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After complete recovery, this indicator may remain unchanged for several months, which should not be alarming only if there are no other changes in the blood.

An increased ESR in a child should not be perceived by parents as a sign of serious illness, as it may indicate minor changes in the body that do not require treatment. Despite this, after receiving “alarming” results, you should take a biochemical blood test, a urine test, and also conduct an external examination of the child. Erythrocyte sedimentation rate is a fairly serious indicator, so it is not recommended to ignore it.

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 settle at the bottom of a capillary or medical plug over a certain period of time 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 the 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, 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.

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.

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!

Let's find out what ESR is, what the norm is for children, and whether we should worry if the criterion deviates?

The normal erythrocyte sedimentation rate (ESR) is a laboratory criterion determined during a general blood test in children.

This is due to the fact that the level of ESR can increase with autoimmune pathologies, infectious diseases, post-traumatic conditions, severe stress, etc.

Due to their negative charge, red blood cells (erythrocytes) repel each other and do not stick together. When the immune system is activated, active synthesis of protective proteins begins: blood clotting factor I and immunoglobulins of various classes. Both factors influence ESR and act as a connecting “bridge” for red blood cells.

As a result, the process of red blood cell clumping is activated. The resulting aggregates of red blood cells are much heavier than individual cells and settle faster in the liquid medium of the blood.

Thus, the presence of specific proteins is the first sign of activation of the immune response to infection or internal pathologies, and an increase in ESR is additional confirmation of this process.

On what factors does a child’s ESR depend?

The ESR indicator in children is extremely sensitive to many external and internal factors. Among them, the quantitative content of protective specific proteins in the bloodstream that respond to infectious microorganisms and tumor neoplasms.

An increase in low-density lipoproteins (“bad cholesterol”), the bile pigment bilirubin and bile acids also has an effect. In this case, there is a significant increase in ESR.

The main causes of increased erythrocyte sedimentation rate are infectious diseases, tumors and autoimmune inflammatory processes.

How to take an ESR test for children?

The accuracy and reliability of the result depends on how correctly the preanalytical stage (preparation and collection of biomaterial) is implemented. According to statistics, on average, more than 70% of errors are made at this stage. The consequence is the need for a repeat blood test, and the procedure for taking biomaterial is unpleasant for children.

Biomaterial for ESR analysis:

• venous blood taken from the cubital vein on the child’s elbow;
• capillary blood that collects from the baby’s ring finger or heel.

Venous blood is collected using a sterile vacuum system and a butterfly needle, which significantly speeds up and makes the procedure as safe as possible. The advantage of a vacuum system: no contact of blood with the external environment and minimal risk of hemolysis (destruction of red blood cells in a test tube), which makes analysis impossible.

Capillary blood is collected using a scarifier with a needle stop. Modern scarifiers for children control the depth of needle insertion and automatically hide the blade after a puncture, making it impossible to reuse.

After the puncture, the first drop of blood is removed with a clean cotton swab, and collection begins with the second drop. This technique allows you to prevent random impurities from entering the test tube. Special pressure or squeezing of the child’s finger should be avoided, which can lead to distortion of the analysis result.

Preference should be given to venous blood, since the risk of premature clotting or hemolysis is significantly reduced compared to capillary blood.

How to prepare a child for analysis?

The collection of biomaterial is carried out in the morning, preferably on an empty stomach. For infants, a minimum interval after the last meal of 2 hours is allowed, for children under 5 years old - 5-6 hours, for older patients it is necessary to wait at least 8 hours.

Important: to facilitate blood collection, the child should be given unsweetened water. This will make the blood less viscous and reduce the risk of false results.

It is important that the child is in a calm state. If possible, it should be explained that the procedure will not cause harm and is necessary for his health, and the unpleasant sensation from the injection is not strong and short-lived.

ESR norms in children by age in the table

The results of the blood test must be deciphered by the attending physician, and the information in this section is presented for informational purposes only.

The ESR norm for a child is selected taking into account age. In addition, it is impossible to establish a final diagnosis based on one parameter, so the erythrocyte sedimentation rate is assessed in conjunction with other studies (complete blood count).

The table shows the norm of ESR in the blood of children by age according to the Panchenkov method.

For example, if the results of a blood test for a 5-year-old child indicate an ESR of 10 mm/h, then this is considered normal.

It should be noted that the normal ESR in a blood test for children is 3, 5, 10, etc. years is identical for both sexes. The indicator has no gender differences. However, in girls during menstruation, the indicator may increase to the upper limits of normal.

Detection of an ESR of 16 mm/h in a child over 15 years of age is considered acceptable. In this case, the analysis should be repeated after a few weeks.

Why does ESR increase in children?

The reasons for the increase in the indicator are different, so only a doctor can prescribe treatment.

When collecting a medical history of a small patient, data from laboratory and instrumental research methods, as well as the presence and severity of symptoms of the disease are taken into account. As necessary, the most complete family history of the child is collected, taking into account genetic predisposition to hereditary pathologies.

It should be understood that a slight deviation from the norm has no diagnostic significance. So, if a one-year-old child has an ESR of 11 mm/h, then this is considered acceptable and may indicate a recent infection (the test must be repeated after 2 weeks).

The most common cause of increased ESR is an infectious disease, predominantly of a bacterial nature.

Inflammatory processes of various localizations, burns of varying degrees and mechanical injuries are also among the reasons for deviation of the criterion from the norm.

Also, the level of erythrocyte sedimentation rate may increase if the patient has malignant diseases. A significant excess of the norm is observed in the following oncopathologies:

• multiple myeloma (Rustitsky-Kale disease), localized in the bone marrow. In this case, the value of the criterion reaches critical values. The disease is characterized by excessive production of pathological proteins, leading to the formation of “coin columns” - multiple aggregation of red blood cells;
• Lymphogranulomatosis (Hodgkin's disease) affects people regardless of gender and age. This pathology affects lymphoid tissues. The ESR level is of primary importance not for identifying pathology, but for determining its course and assessing the effectiveness of selected therapeutic methods.

Other malignant neoplasms are also accompanied by an upward deviation from the norm. There is a direct correlation (dependence) between the degree of criterion deviation and the stage of cancer. Thus, the highest ESR values ​​are characteristic of the terminal stage and the spread of metastases to neighboring organs and tissues.

Reasons for decreased ESR in a child

A low ESR is usually of no clinical significance. Most often, this situation occurs during fasting, low muscle mass, following a vegetarian diet, etc.

In rare cases, a similar situation occurs in the case of a pathological change in the morphology of red blood cells, preventing their deposition. Among them:

• hereditary Minkowski-Choffard disease (spherocytosis), in which hemolysis of red blood cells occurs against the background of genetically determined damage to the structural proteins in their membrane;
• Sickle cell anemia is a congenital disease in which red blood cells become elongated.

A variant of the physiological norm is a temporary decrease in the indicator in a child as a result of prolonged diarrhea, dehydration or after vomiting. However, after the body is restored, the ESR value should return to within acceptable limits.

Methods for restoring ESR in children

In order to choose the right therapy, it is first necessary to determine the exact reason why the indicator is outside the normal range. Due to the low specificity of the criterion, the doctor prescribes additional diagnostics:

• determining the value of C-reactive protein, which makes it possible to establish the fact of inflammation and differentiate a viral infection from a bacterial one;
• a comprehensive biochemical blood test that allows you to evaluate the functioning of all systems and organs;
• evaluate other indicators of a general blood test (in particular, a detailed leukocyte formula);
• analysis for the presence of helminths, as well as cysts and vegetative forms of protozoan microorganisms;
• Ultrasound of various organs;
• fluoroscopic examination of the lungs.

Further recommendations for non-compliance with ESR standards depend on the identified cause. Thus, a bacterial infection can be treated with antibiotics. Important: antibacterial drugs are selected exclusively by the child’s attending physician, taking into account the minimum acceptable age for the drug and the presence of contraindications.

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