Erythrocyte sedimentation rate (ESR)

The sedimentation rate of erythrocytes (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 the 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 after 60 years	Up to 20
Men under 60 years old)	Up to 8
Men after 60 years	Up to 15
In the definition of Westergren	Up to 20

The rate of erythrocyte sedimentation (ESR) normally varies with age and sex: in children, ESR is lower (1-8 mm / h) than in adults, and in middle-aged people is less than in elderly and senile individuals. During the day, fluctuations in the values are possible, the maximum level is noted in the daytime.

Since ESR depends mainly on protein changes in the blood (increase in the content of fibrinogen, globulins), it increases in all conditions accompanied by inflammation, destruction of connective tissue, tissue necrosis, malignancy, immune disorders. Acute-phase proteins (C-reactive protein, haptoglobin, alpha1-antitrypsin), adsorbed on the surface of red blood cells, reduce their charge and repulsion from each other, promote the formation of "coins" and the accelerated sedimentation of erythrocytes. In acute inflammatory and infectious processes, the change in ESR is observed 24 hours after the temperature rises and the number of leukocytes increases. In chronic inflammation, the increase in ESR is due to an increase in the concentration of fibrinogen and immunoglobulins.

The formation of "coins" and the agglutination of erythrocytes, increasing the mass of settling particles, precipitate precipitation. The main factor affecting the formation of "coins" of red blood cells is the protein composition of the blood plasma. All protein molecules reduce the zeta potential of erythrocytes (a negative charge that promotes mutual repulsion of red blood cells and keeping them in a suspended state), but asymmetric molecules - fibrinogen, Ig, as well as haptoglobin - have the greatest effect. Therefore, a particularly pronounced increase in ESR (60-80 mm / h) is characteristic of paraproteinemic hemoblastoses (myeloma, Waldenström disease). The sensitivity of ESR to the detection of protein pathology of the plasma is higher in the absence of anemia. Other factors influence the zeta potential of erythrocytes: pH of the plasma (acidosis reduces ESR, alkalosis increases), ion charge of plasma, lipids, blood viscosity, presence of anti-erythrocyte antibodies. The number, shape and size of red blood cells also affect sedimentation. Erythropenia accelerates sedimentation, however, with severe crescent, spherocytosis, anisocytosis

ESR can be low, since the altered form of cells prevents the formation of "coins".

In recent years, the international method for the determination of ESR - the Westergren method - has been actively used. In this method, capillaries of 200 mm length are used, which increases the sensitivity of the method.

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