Update: October 2018 Medicine does not stand still – every day
new diagnostic methods are being introduced and introduced, allowing
identify the causes of changes in the human body and
leading to diseases.
Despite this, the definition of ESR has not lost its relevance.
and is actively used for diagnosis in adults and young
patients. This study is mandatory and in all cases
revealing whether a visit to a doctor due to a disease or
clinical examination and preventive examination.
This diagnostic test is interpreted by a doctor.
specialties, therefore, belongs to the group of general studies
blood. And, if the blood test ESR is elevated, the reason the doctor must
What is soe?
ESR is a term formed from full capital letters.
test names – erythrocyte sedimentation rate. Simplicity of the name
does not conceal any medical background, the test is really
определяет ту самую скорость оседания эритроцитов blood. Red blood cells
– these are red blood cells that when exposed
anticoagulants for some time settle at the bottom of the medical
test tubes or capillary.
The time taken to separate a blood sample into two visible layers (upper
and lower) is interpreted as the erythrocyte sedimentation rate and
estimated by the height of the resulting layer
plasma in millimeters in one hour.
ESR refers to non-specific indicators, but has a high
sensitivity. By changing the ESR, the body can signal
development of a certain pathology (infectious, rheumatological,
oncological and other nature) even before the appearance of an obvious
the clinical picture, i.e. in the period of imaginary well-being.
Erythrocyte sedimentation rate in the blood helps:
- differentiate the diagnosis, for example – angina and heart attack
myocardium, acute appendicitis and ectopic pregnancy (signs),
osteoarthritis and rheumatoid arthritis, etc.
- determine the response of the body during treatment with
tuberculosis, rheumatoid arthritis, lymphogranulomatosis,
disseminated lupus erythematosus, etc.
- state the underlying disease, however even
normal ESR value does not preclude a serious illness or
Diseases with high ESR
Erythrocyte sedimentation rate has an important diagnostic and
medical value in case of suspicion of a disease. Of course
however, no one doctor refers to the ESR indicator alone;
diagnosis. But along with the symptoms and results of instrumental and
laboratory diagnosis, he occupies a weighty position.
The erythrocyte sedimentation rate almost always increases when
most bacterial infections occurring in the acute phase.
Localization of the infectious process may be the most diverse,
but the pattern of peripheral blood will always reflect the severity
inflammatory response. ESR increases and during the development of infection
In general, the diseases in which an increase in ESR is
A typical diagnostic sign can be divided into groups:
- Diseases of the liver and biliary tract (see gallstones
- Purulent and septic diseases of inflammatory nature;
- Diseases whose pathogenesis is destruction and necrosis
tissues – heart attacks and strokes, malignant neoplasms,
- Blood diseases – anisocytosis, sickle anemia,
- Metabolic diseases and pathological changes of the endocrine
glands – diabetes, obesity, thyrotoxicosis, cystic fibrosis and
- Malignant transformation of the bone marrow in which
red blood cells are inferior and enter the bloodstream unprepared for
performing its functions (leukemia, myeloma, lymphoma);
- Acute conditions leading to an increase in intrinsic viscosity
blood – diarrhea, bleeding, intestinal obstruction, vomiting,
condition after surgery;
- Autoimmune pathologies – lupus erythematosus, scleroderma,
rheumatism, Sjogren’s syndrome and others.
The highest rates of ESR (more than 100 mm / h) are typical for
- SARS, influenza, antritis, bronchitis, pneumonia, tuberculosis and
- urinary tract infections (pyelonephritis, cystitis)
- viral hepatitis and fungal infections
- for a long time, a high ESR may be due to cancer
It is worth noting that during infectious processes this indicator
it does not grow immediately, but one or two days after the onset of the disease, but
after recovery some time (up to several months) ESR
will be slightly increased.
ESR – norm and pathology
Since this indicator is normalized, there are
physiological limits that are normal for different
populations. For children, the ESR rate varies according to
Separately, we consider the condition of a woman as
pregnancy, in this period increased ESR up to 45 mm / h is considered
normal, while a pregnant woman does not need
additional examination to identify pathology.
|Increased ESR in a child||Among women||In men|
||In men нормативы также установлены согласно возрастным
Methods for determining the ESR and interpretation of results
Several different methods are used in medical diagnostics.
determination of ESR, the results of which are different from each other and not
comparable to each other.
The essence of the Westergren method, widely practiced and approved
International Committee for Standardization of Blood Research,
lies in the study of venous blood, which in a certain
the ratio is mixed with sodium citrate. Settling speed
red blood cell count is determined by measuring the distance of the tripod – from
the upper boundary of the plasma to the upper boundary of the settled erythrocytes through
1 hour after mixing and placing in a tripod. If it turns out that
ESR on Westergren increased, the result is more revealing
for diagnosis, especially in the case of accelerating the reaction.
Vintrob’s method is to study undiluted blood,
mixed with anticoagulant. ESR is interpreted on the scale of the tube,
in which the blood is placed. Lack of method – unreliability
results when the indicator is above 60 mm / h due to clogging
tube collapsed erythrocytes.
Panchenkov’s method is to study capillary blood,
diluted with sodium citrate in a 4: 1 ratio.
The blood is settled in a special capillary with 100 divisions.
The result is evaluated after 1 hour.
The Westergren and Panchenkov methods give identical results, but
with elevated ESR, Westergren shows higher
values. Comparative analysis of the indicators presented in the table.
(mm / h).
|Panchenkov method||Westergren method|
It should be noted that automatic
erythrocyte sedimentation rate counters that do not require
human involvement in breeding portions of blood and tracking
results. To correctly decipher the results necessarily
consideration should be given to the factors that determine the variations of a given
In civilized countries, in contrast to Russia (with backward
methods of diagnosis and treatment), ESR is no longer considered as
informative indicator of the inflammatory process, because it has
a lot of false positives and false negatives.
But the indicator of PSA (C-reactive protein) is an acute phase
protein, the increase of which indicates a non-specific response
organism for a wide range of diseases – bacterial, viral,
rheumatic, inflammation of the gallbladder and ducts, abdominal
процессов, туберкулезе, остром гепатите, травмах и etc. —
used in Europe very widely, it is almost replaced
indicator of ESR, as more reliable.
Factors affecting this indicator
Many factors, both physiological and pathological,
affect the rate of ESR, among which are key, i.e.
- the rate of ESR in the female half of humanity is higher than that of
male, due to the physiological peculiarity of the female
- its value is higher in pregnant women than in non-pregnant women, and
ranges from 20 to 45 mm / h;
- women taking contraceptives have an elevated
- people with anemia have a high ESR;
- in the morning, the erythrocyte sedimentation rate is somewhat higher,
than during the day and evening hours (characteristic of all people);
- acute phase proteins lead to faster sedimentation rates
- with the development of infectious and inflammatory process result
analysis changes a day after the onset of hyperthermia and
- in the presence of chronic inflammation, this indicator
always slightly elevated;
- with increased blood viscosity, this figure is lower
- anisocytes and spherocytes (morphological variants of erythrocytes)
slow down the erythrocyte sedimentation rate, and macrocytes, on the contrary,
speed up the reaction.
If the ESR in the blood of a child is increased – what does this mean?
Increased ESR in the blood of a child is likely to indicate
infectious-inflammatory process, which is determined not only
the result of the analysis. Other indicators will be changed as well.
general blood test, as well as in children infectious diseases
always accompanied by disturbing symptoms and worsening in common
states. In addition, ESR may increase with non-infectious
diseases in children:
- autoimmune or systemic diseases – rheumatoid arthritis,
bronchial asthma, systemic lupus erythematosus
- in case of metabolic disorders – hyperteriosis, diabetes,
- with anemia, hemoblastosis, blood diseases
- diseases involving tissue breakdown – cancer
processes, pulmonary tuberculosis and extrapulmonary forms, myocardial infarction
It should be remembered that even after recovery increased
erythrocyte sedimentation rate normalizes slowly enough
about 4-6 weeks after the illness, and if in doubt,
to make sure that the inflammatory process was stopped, you can pass
C-reactive protein analysis (in a paid clinic).
If a significant increase in ESR is found in a child’s cause,
most likely consist in the development of an inflammatory reaction,
therefore, in the case of pediatric diagnostics, talk about its safe
promotion is not accepted.
The most harmless factors of a slight increase in this
child’s indicator can be:
- if the ESR is slightly increased in infants, it may be
the consequence of a violation of the diet of a nursing mother (abundance of fatty foods)
- medication (paracetamol)
- the time when your baby is teething
- vitamin deficiency
- helminthiasis (see the symptoms of worms in children, the treatment of pinworms in
children, roundworm – symptoms, treatment)
Statistics of frequency of increase of ESR at various
- 40% are infectious diseases – upper and lower
respiratory tract, urinary tract, pulmonary tuberculosis and
extrapulmonary forms, viral hepatitis, systemic fungal
- 23% – oncological diseases of the blood and any organs
- 17% – rheumatism, systemic lupus erythematosus
- 8% – anemia, cholelithiasis, inflammatory processes
pancreas, intestines, pelvic organs
(salpingo-oophoritis, prostatitis), diseases of ENT organs (sinusitis,
отит, ангина), сахарный диабет, injuries, беременность
- 3% – kidney disease
When is an increase in ESR considered safe?
Many people know that the increase in this indicator, as a rule,
свидетельствует о какой-то inflammatory response. But it is not
Golden Rule. If elevated ESR is found in the blood, the causes
can be quite safe and do not require any treatment:
- allergic reactions in which the fluctuations initially
increased erythrocyte sedimentation rate makes it possible to judge
correct allergy therapy – if the drug is working, then
the indicator will gradually decrease;
- hearty breakfast before the study;
- fasting, strict diet;
- menstruation, pregnancy and the postpartum period in women.
Causes of false positive ESR analyzes
There is such a thing as a false positive analysis. Test for
ESR is considered to be false positive and does not indicate development.
infections with the following causes and factors:
- anemia, in which there is no morphological change
red blood cells;
- increase in the concentration of all plasma proteins except
- renal failure;
- severe obesity;
- old age of the patient;
- technical errors of diagnostics (wrong time
blood extracts, temperature above 25 ° C, insufficient mixing
крови с антикоагулянтом и etc.);
- the introduction of dextran;
- vaccination against hepatitis B;
- taking vitamin A.
What to do if the causes of elevated ESR are not identified?
There are frequent cases when the causes of increased sedimentation rate
red blood cells are not detected, and the analysis consistently shows high
ESR indicators in dynamics. In any case, will be held
in-depth diagnostics in order to eliminate dangerous processes and
conditions (especially oncological pathology). In some cases,
Some people have this feature of the body when ESR
increased regardless of the presence of the disease.
In this case, it is enough to go through once a half year.
prophylactic medical examination at your doctor, but with
any symptoms should be coming soon
visit a medical facility. In this case, the phrase “be careful
God saves “is an excellent motivation for attentive
relationship to their own health!
Автор: врач-гигиенист, эпидемиолог