Medicine is constantly evolving - every day new diagnostic techniques are created and implemented that make it possible to identify the causes of changes in the human body that cause diseases.
Despite this, the determination of ESR does not lose its relevance and continues to be used for diagnosis in young patients and adults. Such a study is mandatory and indicative in all cases, be it a visit to a specialist as a result of an illness or a preventive examination and medical examination.
This test is interpreted by a doctor of various specialties, and therefore belongs to the category of general blood tests. Therefore, if the ESR blood test is elevated, the doctor must determine the reason for this.
What is ESR?
ESR is a term that reflects the erythrocyte sedimentation rate. The simplicity of the name has no medical basis; the test actually allows you to determine the erythrocyte sedimentation rate, blood cells that, over a certain period of time, settle at the bottom of a capillary or medical plug when exposed to anticoagulants.
The time of separation of the taken blood into 2 visible layers (lower and upper) is interpreted as the erythrocyte sedimentation rate and calculated from the height of the plasma layer obtained during the study in mm per 1 hour.
ESR is a nonspecific indicator that has high sensitivity. A change in ESR can signal the development of one or another pathology (oncological, rheumatological, infectious and other in nature) even before the onset of the clinical picture, namely during a period of imaginary well-being.
The erythrocyte sedimentation rate (ESR) in the blood helps:
differentiate the diagnosis, for example - myocardial infarction and angina pectoris, ectopic pregnancy, acute appendicitis, rheumatoid arthritis and osteoarthritis and others;
identify the response of the human body during treatment for rheumatoid arthritis, tuberculosis, disseminated lupus erythematosus, lymphogranulomatosis, etc.;
to state an asymptomatic disease, but even a normal ESR value does not completely exclude the presence of a malignant neoplasm or serious illness.
What diseases can occur with a high ESR level?
ESR has important medical and diagnostic significance when a certain disease is suspected. Of course, no doctor can rely on one ESR indicator when making a diagnosis. However, in the totality of all the symptoms and results of laboratory and instrumental diagnostics, it is given a significant position.
The erythrocyte sedimentation rate almost always increases in the presence of bacterial infections that occur in the acute phase. Moreover, the localization of the infectious process may be different, but the picture of peripheral blood reflects the severity of inflammation. ESR also increases with the development of a viral infection.
In general, all diseases in which the erythrocyte sedimentation rate increases are a typical diagnostic sign and are divided into the following groups:
Diseases of the jelly tract and liver.
Septic and purulent diseases of an inflammatory nature.
Diseases whose pathogenesis involves necrosis and tissue destruction - strokes and heart attacks, tuberculosis, malignant neoplasms.
Blood diseases - hemoglobinopathies, sickle anemia, anisocytosis.
Pathological changes in the endocrine glands and various metabolic diseases - obesity, diabetes mellitus, cystic fibrosis, thyrotoxicosis and others.
Malignant transformation of bone (red blood cells entering the blood are defective and unprepared to perform their functions - lymphoma, myeloma, leukemia).
Acute conditions that lead to an increase in intrinsic blood viscosity - bleeding, post-operative conditions, diarrhea, vomiting, intestinal obstruction.
Autoimmune pathologies - scleroderma, lupus erythematosus, Sjögren's syndrome, rheumatism and others.
The highest ESR rates, namely more than 100 mm per hour, are characteristic of the following infectious processes:
Flu, ARVI, bronchitis, sinusitis, tuberculosis, pneumonia and others.
Fungal infections and viral hepatitis.
Urinary tract infections (cystitis, pyelonephritis).
For a long time, a high ESR can be accompanied by an oncological process.
It should be noted that this indicator does not increase immediately during infectious processes, but 1-2 days after the onset of the disease, and even after recovery (up to several months), the ESR will be slightly increased.
ESR – pathology and norm
Since such an indicator is normalized, there are physiological limits that are normal for different groups of the population. The ESR norm for children varies depending on age.
Such a condition as pregnancy is considered separately. During this period, the ESR rises to 45 mm per hour, and is the norm, and the woman is not sent for any additional examinations.
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Elevated ESR in children |
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This indicator in a newborn baby varies between 0-22 mm/hour, with a maximum of 2.8 mm/hour. At 1 month the norm is 2-5mm/hour. 2-6 months – 4-6 mm/hour. 6-12 months the norm is 3-10 mm/hour. 1-5 years – from 5 to 11 mm/hour. From 6 to 14 years – from 4 to 12 mm/hour. From 14 years: boys – from 1 to 10 mm/hour; girls – from 2 to 15 mm/hour. |
Up to 30 years – 8-15 mm/hour. From 30 years – up to 25 mm/hour. From 60 years – 50 mm/hour. |
ESR standards for men are also established according to age groups. Up to 60 years – 6-12 mm/hour. From 60 years – 15-20 mm/hour. |
Methods for determining erythrocyte sedimentation rate and interpretation of results
Today in medical diagnostics several methods are used to determine the erythrocyte sedimentation rate, the results of which are not comparable and differ from each other.
The essence of the Westergren method, approved by the International Committee for Standardization of Blood Studies and widely practiced, is to analyze venous blood, which is mixed with sodium citrate in a certain ratio. ESR is determined by measuring the distance of the stand - starting from the upper limit of the plasma and ending with the upper limit of the settled red blood cells one hour after mixing. If Westergren's ESR is elevated, the result is considered more indicative of diagnosis.
The Wintrobe method involves testing undiluted blood that is mixed with an anticoagulant. The erythrocyte sedimentation rate is interpreted by the scale of the tube into which the blood is placed. The only drawback of the method is that if the indicator is more than 60 mm/hour, then the results may be unreliable (due to clogging of the tube with settled red blood cells).
The Panchenkov method involves studying capillary blood, which is diluted with sodium citrate in a ratio of 4:1. In this case, the blood must be thawed in a special capillary with 100 divisions. The result is assessed in exactly one hour.
The Panchenkov and Westergren methods provide the same results, but the Westergren method with an increased ESR shows higher results. A comparative analysis of indicators is given in the table.
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Westergren method |
Panchenkov method |
It is worth noting that today, automatic counters for determining ESR are actively used, which do not require human participation not only in tracking results, but also in diluting blood proportions. To correctly interpret the results, it is necessary to take into account the factors that determine variations in this indicator.
Unlike Russia, in more developed countries ESR is no longer used as an information indicator of the inflammatory process, since it has many both false-negative and false-positive results. But the CRP indicator is an acute-phase protein, and if it increases, one can confidently declare the body’s nonspecific response to many diseases - rheumatic, viral, bacterial, inflammation of the ducts and gall bladder, abdominal processes, injuries, acute hepatitis, tuberculosis, etc. d. It is widely used in European countries, and can be said to have replaced the ESR indicator, since it is more reliable.
What factors influence the ESR indicator?
There are a huge number of factors, both pathological and physiological, that affect the erythrocyte sedimentation rate, among which it is worth highlighting the main ones, that is, those that are of greatest importance:
The erythrocyte sedimentation rate in women is higher than in men, as evidenced by the physiological characteristics of female blood.
In pregnant women, the ESR will always be higher and can vary from 20 to 45 mm/hour.
Anemic people have a higher rate.
Women who use contraceptives have a higher ESR.
In the morning, ESR is slightly higher than in the evening and daytime hours (and this is typical for absolutely all people).
With the development of an inflammatory and infectious process, the results of the analysis should be measured one day after the onset of leukocytosis and hyperthermia.
Acute phase proteins cause accelerated erythrocyte sedimentation.
With increased blood viscosity, ESR is below the physiological norm.
With a chronic focus of inflammation, this indicator is always slightly higher.
Spherocytes and anisocytes (morphological variants of erythrocytes) help slow down the ESR, and macrocytes, in turn, accelerate the reaction.
What does an elevated ESR mean in a child?
Most likely, an increased ESR in a child signals an infectious-inflammatory process, which is determined not only by the results of this analysis. At the same time, other indicators of the general blood test also change, and infectious diseases in children are always accompanied by a deterioration in their general condition and disturbing symptoms. Moreover, ESR in the blood of children often increases with non-infectious diseases:
for blood diseases, hematological malignancies, anemia;
systemic or autoimmune diseases - systemic lupus erythematosus, bronchial asthma, rheumatoid atritis;
in case of metabolic disorders - hypothyroidism, diabetes mellitus, hyperthyroidism;
for diseases accompanied by tissue decay - myocardial infarction, extrapulmonary diseases, pulmonary tuberculosis, oncological processes, etc.;
It is worth remembering that even after a complete recovery, the elevated ESR of erythrocytes normalizes slowly, approximately 4-5 weeks after the illness, and if there are doubts, to make sure that the inflammatory process has stopped, you can take a test (in a paid clinic) for C-reactive protein.
If an excessively high ESR is detected in a child, the reasons are most likely the development of inflammation, so during diagnosis it is not customary to talk about its safe increase.
The most harmless factors for a slight increase in ESR in a child may be:
taking medications (paracetamol);
if this indicator is slightly increased in an infant, this may indicate a malnutrition of the nursing mother (primarily the abundance of fatty foods);
vitamin deficiency;
the time when children are teething;
helminthiases (roundworms, pinworms, worms).
Statistics on the frequency of increased ESR in various diseases
3% are due to kidney disease;
8% - cholelithiasis, anemia, inflammatory processes of the intestines, pancreas, pelvic organs (prostatitis, salpingophoritis), diseases of the ENT organs (tonsillitis, otitis, sinusitis), trauma, diabetes, pregnancy);
17% - systemic lupus erythematosus, rheumatism;
23% - oncological diseases of the blood and various organs;
40% - infectious diseases of the urinary tract, lower and upper respiratory tract, extrapulmonary forms and pulmonary tuberculosis, systemic fungal infections, viral hepatitis.
In what cases is ESR safe?
Many people know that an increase in ESR usually indicates an inflammatory reaction occurring in the body. However, this is not the golden rule. With elevated ESR, the causes may be safe and do not imply any treatment:
strict diet, fasting;
allergic reactions of the body, in which the ESR is increased, allow us to talk about correct anti-allergy therapy - if the drug is effective, then the indicator will gradually decrease;
a hearty breakfast before the start of the study;
pregnancy, menstruation and the postpartum period.
Causes of false-positive erythrocyte sedimentation rate tests
A false-positive test does not signal the development of an infection in the presence of the following factors and causes:
renal failure;
anemia, in which the morphological change in red blood cells does not go away;
hypercholesterolemia;
an increase in the concentration of plasma proteins, with the exception of fibrinogen;
pregnancy;
severe obesity;
hypercholesterolemia;
elderly age of the patient;
administration of dextran;
technical diagnostic errors (temperature more than 25 degrees, incorrect blood holding time, disproportionate mixing of blood with the anticoagulant, etc.);
taking vitamin A;
vaccination against hepatitis B;
administration of dextran.
What to do if the causes of increased ESR are not found?
Quite common cases when the causes of increased ESR are not found, and the analysis signals consistently high erythrocyte sedimentation rates over time. In such situations, specialists prescribe in-depth diagnostics to exclude dangerous conditions and processes (especially oncological pathology). In many cases, some patients have a feature where the erythrocyte sedimentation rate is elevated, despite the presence of the disease.
In this case, it is enough to undergo a preventive medical examination once every 6 months, and if certain symptoms occur, go to a medical facility in the near future. You need to be careful about your own health!
Medicine does not stand still - every day new diagnostic techniques appear and are introduced to identify the causes of changes occurring in the human body and leading to diseases.
Despite this, the determination 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 indicative, be it a visit to a doctor due to a disease or medical examination and preventive examination.
This diagnostic test is interpreted by a doctor of any specialty, and therefore belongs to the group of general blood tests. And, if the ESR blood test is elevated, the doctor must determine the cause.
What is soe?
ESR is a term formed from the capital letters of the full name of the test - erythrocyte sedimentation rate. The simplicity of the name does not conceal any medical implications; the test actually determines the very erythrocyte sedimentation rate of blood. Erythrocytes are red blood cells that, when exposed to anticoagulants, settle at the bottom of a medical test tube or capillary over a certain period of time.
The time it takes for a blood sample to separate into two visible layers (upper and lower) is interpreted as the erythrocyte sedimentation rate and is estimated by the height of the resulting plasma layer in millimeters per hour.
ESR is a nonspecific indicator, but is highly sensitive. By changing the ESR, the body can signal the development of a certain pathology (infectious, rheumatological, oncological and other) even before the onset of an obvious clinical picture, i.e. during a period of imaginary prosperity.
The erythrocyte sedimentation rate in the blood helps:
- differentiate the diagnosis, for example, angina pectoris and myocardial infarction, and osteoarthritis and rheumatoid arthritis, etc.
- determine the body's response during treatment for tuberculosis, lymphogranulomatosis, disseminated lupus erythematosus, etc.
- to state a latent disease, however, even a normal ESR value does not exclude a serious disease or malignant neoplasm
Diseases accompanied by high ESR levels
The erythrocyte sedimentation rate has important diagnostic and medical significance when a disease is suspected. Of course, not a single doctor refers to the ESR indicator alone when making a diagnosis. But together with the symptoms and results of instrumental and laboratory diagnostics, it occupies a significant position.
The erythrocyte sedimentation rate almost always increases with most bacterial infections occurring in the acute phase. The localization of the infectious process can be very diverse, but the picture of peripheral blood will always reflect the severity of the inflammatory reaction. ESR also increases with the development of an infection of viral etiology.
In general, 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);
- Purulent and septic diseases of an inflammatory nature;
- Diseases whose pathogenesis involves tissue destruction and necrosis - heart attacks and strokes, malignant neoplasms, tuberculosis;
- – anisocytosis, sickle anemia, hemoglobinopathies;
- Metabolic diseases and pathological changes in the endocrine glands - diabetes mellitus, obesity, thyrotoxicosis, cystic fibrosis and others;
- Malignant transformation of the bone marrow, in which red blood cells are defective and enter the blood unprepared to perform their functions (leukemia, myeloma, lymphoma);
- Acute conditions leading to an increase in intrinsic blood viscosity - diarrhea, bleeding, intestinal obstruction, vomiting, condition after surgery;
- Autoimmune pathologies - lupus erythematosus, scleroderma, rheumatism, Sjögren's syndrome and others.
The highest ESR rates (more than 100 mm/h) are characteristic of infectious processes:
- ARVI, influenza, sinusitis, bronchitis, pneumonia, tuberculosis, etc.
- urinary tract infections (pyelonephritis, cystitis)
- viral hepatitis and fungal infections
- For a long time, high ESR can occur during an oncological process.
It is worth noting that during infectious processes this indicator does not increase immediately, but one or two days after the onset of the disease, and after recovery for some time (up to several months) the ESR will be slightly increased.
ESR – norm and pathology
Because this indicator is standardized, there are physiological limits that are normal for different population groups. For children, the ESR norm varies depending on age.
Separately, a woman’s condition such as pregnancy is considered; during this period, an increased ESR of up to 45 mm/h is considered normal, and the pregnant woman does not need additional examination to identify pathology.
| Increased ESR in a child | Among women | In men |
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For men, standards are also set according to age groups.
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Methods for determining ESR and interpretation of results
In medical diagnostics, several different methods for determining ESR are used, the results of which differ from each other and are not comparable with each other.
The essence of the Westergren method, widely practiced and approved by the International Committee for Standardization of Blood Research, is the study of venous blood, which is mixed in a certain ratio with sodium citrate. The erythrocyte sedimentation rate is determined by measuring the distance of the rack - from the upper limit of the plasma to the upper limit of the settled erythrocytes 1 hour after mixing and placing in the rack. If it turns out that Westergren's ESR is elevated, the result is more indicative of diagnosis, especially if the reaction is accelerated.
The Wintrobe method involves testing undiluted blood mixed with an anticoagulant. The ESR is interpreted by the scale of the tube into which the blood is placed. The disadvantage of the method is the unreliability of the results when the reading is above 60 mm/h due to clogging of the tube with settled red blood cells.
The Panchenkov method consists of studying capillary blood diluted with sodium citrate in a quantitative ratio of 4:1. The blood settles in a special capillary with 100 divisions. The result is assessed after 1 hour.
The Westergren and Panchenkov methods give the same results, but with increased ESR, the Westergren method shows higher values. A comparative analysis of indicators is presented in the table (mm/h).
| Panchenkov method | Westergren method |
| 15 | 14 |
| 16 | 15 |
| 20 | 18 |
| 22 | 20 |
| 30 | 26 |
| 36 | 30 |
| 40 | 33 |
| 49 | 40 |
It is worth noting that automatic counters for determining the erythrocyte sedimentation rate are now actively used, which do not require human participation in diluting a portion of blood and monitoring the results. To correctly interpret the results, it is imperative to take into account the factors that determine variations in this indicator.
In civilized countries, unlike Russia (with backward methods of diagnosis and treatment), ESR is no longer considered as an informative indicator of the inflammatory process, since it has a lot of both false-positive and false-negative results. But the CRP (C-reactive protein) indicator is an acute-phase protein, the increase of which indicates a nonspecific response of the body to a wide range of diseases - bacterial, viral, rheumatic, inflammation of the gallbladder and ducts, abdominal processes, tuberculosis, acute hepatitis, injuries, etc. . - is used very widely in Europe, it has practically replaced the ESR indicator as more reliable.
Factors influencing this indicator
Many factors, both physiological and pathological, influence the ESR indicator, among which the key ones are identified, i.e. of greatest importance:
- the ESR indicator in the female half of humanity is higher than in the male half, which is due to the physiological characteristics of female blood;
- 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 increased rate;
- people suffering from anemia have a high ESR;
- in the morning, the erythrocyte sedimentation rate is slightly higher than in the afternoon and evening hours (typical for all people);
- acute phase proteins lead to an acceleration of the erythrocyte sedimentation rate;
- with the development of an infectious and inflammatory process, the result of the analysis changes one day after the onset of hyperthermia and leukocytosis;
- in the presence of a chronic focus of inflammation, this indicator is always slightly increased;
- with increased blood viscosity, this indicator is below the physiological norm;
- anisocytes and spherocytes (morphological variants of erythrocytes) slow down the erythrocyte sedimentation rate, and macrocytes, on the contrary, accelerate the reaction.
If the ESR in a child’s blood is elevated, what does this mean?
An increased ESR in the blood of a child most likely indicates an infectious-inflammatory process, which is determined not only by the result of the analysis. At the same time, other indicators of the general blood test will also change, and in children, infectious diseases are always accompanied by disturbing symptoms and a deterioration in their general condition. 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 - hyperthyroidism, diabetes mellitus, hypothyroidism
- for anemia, hematological malignancies, blood diseases
- diseases accompanied by tissue decay - oncological processes, pulmonary tuberculosis and extrapulmonary forms, myocardial infarction, etc.
- injuries
It should be remembered that even after recovery, the increased erythrocyte sedimentation rate normalizes quite slowly, approximately 4-6 weeks after the illness, and if in doubt, to make sure that the inflammatory process has stopped, you can get tested for C-reactive protein (in a paid clinic) .
If a significantly increased ESR is detected in a child, the reasons most likely lie in the development of an inflammatory reaction, therefore, in the case of pediatric diagnosis, it is not accepted to talk about its safe increase.
The most harmless factors for a slight increase in this indicator in a child may be:
- if the ESR is slightly increased in a baby, this may be a consequence of a violation of the diet of the nursing mother (an abundance of fatty foods)
- taking medications ()
- time when baby is teething
- vitamin deficiency
- helminthiasis (see,)
Statistics on the frequency of increased ESR in various diseases
- 40% are infectious diseases - upper and lower respiratory tract, urinary tract, pulmonary tuberculosis and extrapulmonary forms, viral hepatitis, systemic fungal infections
- 23% - oncological diseases of the blood and any organs
- 17% - rheumatism, systemic lupus erythematosus
- 8% - anemia, cholelithiasis, inflammatory processes of the pancreas, intestines, pelvic organs (salpingoophoritis, prostatitis), diseases of the ENT organs (sinusitis, otitis media, tonsillitis), diabetes mellitus, trauma, pregnancy
- 3% - kidney disease
When is increasing ESR considered safe?
Many people know that an increase in this indicator, as a rule, indicates some kind of inflammatory reaction. But this is not the golden rule. If an increased ESR is detected in the blood, the causes may be completely safe and do not require any treatment:
- allergic reactions, in which fluctuations in the initially increased erythrocyte sedimentation rate make it possible to judge the correct anti-allergy therapy - if the drug works, the rate will gradually decrease;
- a hearty breakfast before the study;
- fasting, strict diet;
- menstruation, pregnancy and the postpartum period in women.
Causes of false-positive ESR tests
There is such a thing as a false positive analysis. The ESR test is considered false positive and does not indicate the development of infection if the following causes and factors are present:
- anemia, in which there is no morphological change in red blood cells;
- an increase in the concentration of all plasma proteins except fibrinogen;
- renal failure;
- hypercholesterolemia;
- severe obesity;
- pregnancy;
- elderly age of the patient;
- technical diagnostic errors (incorrect blood holding time, temperature above 25 C, insufficient mixing of blood with the anticoagulant, etc.);
- administration of dextran;
- vaccination against hepatitis B;
- taking vitamin A.
What to do if the causes of increased ESR are not identified?
There are often cases when the reasons for the increased erythrocyte sedimentation rate are not found, and the analysis consistently shows high ESR rates over time. In any case, an in-depth diagnosis will be carried out in order to exclude dangerous processes and conditions (especially oncological pathology). In some cases, some people have such a feature of the body when the ESR is increased, regardless of the presence of the disease.
In this case, it is enough to undergo a preventive medical examination with your doctor once every six months, but if any symptoms occur, you should visit a medical facility as soon as possible. In this case, the phrase “God protects those who are careful” is an excellent motivation for being careful about your own health!
ESR (erythrocyte sedimentation rate in the blood) is determined using a general blood test, which is the safest for the baby. This research indicator indicates how long and how quickly red blood cells can mate with each other. ESR in a child’s blood does not determine whether there are any abnormalities in the condition of the baby’s body, but together with other components it gives a general picture of the disease or health condition.
Norm
In children, as in adults, it depends on the age and gender of the patient. The number shown by the procedure is never constant. Study indicators may change constantly.
In a child it has a wider range of meanings depending on the age of the baby. For example, if the ESR in the blood of children from one to twelve months is from 3-10 mm/s, then for a child aged one to five years it has higher values from 5-11 mm/h.
If the ESR level is normal, then this suggests that the circulatory system is not subject to any pathology. But, if such an indicator is high or low, this means that there is some kind of anomaly in the little person’s body.
Promotion
When the ESR in a child’s blood is elevated, the presence of an inflammatory process in the baby is diagnosed. If in children it exceeds the norm, then they speak of the presence of a virus in the child’s body. If the number of neutrophils is higher than normal, then they speak of the presence of bacteria in the organs and systems of the body.
Maybe in children for other reasons. For example, in newborn children, ESR is usually higher than normal during the period when they are teething or simply from a lack of vitamins and minerals.
In adolescents, the normal erythrocyte sedimentation rate may be exceeded due to the use of certain medications or from excessive consumption of fatty foods. During exams, the body reacts to stressful situations or emotional overload.
Pathologies of a viral or bacteriological nature with elevated blood ESR:
- Injuries.
- Allergy.
- Malfunctions of the immune system.
- An infectious disease that has an acute or chronic form.
- Poisoning of the child’s body with toxic substances.
Before identifying the disease and starting treatment procedures, additional examinations are prescribed: biochemistry, urine testing, radiography and other procedures.
False positive
In some cases, it gives a false elevated ESR level when no inflammatory diseases are observed.
This happens when:
- Obesity.
- In front of everyone.
- If the child takes vitamin A for a long time.
- Hypercholestyrinemia.
- If the child has kidney failure.
- Hyperproteinemia.
- If your child has recently been vaccinated against hepatitis B.
If a child has an increased ESR in the blood, but no pathologies are detected using additional tests, and the baby does not complain about anything, then this is a feature that is inherent in this human body.
Sometimes most blood components show normal levels and only the erythrocyte sedimentation rate is very high, then after a short amount of time an additional study is done so that the doctor can make sure that the child has it.
For inflammatory processes, treatment with medications is prescribed, including antihistamines, antiviral agents and antibiotics.
If high ESR levels in children were not caused by a viral disease, then other means of correction are recommended.
It is not observed so often in children. In this case, experts talk about blood thinning, poor blood clotting, etc. Of course, red blood cells are observed in huge numbers, but they do not interface with each other.
Factors that reduce ESR in a child’s body include exhaustion, dehydration, poisoning, and problems with defecation. It happens that such a pathology indicates the presence of a chronic disease associated with the hematopoietic system or viral hepatitis.
What to do
If the erythrocyte sedimentation rate in the child’s circulatory system is outside the normal range, but its fluctuations are insignificant, and the child does not complain about the state of his health, then nothing significant is observed in him and he is not sick with anything. But just to be sure, you can ask your doctor for a referral for additional blood tests to make sure that your child is absolutely healthy.
If the ESR is between 40-50 mm/h, then the doctor will diagnose a serious disease, the treatment of which will take quite a long time and you need to be prepared for this.
It should be remembered that increased or decreased blood ESR does not require treatment, but it is necessary to identify the cause or disease that caused this anomaly. In the future, the erythrocyte sedimentation rate will return to its normal state, but this will happen after recovery and will take more than one month.
If there are complaints about changes in the body or suspicions of serious diseases, doctors often prescribe a general blood test to the patient, along with other studies, whether for an adult or a child. It reveals various indicators, including ESR (erythrocyte sedimentation rate), or ROE (erythrocyte sedimentation reaction). This indicator means how quickly red blood cells stick together.
But for each individual indicator in a blood test it is impossible to make one or another diagnosis. Therefore, if an increased ESR is detected in a child, you should not worry. This may well be caused by fairly harmless reasons. If other indicators also reveal data that does not correspond to the norm, doctors will make a diagnosis or prescribe other studies based on them.
How is ESR analysis performed?
A complete blood count should be performed on an empty stomach. On the eve of donating blood, you should eat your last meal approximately 8 to 10 hours before donating blood. To obtain reliable results, doctors also advise not to eat fatty and fried foods two days before the examination. 60 - 75 minutes before the analysis you need to exclude smoking, emotional excitement, you should also rest for 11 - 14 minutes before the analysis. If the patient is taking any medications, the doctor should be informed about this.
This analysis does not need to be performed after x-rays, rectal examinations, or physical therapy procedures.
To determine ESR, blood taken from a finger is placed in specially designed containers, in which, under the influence of gravity, red blood cells begin to settle. The speed at which this process occurs is measured by a laboratory assistant. The ESR norm for different age groups has its own indicators:
- in newborns – from 0 to 2 mm/h;
- in babies under 6 months of age – 12 - 17 mm/h;
- in girls – 3 - 15 mm/h;
- for boys – 2 - 10 mm/h.
What does an elevated ESR level indicate?
If red blood cells are deposited at a rate that is higher than normal, this indicates that certain changes are occurring in the body. Red blood cells may settle faster if
- blood pH level increases;
- The viscosity of the blood decreases, it thins out;
- the level of albumin decreases (the main blood protein that is produced in the human liver);
- there is an acute or subacute period of any inflammatory process;
- the child has received some kind of injury, he is experiencing poisoning, stress, all kinds of allergic reactions, the presence of helminths or infections that have not been fully treated;
- metabolic disorders (hyper- and hypothyroidism, diabetes mellitus);
- diseases occurring in the connective tissue of the body;
- autoimmune diseases.
If there are no objective reasons for an increase in the erythrocyte sedimentation rate, the local pediatrician may prescribe another blood test and an additional examination of the body: determining the condition of the tonsils and lymph nodes, palpation of the spleen, examination of the kidneys, heart, an electrocardiogram, X-ray of the lungs, blood tests for protein, immunoglobulins , platelets, reticulocytes, biochemical blood test, general urine test, thorough external examination and questioning of parents regarding the child’s health. What diseases can be detected after such an examination?
- With an increase in the level of leukocytes and accelerated ESR, we can talk about an acute inflammatory process.
- If the leukocytes are normal, and the ESR is increased, then this is a sign of damage to the child’s body by certain viral infections or an indicator that recovery is occurring (leukocytes return to normal faster than the ESR).
- Anemia (the number of red blood cells in the blood decreases) also provokes an increase in ESR.
- Parents should be aware that the erythrocyte sedimentation rate may be slightly higher in girls than in boys. The ESR level can fluctuate depending on the time of day: from 13.00 to 18.00 it increases. Also, in children there are age periods when the erythrocyte sedimentation rate increases for no reason. These include 27-32 days from the birth of the baby and two years of age.
If it is not possible to associate a prolonged increase in the ESR level with any disease, and also after a thorough examination of the child’s health, this fact can be correlated with the individual characteristics of the child’s body. It is also necessary to keep in mind the fact that there are cases of false-positive acceleration of ESR, when certain factors can cause a prolonged rise in this indicator:
- decrease in hemoglobin and red blood cells;
- taking certain vitamins;
- vaccination against hepatitis;
- overweight child.
By the appearance of a child, as a rule, one can determine whether he is actually sick or healthy. If the child eats and sleeps well, he is mobile, cheerful, active and in a good mood, then most likely the baby is healthy, and the high ESR is caused by slightly different reasons:
- the presence of fatty or spicy foods in the diet (if we are talking about infants, then the reason may be a violation of the mother’s diet);
- insufficient amount of vitamins;
- process of teething;
- taking certain medications that contain paracetamol;
- the influence of stressful situations (this also includes fear of the blood donation process);
- It is also necessary to take into account the influence of the human factor: it is quite possible that the laboratory assistants made mistakes during the testing and calculation of the ESR indicator.
Elevated ESR syndrome
Sometimes, quite rarely, there are patients who have a very high ESR (50-60 mm/h or higher) for a long time.
The so-called increased ESR syndrome (or accelerated ESR syndrome) requires careful monitoring by doctors. This is only a sign that an in-depth diagnostic study of the patient is necessary. If no inflammation, tumors, or rheumatic diseases are detected in the body after various studies, and the patient’s health is still cheerful and good, high ESR does not need treatment separately.
Modern doctors today often prescribe another test - a test for C-reactive protein, which shows whether there is a real reason for concern. This study does not depend on many factors, such as the determination of ESR (for example, maintaining high ESR levels for a month or two even after recovery), and also immediately shows whether there is any inflammation in the body or not.
Thanks to a child's blood test, you can determine whether the baby is healthy or has any diseases. This is especially important if the disease is hidden. To identify such hidden pathologies, all children are routinely sent for tests at a certain age. And increased attention is paid to blood tests in children.
One of the important indicators determined in the laboratory during blood testing is ESR. Seeing this abbreviation on a blood test form, many parents do not know what it means. If, in addition, the analysis revealed an increased ESR in the child’s blood, this causes worry and anxiety. To know what to do with such changes, you need to understand how ESR analysis is carried out in children and how its results are deciphered.
What is ESR and how is its value determined?
The abbreviation ESR abbreviates the “erythrocyte sedimentation rate,” which is found during a clinical blood test.
The indicator is measured in millimeters per hour. To determine it, blood combined with an anticoagulant (it is important that it remains liquid) is left in a test tube, allowing its cells to settle under the influence of gravity. After one hour, the height of the upper layer is measured - the transparent part of the blood (plasma) above the blood cells that have settled down.
Nowadays, in many medical institutions, ESR is determined using an automatic device.
Table of norm values
When a blood test is deciphered, all indicators are compared with standards, which depend on the age of the children. This also applies to the sedimentation rate of red blood cells, because the ESR immediately after birth will be the same, at the age of 2-3 years or 8-9 years the indicator will be different.
The normal ESR results are: | |
In a newborn in the first days of life | |
In an infant up to one year old |
In children older than one year
An increase in the rate between the 27th day of life and two years is considered normal. In children of this age, ESR can reach 12-17 mm/h. In adolescence, the results differ for girls (up to 14 mm per hour is considered normal) and for boys (ESR 2-11 mm per hour is considered normal).
Deviations of ESR from the norm are often manifested by an increase in this indicator, and a decrease in the rate at which red blood cells are deposited is observed much less frequently. The most common cause of such changes is increased blood viscosity.
A lower ESR occurs when:
- Dehydration, for example due to acute intestinal infection.
- Heart defects.
- Sickle anemia.
- Acidosis (lowering blood pH).
- Severe poisoning.
- Sharp weight loss.
- Taking steroid medications.
- An increase in the number of blood cells (polycythemia).
- The presence in the blood of red blood cells with an altered shape (spherocytosis or anisocytosis).
- Pathologies of the liver and gall bladder, especially manifested by hyperbilirubinemia.
Reasons for increasing ESR
A high ESR in a child does not always indicate health problems. This indicator can change under the influence of various factors, sometimes harmless or temporarily affecting the child. However, quite often an increase in ESR is a sign of illness, and sometimes very serious.
Non-hazardous
For such reasons it is typical a slight increase in ESR, for example, up to 20-25 mm/h. T What ESR indicator can be detected:
- During teething.
- With hypovitaminosis.
- If your child is taking retinol (vitamin A).
- In case of strong emotions or stress, for example, after a baby has been crying for a long time.
- During a strict diet or fasting.
- When taking certain medications, such as paracetamol.
- If there is an excess of fatty foods in the diet of a baby or a nursing mother.
- After vaccination against hepatitis B.
In addition, in childhood the so-called C syndrome of increased ESR. With it, the indicator is high, but the child does not have any complaints or health problems.
Pathological
In diseases, ESR increases much more than normal, for example, to 45-50 mm/h and higher. One of the main reasons for faster erythrocyte sedimentation is an increase in the amount of protein in the blood due to an increase in the level of fibrinogen and the production of immunoglobulins. This condition occurs during the acute phase of many diseases.
Also, a common reason for a higher ESR is the appearance of immature red blood cells during inflammatory diseases. All these changes lead to faster sedimentation of blood cells, resulting in an increase in ESR.
An increase in ESR is observed when:
- Infectious diseases. An increased rate is often diagnosed with bronchitis, ARVI, scarlet fever, sinusitis, rubella, cystitis, pneumonia, mumps, as well as tuberculosis and other infections.
- Poisoning, for example, caused by toxins in food or salts of heavy metals.
- Helminthiasis and giardiasis.
- Anemia or hemoglobinopathies.
- Injuries of both soft tissues and bones. ESR also increases during the recovery period after surgery.
- Allergic reactions. ESR increases both during diathesis and anaphylactic shock.
- Joint diseases.
- Tumor processes, for example, with leukemia or lymphoma.
- Endocrine pathologies, for example, diabetes mellitus or thyrotoxicosis.
- Autoimmune diseases, in particular lupus.
ESR in infections
The most common pathological cause of an increase in ESR is infectious diseases. In this case, the nature of the infection can be determined by the leukocyte formula, because leukocytes and ESR are elevated in a child with both a viral and bacterial infection. However, in case of infection with a virus, the leukoformula will show lymphocytosis. If the infection is bacterial, a white blood cell count will indicate an increased number of neutrophils.
It should be remembered that to diagnose an infection, not only changes in the blood are taken into account, but also the clinical picture and anamnesis. In addition, it is important to note that after recovery, the ESR remains elevated for several months.
For information about the ESR norm and the reasons for increased indicators, see the following video.
Symptoms
In some cases, nothing bothers the child at all, and changes in ESR are detected during a routine examination. However, often a high ESR is a sign of illness, so babies will also have other symptoms:
- If red blood cells sediment faster due to diabetes, the child will experience increased thirst, increased urination, weight loss, skin infections, thrush and other signs.
- With an increase in ESR due to tuberculosis the child will lose weight, complain of malaise, cough, chest pain, headaches. Parents will notice a slight increase in temperature and poor appetite.
- With such dangerous cause of increased ESR, such as an oncological process, the baby’s immunity will decrease, lymph nodes will increase, weakness will appear, and weight will decrease.
- Infectious processes, in which the ESR increases most often, will be manifested by a sharp rise in temperature, increased heart rate, shortness of breath and other signs of intoxication.
What to do
Since most often a high ESR signals the doctor about the presence of an inflammatory process in the child’s body, a change in this indicator should not go unnoticed by the pediatrician. In this case, the actions of doctors are determined by the presence of any complaints in the child.
As a rule, the activity of the disease and the level of ESR have a direct relationship - the more extensive the inflammation and the more severe the disease, the higher the ESR will be. And therefore, indicators of 13 mm/h or 16 mm/h will not alert the pediatrician as much as ESR of 30, 40 or 70 mm/h.
If the child does not have any manifestations of the disease, and the ESR in the blood test is high, the doctor will refer the child for additional examination, which will include a biochemical and immunological blood test, chest x-ray, urinalysis, ECG and other methods.
If no pathologies are detected, and an increased ESR, for example, 28 mm/h, remains the only warning symptom, after some time the pediatrician will refer the baby to retake a clinical blood test. The child will also be recommended to determine C-reactive protein in the blood, which is used to judge the activity of inflammation in the body.
If an increase in ESR is a symptom of a disease, the pediatrician will prescribe medication.
As soon as the child recovers, the indicator will return to normal values. In case of an infectious disease, the child will be prescribed antibiotics and other medications; in case of allergies, the child will be prescribed antihistamines.
In any case, parents should understand that an increase in ESR is not an independent disease, but is only one of the symptoms. In this case, treatment should be aimed at the reason why red blood cells settle faster.
How to get tested
- To avoid a false positive result (an increase in ESR without the presence of inflammation in the body), it is important to get a correct blood test.
- ESR is influenced by quite a few factors, so when taking the test it is recommended to do it on an empty stomach and in a calm state.
- You should not donate blood after an X-ray, eating, crying for a long time, or physical therapy.
- It is advisable that the child eats no later than 8 hours before blood sampling.
- In addition, two days before the examination, very high-calorie and fatty foods should be excluded from the child’s diet.
- The day before the test, the child should not be given fried or smoked foods.