The test for erythrocyte sedimentation rate (ESR) is accepted in the medicine of the whole world as obligatory when performing a general blood test. It is carried out during the preventive examination, dispensary examination and diagnosis of diseases.
Norm ESR in the patient’s blood indicates the absence of a pronounced inflammatory reaction in organs and tissues. However, the ESR indicator is not considered unique and unique in the diagnosis. The correct interpretation is possible only together with other results of the analysis: the total number of leukocytes is taken into account, the blood leukocyte formula, c-reactive protein. The ESR indicator can also be affected by the number of red blood cells, their qualitative composition. Consider how the laboratory analysis is conducted.
Method of determining ESR
In Russia, the well-known Panchenkov method is used.
The essence of the method: if you mix blood with sodium citrate, then it does not coagulate, and is divided into two layers. The bottom layer is formed by erythrocytes, the top – transparent plasma. The erythrocyte sedimentation process is associated with the chemical and physical properties of blood.
In the formation of sediment passes through three stages:
- in the first ten minutes, vertical clumps of cells are formed, which are called coin columns;
- then forty minutes goes on settling;
- for another ten minutes, the red blood cells stick together and thicken.
This means that a maximum of 60 minutes is needed for the entire reaction.
For the study, they take a drop of blood from a finger, blow it into a special recess on the plate, where a 5% solution of sodium citrate is pre-applied. After mixing, the diluted blood is drawn into thin glass graduated capillary tubes up to the top mark and installed in a special tripod strictly vertically. In order not to confuse the analyzes, the lower end of the capillary is pierced with a note with the patient’s name. The time is indicated by a special laboratory clock with an alarm. Exactly one hour later, the results are recorded at the height of the column of red blood cells. The answer is recorded in mm per hour (mm / h).
Despite the simplicity of the technique, there are indications that must be followed when performing the test:
- take blood only on an empty stomach;
- apply a deep enough prick to the pulp of the finger so that the blood does not have to be squeezed out (red blood cells are destroyed under pressure);
- use fresh reagent, dry washed capillaries;
- fill the capillary with blood without air bubbles;
- observe the correct ratio between sodium citrate solution and blood (1: 4) with stirring;
- carry out the determination of ESR at an ambient temperature of 18-22 degrees.
Any violations in the analysis may lead to unreliable results. It is necessary to look for the causes of the erroneous result in violation of the technique of conducting, inexperience of the laboratory technician.
Under normal conditions, erythrocytes settle slowly, which means that in an hour the rate will be quite low. At various diseases in the blood there is an increased amount of protein, fibrin. They make red blood cells settle faster. The magnitude of the ESR increases.
The rates of ESR in the blood depend on the age, physiological state (pregnancy). In women, men and children, they are different. There is evidence that they even differ somewhat from residents of different territories.
To determine the exact standard mass surveys were carried out. Normal is considered to be the average.
The rate of ESR in a child, depending on age, is presented in the table.
In women during pregnancy, the association of the norm with the variant of body build
In addition, the dependence of the erythrocyte sedimentation rate on the hemoglobin level in a pregnant woman is traced.
The rates of ESR in adults also change with age.
For example, in acute myocardial infarction, the number of leukocytes increases during the first hours of the disease, while the ESR remains normal. On the fifth day, the symptom of “scissors” is expected, when the level of leukocytes falls, and the ESR on the contrary rises and stays above the norm for a long time. In the future, leukocytes remain normal, and according to the erythrocyte sedimentation rate, the scarring of the heart muscle and the effectiveness of the treatment are judged.
The combination of high white blood cell count, accelerated ESR allows the physician to continue diagnosis in terms of finding the source of the inflammatory response.
Significantly increased the value of ESR in allergic processes in the body, especially in diseases associated with erroneous autoallergic reactions to their own cells. These include systemic diseases: lupus erythematosus and rheumatoid polyarthritis.
Deciphering high numbers of erythrocyte sedimentation rates reveals tumor diseases, blood diseases (acute leukemia, myeloma), is important for the diagnosis of various anemias (anemia), the degree of blood loss in injuries, surgical interventions, kidney disease, renal failure.
Elevated levels of ESR are determined in infectious diseases: rheumatism, tuberculosis, any viral infection complicated by bacterial inflammation (sinuses with influenza, measles and scarlet fever in children). Erythrocyte reaction signals how long the inflammation lasts.
Reduction of ESR is noted in the defeat of erythrocytes (erythremia, sickle cell anemia), extensive burns that increase blood viscosity, cholera due to fluid loss, congenital heart defects with chronic heart failure, liver disease and kidneys with a decrease in protein in the blood.
Once detected, an unusual analysis must be repeated to exclude the influence of various factors. The persistent increase in ESR is a serious reason for in-depth examination.
It is possible to find out exactly what caused the increase in the erythrocyte sedimentation rate in a particular case after the diagnosis, taking into account the verification of other objective symptoms of the disease. Clinical examination allows to detect the disease at the stage of the absence of clinical manifestations.