kidney disease
- Acute or chronic infections
- Cardiogenic, painful or anaphylactic shock,
- Myocardial infarction,
- Burns, injuries,
- Condition after surgery.
In addition, the erythrocyte sedimentation reaction can be influenced by therapy with estrogens, glucocorticosteroids.
If ESR is reduced
The reasons for the decrease in the erythrocyte sedimentation rate:
- Violation of water-salt metabolism;
- Progressive myodystrophy;
- 1st and 2nd trimester of pregnancy;
- Taking corticosteroids;
- Vegetarian diet;
- Starvation.
In the event of a deviation from the norm, you should consult a doctor to find out the reason for this state of health.
Editorial opinion
The ESR indicator depends not only on the physiological processes in the human body, but also on the psychological component. Both negative and positive emotions affect the ESR indicators. Severe stress, a nervous breakdown will definitely change the erythrocyte sedimentation reaction. Therefore, on the day of donating blood and on the eve of it, it is advisable to normalize your psycho-emotional state.
Author of the article: Alekseeva Maria Yurievna | Therapist
Education: From 2010 to 2016 Practitioner of the therapeutic hospital of the central medical-sanitary unit No. 21, city of elektrostal. Since 2016 she has been working in the diagnostic center No. 3.
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