Analysis of soy 15. Decoding of soy in a blood test. Increase in men

Content

If a serious illness is suspected, the patient is sent for a general analysis of capillary or venous blood. If the ESR is increased in the results, then most likely an inflammatory process has begun in the body. This non-specific laboratory indicator helps the doctor decide on the tactics of treatment and prescribe the right drug.

What is SOE

The erythrocyte sedimentation rate, or ESR, is an important indicator in a blood test. It informs how quickly red blood cells sink under the influence of gravity. The value must be measured in millimeters per hour (mm/h). During the study, erythrocytes are in a special vertical test tube. The laboratory assistant measures the time it takes for them to reach the bottom, and then calculates the rate of settling.

In a healthy person, the level is low, but when inflammation has already begun in the body, the cells begin to stick together, become heavier and fall faster, which increases the ESR in the blood. The specialist who sends the patient for examination, according to the results, can draw up a clinical picture of the disease and prescribe treatment. There are two methods for counting blood cells - the Westergren method and the Panchenkov method.

ESR norm

The results may be different in children, men and women, they must be deciphered by a medical professional. It focuses on generally accepted indicators corresponding to the gender and age of the patient. Each category has its own ESR standard. If there is an excess in the analysis, the doctor decides whether additional examinations are needed to clarify the disease.

ESR above normal - what does it mean

The process of increasing the number of red blood cells per unit of blood volume is called polycythemia. There are various reasons for the increase in ESR in the blood. The indicator begins to rise after a few days from the onset of the disease, and after 2 weeks it reaches its highest point, but there are exceptions. It all depends on the type of disease that precedes the increase in ESR. A change in the indicator may mean the presence of:

• kidney pathology;
• SARS;
• rheumatoid arthritis;
• lymphomas;
• leukemia;
• diabetes;
• bacterial infection;
• rheumatism;
• hyperthyroidism and hypothyroidism;
• heart failure;
• other physiological disorders.

Deviation from the norm is often the result of stress, malnutrition, lack of vitamins in the body. Sometimes non-compliance with the rules for taking tests can increase the readings. To prevent this from happening, you need to give up food for 3-4 hours, from alcoholic beverages and alcohol-containing drugs per day, to exclude unrest. In addition, scientists have confirmed the fact that 5% of people on the planet have ESR more than normal from birth.

Increased ESR in the blood in women

The results of the analysis according to the average data in the adult female population range from 5-25 mm / h. There are many factors that can accelerate the sedimentation of red blood cells. Causes of increased ESR in the blood in women:

• pregnancy;
• menstruation;
• postpartum period;
• preclimatic period.

A woman should alert the doctor if any of the conditions on the list is present. The conditions are not pathological, but at this time the concentration of plasma proteins in the blood increases. Due to monthly blood loss, hemoglobin decreases, anemia may develop. The same thing happens after childbirth, and while carrying a child, the mother gives him some of the vitamins, so the indicator becomes high.

In other cases, an approximate calculation by age is used:

1. from 4 to 15 mm / h - at 18-30 years old;
2. from 8 to 25 mm / h - at 30-60 years old;
3. from 12 to 52 mm / h - at 60 years and older.

Elevated ESR in a child

For newborns, the readings can be very low, this is not a deviation from the norm. As they get older, they get bigger. An increased ESR in the blood of a child indicates that there is an exacerbation of the inflammatory process, but sometimes the causes are sleep disturbances, indigestion, or teething. The following results are considered normal:

1. 0-1 year - 1-6 mm/h;
2. 1-7 years - 4-8 mm / h;
3. 7-12 years - 4-12 mm / h;
4. 12-18 years - 4-15 mm / h.

Increased ESR in the blood in men

In the analysis for men, the indicator is slightly different from the female. The difference is about 1-10 units. Among the possible causes of increased ESR in the blood in men, doctors call:

• hepatitis;
• infections of the genitourinary system;
• heart attack;
• oncology;
• tuberculosis.

With age, the indicator changes: at 20-50 years old, it is normal at 0-15 mm / h, and after 50 years, the frames move apart to 5-25 mm / h. The doctor must take into account medication, which also affects the analysis. A patient's lifestyle can tell a lot. Smoking and drinking alcohol often lead to an exacerbation of chronic pulmonary and hepatic diseases: in such people, blood viscosity is reduced.

Elevated ESR during pregnancy

When there is an increase in ESR during pregnancy, the gynecologist takes into account the complexion of the patient. In a thin woman, the normal figures in the first and early second trimester are 20-62 mm / h, and at the end of the second and third - 35-80 mm / h, and in a future mother with a tendency to be overweight, fluctuations are 18-46 mm / h and 30-72 mm/h. Anemia of pregnancy and chronic diseases also affect the results of the analysis.

Increased ESR - what to do

You should not immediately sound the alarm if the ESR in the blood is increased: this fact in itself cannot indicate specific violations. The first thing to do when the erythrocyte sedimentation rate is increased in the analysis is to seek clarification from the attending physician. When deciphering, the specialist conducts a survey of the patient for the presence of any symptoms that entail an increase in the indicator.

For a patient who strictly observes the conditions for passing the analysis, in the absence of obvious signs of the disease in the form of fever, an additional examination is prescribed by other doctors, using modern equipment. High ESR in the blood is an indirect sign of serious illness and even a malignant tumor. If these cases are excluded, the right drugs for treatment help to reduce this value.

The erythrocyte sedimentation rate is an analysis used to detect inflammation in the body.

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

The analysis allows the diagnosis of many disorders (including cancer) and is a necessary test to confirm many diagnoses.

Let's see what it means when the erythrocyte sedimentation rate (ESR) in the general blood test of an adult or a 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 abnormalities. In pediatrics, this analysis helps diagnose rheumatoid arthritis in children or.

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

Many factors such as age or drug use may 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 boost

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

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

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

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

Interpretation of results and possible causes

What does it mean if the erythrocyte sedimentation rate (ESR) in the blood test of an adult or a child is increased or decreased, is it worth being afraid of indicators above the norm or below?

High levels in a blood test

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

• Autoimmune diseases - Liebman-Sachs disease, giant cell, polymyalgia rheumatica, necrotizing vasculitis, rheumatoid arthritis (the immune system is the body's defense against foreign substances. Against the backdrop of an autoimmune process, it mistakenly attacks healthy cells and destroys body tissues);
• Cancer (this can be any form of cancer, from lymphoma or multiple myeloma to colon and liver cancer)
• Chronic kidney disease (polycystic kidney disease and nephropathy);
• Infection, such as pneumonia, pelvic inflammatory disease, or appendicitis;
• Inflammation of the joints (rheumatic polymyalgia) 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 concentrations of fibrinogen in serum or hypofibrinogenemia;
• Pregnancy and toxicosis;
• Viral infections (HIV, tuberculosis, syphilis).

Because the ESR is a non-specific marker of inflammation and correlates with other causes, the results of the analysis should be taken into account together with the patient's medical 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 match, 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 rule out disease. Moderately elevated levels may be due to aging.

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

This video talks more about the norms and deviations of this indicator in the blood:

Low performance

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

• A disease or condition that increases the production of red blood cells;
• A disease or condition that increases the production of white blood cells;
• If a patient is being treated for an inflammatory disease, a downward grade of sedimentation is a good sign and indicates 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 the shape of cells);
• Severe liver disease.

Any factor can be the reason for the downgrade., For example:

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

Increased data for diagnosing cardiovascular disease

In patients with co-morbidity or myocardium, ESR is used as an additional potential indicator of coronary heart disease.

ESR used for diagnosis- (inner layer of the heart). Endocarditis develops when bacteria or viruses migrate from some 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 necessarily prescribes a blood test. Along with high levels of sedimentation rate, endocarditis is characterized by a decrease in platelets(lack of healthy red blood cells), often the patient is 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 normal "heart failure," congestive refers to the stage in which excess fluid builds up 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, the analysis for an extended profile may indicate the presence of abnormal cells and infections(sedimentation rate will be higher than 65mm/h).

At myocardial infarction always provoked by an increase in ESR. 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, a condition called "myocardial ischemia" begins.

Against the background of a heart attack, ESR reaches peak values(70 mm/h and above) within a week. Along with an increase in the rate of sedimentation, the lipid profile will show elevated levels of triglycerides, LDL, HDL and cholesterol in the blood serum.

A significant increase in the erythrocyte sedimentation rate is observed against the background of acute pericarditis. This, which begins suddenly, causes blood components such as fibrin, erythrocytes, and leukocytes 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/h), an increase in the concentration of urea in the blood as a result of kidney failure.

The erythrocyte sedimentation rate is significantly increased in the presence of an aortic aneurysm or . Together with high values ​​of ESR (above 70 mm / h), blood pressure will be elevated, patients with an aneurysm are often diagnosed with a condition called “thick blood”.

conclusions

ESR plays an important role in the diagnosis of cardiovascular diseases.. The indicator turns out to be increased 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 are directly correlated with the risk of myocardial infarction and coronary heart disease. For high settling levels and suspected cardiovascular disease the patient is referred for further diagnostics, including echocardiogram, MRI, electrocardiogram to confirm the diagnosis.

Experts use the erythrocyte sedimentation rate to determine the foci of inflammation in the body, the measurement of ESR is a convenient method for monitoring the course of treatment of diseases accompanied by inflammation.

Accordingly, a high sedimentation rate 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 regression.

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

A complete blood count is a very important study that helps the doctor identify some deviations from the norm for a healthy person. It shows several very important parameters, among which the ESR indicator is important. If everything is in order with a person’s health, soy in the blood is within the normal range. In adults and children, normal values ​​differ.

What is SOE?

Red blood cells are blood cells that perform a very important function in the body. These particles transport oxygen in human blood. ESR (erythrocyte sedimentation rate) is an indicator that is determined by conducting a study of a general blood test. Its deviations do not always unambiguously indicate that a person has some kind of disease or inflammatory process.

If the ESR exceeds the norm, you need to pay attention to other analysis data that can confirm the presence of the disease. If all other characteristics are normal, it is worth conducting additional studies. An increase or decrease in this characteristic is a signal for a doctor that he cannot ignore. Timely adoption of measures will help maintain human health.

Physiological limits of normal in women

For a healthy woman, there are their own criteria and the norm of soy in the blood. The erythrocyte sedimentation rate depends on the state of health and age. So, if the girl is not in a state of pregnancy, then this indicator should be in the range from 3 to 15 mm / h. Compared with men, their ESR should be in the range of 2 to 10 mm / h. After 60 years, in women and men, the norm of this indicator is the same - 15-20 mm / h.

For pregnant women, an increased ESR is very often characteristic, the indicator sometimes reaches 25 mm / h. Anemia often occurs in women in position, as a result of which blood thinning and an increase in the erythrocyte sedimentation rate are observed. Due to the individual characteristics of the organism, such characteristics may be different for each individual person.

How is a blood test done?

First, the patient will need to donate blood. It is optimal to do this in the morning and on an empty stomach in order to prevent the deviation of the indicator due to the presence of other factors. Biological material is sent for research, which is carried out by a specially trained laboratory assistant, or it is done automatically using a special device. Only a few drops of liquid are required for the study.

The erythrocyte sedimentation rate is determined using a special test, which with a high degree of probability will give the real indicator of soy in human blood. The study of biological material is a simple process, it takes about an hour to complete. The liquid is placed in a test tube, and the laboratory assistant monitors how quickly the erythrocytes settle to its bottom. Blood plasma itself has a slightly lower density than red blood cells, which is why they sink to the bottom.

It is very important not to get hung up on this parameter, it will only tell you what to pay attention to. The effectiveness of the study increases in conjunction with other diagnostics, which can tell more about a person's condition. The whole research process has three phases, the longest of them is the second, which lasts 40 minutes. The first and third stages take 10 minutes each. During this time, red blood cells sink to the bottom, settle and turn into a clot.

The indicator of the result of the study was obtained as a result of simple mathematical operations. The distance that the red blood cells descended is divided by the time spent on this operation. The unit of measure is mm/h. The decoding of the received data is carried out by a specialist who must take into account all related characteristics. The more pronounced the deviation of the ESR from the norm of a healthy person, the more dangerous and longer the inflammatory process in the body.

Why does the level of ESR in the blood rise?

The erythrocyte sedimentation rate indicates that not everything is in order with blood circulation, or vice versa. Sometimes elevated ESR levels are due to special causes, such as pregnancy or the consequences of surgery. If there are inflammatory processes or oncological diseases in the body, then the ESR level will be somewhat overestimated. Normal ESR data for different categories of people are different. If the score is high, then:

1. The density of erythrocytes is reduced.
2. There is a large amount of alkali in the blood.
3. The level of albumin content decreases.

All these factors are the result of blood thinning. But other points also influence the acceleration of erythrocyte sedimentation, for example, malnutrition, if there is a lack of vitamins and minerals in the body. In an infant, ESR increases during teething. Other causes may be hormonal disorders, pregnancy, fever, blood cancer, tuberculosis. This phenomenon often occurs due to chronic diseases in the active phase.

Causes of low ESR

Doctors say that more dangerous is an increased erythrocyte sedimentation rate. But do not forget about the lower bounds of this parameter. The reason for the decrease in the level of ESR can be the following diseases or pathologies:

1. Polycythemia. The blood becomes very viscous, and the ESR is minimal.
2. Diseases of the liver and kidneys. This lowers the level of fibrinogen in the blood.
3. Some cardiac pathologies.

Fasting, chronic circulatory failure, viral hepatitis, taking certain medications (calcium chloride, salicylates) can lower ESR. In epilepsy and neurosis, there is also a low erythrocyte sedimentation rate. But all this is revealed in the process of a comprehensive analysis of many characteristics of a person's state of health, therefore, when prescribing treatment, the doctor must rely not only on the ESR.

Treatment for elevated ESR in the blood

An elevated ESR does not clearly indicate pathologies. Treatment is prescribed to lower it to normal. There is no single algorithm for getting rid of this phenomenon. First of all, the reason for the increase in ESR is revealed. This may require more than one laboratory study. If, as a result, a person does not have other symptoms of diseases or inflammation, then treatment is not prescribed.

If the reason is clear, the doctor will prescribe an appropriate course of treatment, during which it will be necessary to periodically take a general blood test and observe the ESR. The closer this indicator is to the norm, the more correct and effective the treatment is. Soy in human blood is an important indicator, but this parameter must be monitored, especially if a person is at risk.

Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.

General blood analysis prescribed for almost all diseases, during pregnancy and as a preventive measure to detect diseases. A general blood test is taken from a finger.

General blood analysis includes the determination of hemoglobin concentration, the number of erythrocytes, leukocytes and platelets, hematocrit and erythrocyte indices (MCV, MCH, MCHC).

Indications for a general blood test and ESR

A complete blood count, together with a leukocyte formula, is widely used as one of the most important examination methods for most diseases. The changes occurring in the peripheral blood are nonspecific, but at the same time reflect the changes occurring in the whole organism.

The study of the leukocyte formula is of great importance in the diagnosis of hematological, infectious, inflammatory diseases, as well as in assessing the severity of the condition and the effectiveness of the therapy. At the same time, changes in the leukocyte formula are not specific - they may have a similar character in different diseases or, on the contrary, dissimilar changes may occur in the same pathology in different patients. The leukocyte formula has age-specific features, so its shifts should be assessed from the position of the age norm (this is especially important when examining children).

Erythrocyte sedimentation rate (ESR):

Inflammatory diseases.
Infections.
Tumors.
Screening examination during preventive examinations.

Measurement of ESR should be considered as a screening test that is not specific to any particular disease. ESR is usually used in the complex of a complete blood count.

Preparation for a general blood test and ESR

A general blood test is performed on an empty stomach. Between the last meal and blood donation for a general analysis, at least 8 hours must pass. It is advisable to exclude fatty, fried and alcohol from the diet 1-2 days before the examination. One hour before taking blood, you must refrain from smoking.

It is necessary to exclude factors that affect the results of the research: physical stress (running, climbing stairs), emotional arousal. Before the procedure, you need to rest for 10-15 minutes, calm down.

Be sure to tell your doctor about taking medications.

Blood should not be donated after x-rays, rectal examinations, or physical therapy procedures.

Different laboratories may use different test methods and units of measurement. In order for the evaluation of the results to be correct, we recommend that you undergo studies in the same laboratory, at the same time. Comparison of such results will be more comparable.

Deciphering the general blood test

Modern hematological analyzers make it possible to obtain accurate and highly informative characteristics of blood cells.

Any changes in the general blood test and deviations from the norm are interpreted as pathological and require a thorough examination of the patient. Changes in the hemogram in many diseases can be nonspecific. In this case, they are used for dynamic monitoring of the patient and in terms of assessing the prognosis.

In diseases of the hematopoietic system, the study of a complete blood count becomes of paramount diagnostic importance. It determines the further strategy for examining the patient with the subsequent choice of treatment regimen and is necessary for monitoring ongoing therapy.

In hematology analyzers from various manufacturers, normal blood counts can vary significantly depending on the standards used in a particular country. The following are normal peripheral blood counts in adults according to the order of the Ministry of Health of the Russian Federation.

Norms of blood parameters

Erythrocyte indicators (parameters) of blood

• red blood cells
• Erythrocytosis
• Hemoglobin
• Hematocrit
• Average erythrocyte volume
• The average content of hemoglobin in an erythrocyte
• The average concentration of hemoglobin in the erythrocyte
• The indicator of anisocytosis (heterogeneity) of erythrocytes (RDW - red cell distribution width)
• Morphology of erythrocytes
• Reticulocytes
• Erythrocyte sedimentation rate (ESR level)

Platelet blood parameters

• Platelets (PLT - platelet)
• thrombocytosis
• thrombocytopenia
• Average platelet volume (MPV - mean platelet volume)
• Platelet distribution width (PDW)
• Thrombocrit (PCT - platelet crit)

Leukocyte blood parameters

• White blood cell count
• Neutrophils
• Eosinophils
• Basophils
• Monocytes
• Lymphocytes
• Plasma cells
• Atypical mononuclear cells

The leukocyte formula is the percentage of different types of leukocytes (neutrophils, lymphocytes, eosinophils, monocytes, basophils). The leukocyte formula includes the determination (in%) of neutrophils, lymphocytes, eosinophils, basophils, monocytes.

Erythrocyte sedimentation rate (ESR)

Erythrocyte sedimentation rate (ESR) is a non-specific indicator of inflammation.

ESR is an indicator of the rate of blood separation in a test tube with added anticoagulant into 2 layers: upper (transparent plasma) and lower (settled erythrocytes). The erythrocyte sedimentation rate is estimated by the height of the formed plasma layer (in mm) for 1 hour. The specific gravity of erythrocytes is higher than the specific gravity of plasma, therefore, in a test tube, in the presence of an anticoagulant (sodium citrate), under the action of gravity, erythrocytes settle to the bottom.

The process of sedimentation (sedimentation) of erythrocytes can be divided into 3 phases, which occur at different rates. At first, red blood cells slowly settle into individual cells. Then they form aggregates - "coin columns", and settling occurs faster. In the third phase, a lot of erythrocyte aggregates are formed, their sedimentation first slows down, and then gradually stops.

The ESR indicator varies depending on many physiological and pathological factors. The values ​​of ESR in women are slightly higher than in men. Changes in the protein composition of the blood during pregnancy lead to an increase in ESR during this period.

A decrease in the content of erythrocytes (anemia) in the blood leads to an acceleration of ESR and, conversely, an increase in the content of erythrocytes in the blood slows down the rate of sedimentation. During the day, fluctuations in values ​​are possible, the maximum level is noted in the daytime. The main factor influencing the formation of "coin columns" during erythrocyte sedimentation is the protein composition of blood plasma. Acute phase proteins, being adsorbed on the surface of erythrocytes, reduce their charge and repulsion from each other, contribute to the formation of "coin columns" and accelerated erythrocyte sedimentation.

An increase in acute phase proteins, for example, C-reactive protein, haptoglobin, alpha-1 antitrypsin, in acute inflammation leads to an increase in ESR. In acute inflammatory and infectious processes, a change in the erythrocyte sedimentation rate is noted 24 hours after an increase in temperature and an increase in the number of leukocytes. In chronic inflammation, an increase in ESR is due to an increase in the concentration of fibrinogen and immunoglobulins.

Westergren method differs from the common method for determining ESR in Panchenkov's device the characteristics of the tubes used and the scale of results calibrated according to the Westergren method. The results obtained by these two methods coincide in the range of normal values, both methods have the same reference values. The Westergren method is more sensitive to an increase in ESR, and the results in the zone of elevated values ​​obtained by the Westergren method are higher than the results obtained by the Panchenkov method.

The determination of ESR in dynamics, in combination with other tests, is used to monitor the effectiveness of the treatment of inflammatory and infectious diseases.

ESR(Erythrocyte sedimentation rate) - a non-specific indicator of inflammation of various origins (in a vertically placed test tube).

In clinical practice, the definition of ESR is accessible, easy to do method to assess the patient's condition and assess the course of the disease when performing the test in dynamics.

Main indications for use:
preventive examinations(screening study)
diseases that occur with inflammatory processes- heart attack, tumors, infections, connective tissue diseases and many other diseases

Erythrocyte sedimentation rate- non-specific indicator , reflecting the course of inflammatory processes of various etiologies.

An increase in ESR often, but not always, correlates with an increase in the number of leukocytes and an increase in the concentration of C-reactive protein, which is a biochemical non-specific indicator of inflammation.
An increase in the formation of acute phase proteins during inflammation (C-reactive protein and many others), a change in the number and shape of erythrocytes leads to a change in the membrane properties of blood cells, contributing to their gluing. This leads to an increase in ESR.

!!! It is now believed that the most specific, sensitive and therefore the preferred indicator of inflammation, necrosis compared to the determination of ESR is the quantitative determination of C-reactive protein.

ESR - an indicator of the rate of blood separation in a test tube with added anticoagulant into 2 layers:
upper - transparent plasma
lower - settled erythrocytes

The erythrocyte sedimentation rate is estimated from the height of the formed plasma layer in millimeters per 1 hour (mm/h).

The specific gravity of erythrocytes is higher than the specific gravity of plasma, therefore, in a test tube, in the presence of an anticoagulant (sodium citrate), under the action of gravity, erythrocytes settle to the bottom.

The process of sedimentation (sedimentation) of erythrocytes can be divided into 3 phases that occur at different rates:
1.erythrocytes slowly settle into individual cells
2.erythrocytes form aggregates - "coin columns", and sedimentation occurs faster
3. a lot of erythrocyte aggregates are formed, their sedimentation first slows down, and then gradually stops

Determination of ESR in dynamics, in combination with other tests, used to monitor the effectiveness of treatment inflammatory and infectious diseases.

FACTORS AFFECTING ESR

The ESR indicator varies depending on many physiological and pathological factors.

ESR values slightly higher in women than in men.
Changes in the protein composition of the blood during pregnancy lead to an increase in ESR during this period.

During the day, fluctuations are possible, the maximum level is noted in the daytime.

The main factor influencing the formation of "coin columns" during erythrocyte sedimentation is the protein composition of blood plasma. Acute-phase proteins, being adsorbed on the surface of erythrocytes, reduce their charge and repulsion from each other, promote the formation of coin columns and accelerated erythrocyte sedimentation.

Elevation of acute phase proteins, for example, C-reactive protein, haptoglobin, alpha-1-antitrypsin, in acute inflammation leads to an increase in ESR.

In acute inflammatory and infectious processes a change in the erythrocyte sedimentation rate is noted 24 hours after the temperature increase and the increase in the number of leukocytes.

For chronic inflammation an increase in ESR is due to an increase in the concentration of fibrinogen and immunoglobulins.

Some morphological variants of erythrocytes may also affect ESR. Anisocytosis and spherocytosis inhibit erythrocyte aggregation. Macrocytes have a charge corresponding to their mass and settle faster.

With anemia drepanocytes affect ESR so that even with inflammation, ESR does not increase.

The ESR value depends on gender and age:
in newborns, ESR is very slow - about 2 mm, which is associated with a high hematocrit and a low content of globulins
by 4 weeks, ESR is slightly accelerated,
by 2 years it reaches 4-17 mm
in adults and children over 10 years of age ESR ranges from 2 to 10 mm for men and from 2 to 15 mm for women, which may be explained by different levels of androgenic steroids
in the elderly, the normal ESR level ranges from 2 to 38 in men and from 2 to 53 among women.

REASONS FOR CHANGES IN ESR

Blood viscosity and the total number of erythrocytes also have a significant impact on this indicator.

With anemia, accompanied, as you know, by a significant decrease in blood viscosity, an increase in ESR is observed, and with erythrocytosis, an increase in viscosity and a decrease in ESR.

Increasing the value of ESR

The most common cause of an increase in ESR is an increase in the content of coarse proteins (fibrinogen, a- and g-globulins, paraproteins) in the plasma, as well as a decrease in the content of albumins. Coarsely dispersed proteins have a smaller negative charge. Being adsorbed on negatively charged erythrocytes, they reduce their surface charge and contribute to the convergence of erythrocytes and their faster agglomeration.

And so, the reason for the increase in ESR can be:
Infections, inflammatory diseases, tissue destruction.
Other conditions leading to an increase in plasma fibrinogen and globulins, such as malignant tumors, paraproteinemias (eg, macroglobulinemia, multiple myeloma).
Myocardial infarction.
Pneumonia.
Liver diseases - hepatitis, cirrhosis of the liver, cancer, etc., leading to severe dysproteinemia, immune inflammation and necrosis of the liver tissue.
Kidney disease (especially accompanied by nephrotic syndrome (hypoalbuminemia) and others).
collagenoses.
Diseases of the endocrine system (diabetes).
Anemia (ESR increases depending on the severity), various injuries.
Pregnancy.
Poisoning by chemical agents.
Elderly age
Intoxication.
Trauma, broken bones.
Condition after shock, surgical interventions

Decreased ESR value

Three main factors contribute to the reduction of ESR:
1) blood clots
2) acidosis
3) hyperbilirubinemia

And so, the reason for lowering the ESR value can be:
Polycythemia.
Sickle cell anemia.
Spherocytosis.
Hypofibrinogenemia.
Hyperbilirubinemia.
Starvation, loss of muscle mass.
Taking corticosteroids.
Pregnancy (especially 1st and 2nd semester).
Vegetarian diet.
Hyperhydration.
Myodystrophy.
Severe symptoms of circulatory failure.

REMEMBER!!!

The increase in ESR is very sensitive, But non-specific hematological indicator of various pathological processes.

The most significant increase in ESR (up to 50-80 mm / h) is most often observed with:
paraproteinemic hemoblastoses - multiple myeloma, Waldenström's disease
connective tissue diseases and systemic vasculitis - systemic lupus erythematosus, periarteritis nodosa, scleroderma, etc.

The most common cause of a significant decrease in ESR is an increase in blood viscosity in diseases and syndromes accompanied by an increase in the number of red blood cells (erythremia, secondary erythrocytosis).

RELIABILITY OF THE RESULTS OF THE DETERMINATION OF ESR

The results of determining the ESR can be considered reliable only if, if no other parameters, except for the assumed ones, affect the indicator under study. Too many factors influence the results of the test, and therefore its clinical significance should be reconsidered.

The main influence on the erythrocyte sedimentation rate suspended in plasma is exerted by their degree of aggregation.

There are 3 main factors that affect erythrocyte aggregation:
surface energy of cells
cell charge
dielectric constant

The last indicator is a characteristic of the plasma, associated with the concentration of asymmetric molecules. An increase in the content of these proteins leads to an increase in the strength of bonds between erythrocytes, leading to agglutination and sticking (formation of columns) of erythrocytes and a higher sedimentation rate.

A moderate increase in the concentration of plasma proteins of classes 1 and 2 can cause an increase in ESR:
extremely asymmetric proteins- fibrinogen
or
moderately asymmetric proteins- immunoglobulins

Due to the fact that fibrinogen is an acute phase marker, an increase in the level of this protein indicates the presence of infection, inflammation, or the appearance of tumor cells in the blood, leading to an increase in ESR during these processes.

!!! Despite the recognized non-specificity of the method for determining ESR, it is often not taken into account that most other factors, except for the presence and severity of the inflammatory process, affect ESR, which casts doubt on the clinical significance of the test.

Causes of a false positive increase in ESR:
Anemia with normal erythrocyte morphology. This effect is explained by a change in the ratio of erythrocytes and plasma, which contributes to the formation of columns of erythrocytes, regardless of the concentration of fibrinogen.
An increase in the plasma concentration of all proteins, except for fibrinogen (M-protein, macroglobulins and erythrocyte agglutinins).
Renal failure. In compensated patients, renal failure may be associated with an increase in plasma fibrinogen levels.
Heparin. Sodium citrate dihydrate and EDTA do not affect ESR.
Hypercholesterolemia.
Extreme obesity. The increase in ESR is possibly associated with an increase in the level of fibrinogen.
Pregnancy (the definition of ESR was originally used to establish pregnancy).
Female.
Elderly age. According to rough estimates, for men, the upper level of normal ESR is the figure obtained by dividing age by 2, for women - age plus 10, and divided by 2.
Technical errors. The deviation of the test tube from the vertical position to the sides increases the ESR. Erythrocytes settle at the bottom of the tube, and the plasma rises to the top. Accordingly, the inhibitory effect of plasma weakens. An angle of 3° from the vertical line can lead to an increase in ESR up to 30 units.
Introduction to dextran.
Vaccination against hepatitis B.
Use of oral contraceptives.
Taking vitamin A.

Causes of a false positive decrease in ESR:
Morphological changes in erythrocytes. The most common forms of erythrocytes can lead to a change in the aggregation properties of erythrocytes, which, in turn, will affect the ESR. Red blood cells that are abnormal or unusually shaped, such as sickle-shaped, with a shape that prevents the formation of pillars, lead to a decrease in ESR. Spherocytes, anisocytes and poikilocytes also have an effect on erythrocyte aggregation, reducing ESR.
Polycythemia. It has an effect opposite to that which anemia has on erythrocyte aggregation.
A significant increase in the level of leukocytes.
DIC (due to hypofibrinogenemia).
Dysfibrinogenemia and afibrinogenemia.
A significant increase in the level of bile salts in the blood plasma (due to changes in the properties of the erythrocyte membrane).
Congestive heart failure.
Valproic acid.
Low molecular weight dextran.
Cachexia.
Lactation.
Technical errors. Due to the fact that ESR increases with increasing ambient temperature, chilled blood samples cannot be used in the test. If the samples were still frozen, before determining the ESR, it is necessary to warm the tube with blood to room temperature. It is equally important that the determination of ESR is carried out using blood samples obtained 2 hours before the test. If a test tube with blood is left on the laboratory table for a long time, the red blood cells take on a spherical shape, which leads to a decrease in the ability to form columns.
Application at the time of determining the ESR: corticotropin, cortisone, cyclophosphamide, fluorides, glucose, oxalates, quinine.

Sources of errors when running an analysis:
If the test blood is at room temperature, the ESR should be determined no later than 2 hours after taking the blood. If the blood is at +4°C, the ESR should be determined within no more than 6 hours, but before performing the method, the blood should be warmed to room temperature.
To obtain correct results, the determination of ESR should be performed at 18-25°C. At higher temperatures, the ESR value increases, and at lower temperatures it slows down.
The venous blood must be well mixed prior to analysis to ensure better reproducibility of the results.
Sometimes, more often with regenerative anemia, there is no sharp boundary between the erythrocyte column and plasma. Above the compact mass of erythrocytes, a light "veil" of several millimeters is formed, mainly from reticulocytes. In this case, the boundary of the compact layer is determined, and the erythrocyte veil is assigned to the plasma column.
Some plastics (polypropyl, polycarbonate) can replace glass capillary pipettes. Not all plastics have these properties and require testing and evaluation of the degree of correlation with glass capillary pipettes.

Factors distorting the result:
Wrong choice of anticoagulant.
Insufficient mixing of blood with anticoagulant.
Late sending of blood to the laboratory.
Using too thin a needle to puncture a vein.
Hemolysis of a blood sample.
Thickening of the blood due to prolonged squeezing of the arm with a tourniquet.

METHODS FOR DETERMINING ESR

1. The most common method for determining ESR in our country is the micromethod of T. P. Panchenkov , based on the property of erythrocytes to settle at the bottom of the vessel under the influence of gravity.

Equipment and reagents:
1. Panchenkov's apparatus.
2. Panchenkov's capillaries.
3. 5% sodium citrate solution (freshly prepared).
4. Watch glass.
5. Frank's needle or scarifier.
6. Cotton wool.
7. Alcohol.

Panchenkov's apparatus consists of a stand with capillaries (12 pcs.) 1 mm wide, on the wall of which divisions from 0 (top) to 100 (bottom) are marked. At level 0, there is the letter K (blood), and in the middle of the pipette, near the 50 mark, there is the letter P (reagent).

Research progress:
A 5% solution of sodium citrate is drawn into Panchenkov's capillary to the mark of 50 (letter P) and blown onto a watch glass. From a finger prick, holding the capillary horizontally, draw blood up to the mark 0 (Letter K). Then blood is blown onto a watch glass with sodium citrate, after which blood is drawn a second time to the 0 mark and released in addition to the first portion. Therefore, on a watch glass there is a ratio of citrate and blood equal to 1:4, i.e. four volumes of blood in one volume of the reagent. Mix the blood with the end of the capillary, draw it up to the 0 mark and place it strictly vertically in the Panchenkov apparatus. An hour later, note the number of millimeters of the plasma column.

2. Research method: according to Westergren, modified (recommended by the ICSG).

!!! This is an international method for determining ESR. It differs from the Panchenkov method in the characteristics of the test tubes used and in the scale of results calibrated in accordance with the Westergren method. The results obtained by this method, in the region of normal values, coincide with the results obtained when determining the ESR by the Panchenkov method. But the Westergren method is more sensitive to an increase in ESR, and the results in the zone of elevated values ​​obtained by the Westergren method are higher than the results obtained by the Panchenkov method.

Sample requirements:
Whole blood (Na citrate).

Reference limits:
Children: 0-10mm/h
adults,<50 лет, М: 0-15 Ж: 0-20 >50 years, M: 0-20 W: 0-30

Notes:

3. Research method: microESR.

Sample requirements:
Capillary blood (EDTA).

Notes:
ESR correlates well with plasma fibrinogen levels and depends on the formation of a column of erythrocytes. Therefore, poikilocytosis slows down settling; on the other hand, a change in the shape (flattening) of erythrocytes in obstructive liver diseases leads to an acceleration of sedimentation. The sensitivity of ESR to the detection of plasma protein pathology is better in the absence of anemia; in anemia, REZ is preferred. The Wintrobe method is more sensitive in the normal or slightly elevated ranges, while the Westergren method is more sensitive in the elevated ranges. The micromethod can be useful in pediatrics. ESR should not be used as a screening method for disease detection in asymptomatic patients. With the acceleration of ESR, a thorough questioning and physical examination of the patient usually allows us to find out the cause. The test is useful and indicated for the diagnosis and monitoring of patients with temporal arteritis and polymyalgia rheumatica. ESR is of little diagnostic value in RA, but may be useful in monitoring disease activity when clinical manifestations are uncertain. Since the test is often not modified in patients with malignant tumors, infections, and connective tissue diseases, the determination of ESR cannot be used to exclude these diseases in patients with unclear complaints.

4. Research method: according to Wintrobe.

Sample requirements:
Whole blood (EDTA).
Do not use heparin.

Reference limits:
Children: 0-13mm/h
Adults, M: 0-9 W: 0-20

Notes:
ESR correlates well with plasma fibrinogen levels and depends on the formation of a column of erythrocytes. Therefore, poikilocytosis slows down settling; on the other hand, a change in the shape (flattening) of erythrocytes in obstructive liver diseases leads to an acceleration of sedimentation. The sensitivity of ESR to the detection of plasma protein pathology is better in the absence of anemia; in anemia, REZ is preferred. The Wintrobe method is more sensitive in the normal or slightly elevated ranges, while the Westergren method is more sensitive in the elevated ranges. The micromethod can be useful in pediatrics. ESR should not be used as a screening method for disease detection in asymptomatic patients. With the acceleration of ESR, a thorough questioning and physical examination of the patient usually allows us to find out the cause. The test is useful and indicated for the diagnosis and monitoring of patients with temporal arteritis and polymyalgia rheumatica. ESR is of little diagnostic value in RA, but may be useful in monitoring disease activity when clinical manifestations are uncertain. Since the test is often not modified in patients with malignant tumors, infections, and connective tissue diseases, the determination of ESR cannot be used to exclude these diseases in patients with unclear complaints.

5. Test method: POS (Zeta deposition index).

Sample requirements:
Whole blood (EDTA).
Stable 2 hours at 250C, 12 hours at 40C.

Notes:
Unlike the Westergren and Wintrobe methods, POI is not affected by anemia. Determination of PHO requires special equipment.