Erythrocyte sedimentation rate (ESR)

The erythrocyte sedimentation rate (ESR) is directly proportional to the mass of erythrocytes, the difference in the density of erythrocytes and plasma, and inversely proportional to the viscosity of plasma.

Units of measurement: millimeters per hour (mm/h).

Reference values of ESR

Age	ESR, mm/h
Newborns	0-2
Children up to 6 months	12-17
Women under 60 years old	Up to 12
Women over 60	Up to 20
Men up to 60 years old)	Up to 8
Men over 60	Up to 15
When determined according to Westergren	Up to 20

The erythrocyte sedimentation rate (ESR) normally varies depending on age and gender: in children, the ESR is lower (1-8 mm/h) than in adults, and in middle-aged people it is lower than in elderly and old people. Values may fluctuate during the day, with the maximum level observed during the day.

Since ESR depends mainly on protein changes in the blood (increased fibrinogen and globulin levels), it increases in all conditions accompanied by inflammation, connective tissue destruction, tissue necrosis, malignancy, and immune disorders. Acute-phase proteins (C-reactive protein, haptoglobin, alpha1-antitrypsin), adsorbed on the surface of erythrocytes, reduce their charge and repulsion from each other, promote the formation of "royal columns" and accelerated sedimentation of erythrocytes. In acute inflammatory and infectious processes, a change in ESR 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.

The formation of "route columns" and agglutination of erythrocytes, increasing the mass of sedimenting particles, accelerate sedimentation. The main factor influencing the formation of "route columns" from erythrocytes is the protein composition of blood plasma. All protein molecules reduce the zeta potential of erythrocytes (a negative charge that promotes mutual repulsion of erythrocytes and maintains them in a suspended state), but the greatest influence is exerted by asymmetric molecules - fibrinogen, Ig, and haptoglobin. Therefore, a particularly pronounced increase in ESR (60-80 mm / hour) is characteristic of paraproteinemic hemoblastoses (myeloma, Waldenstrom's disease). The sensitivity of ESR to the detection of protein pathology of plasma is higher in the absence of anemia. The zeta potential of red blood cells is also affected by other factors: plasma pH (acidosis reduces ESR, alkalosis increases it), plasma ionic charge, lipids, blood viscosity, and the presence of anti-erythrocyte antibodies. The number, shape, and size of red blood cells also affect sedimentation. Erythropenia accelerates sedimentation, but with pronounced sickle cell formation, spherocytosis, and anisocytosis

ESR may be low because the altered shape of the cells prevents the formation of rouleaux.

In recent years, the international method of determining ESR - the Westergren method - has been actively used. This method uses 200 mm long capillaries, which increases the sensitivity of the method.

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