LOW ESR symptoms and causes

The feedback from Low ESR it is less frequent than the finding of high ESR. The main ones causes of low ESR are dehydration, increased blood density due to the presence of a high number of red blood cells in the blood, a reduction in the protein concentration in the blood or an allergic state. The main symptoms of reduced ESR are those related to the underlying pathology.

What is ESR?

There VES is a blood test that evaluates the sedimentation rate of erythrocytes. The abbreviation VES in fact indicates Erythrocyte sedimentation rate, that is, the rate it takes for red blood cells to settle to the bottom of a laboratory tube. There ESR is an inflammatory index of good sensitivity (ie it rises when there is inflammation) but of poor specificity (ie it rises also for other causes other than an inflammatory state).

Low ESR values

For ESR measurement, normal values may vary from laboratory to laboratory, depending on the ranges considered by individual centers and measurement methods.

In general, values below the normal range, which is between 0-22 mm / h (millimeters per hour) in men, and between 0-29 mm / h in women, are considered low values of ESR (Mayo Clinic). In other words one Low ESR it is a negative ESR.

The ESR varies according to the sex of the person and his age: there is a calculation, Miller's formula, which allows you to approximate normal values.

VES less than: [ age in years (+ 10 if female)] / 2

Therefore, for a 60-year-old female person, the ESR values must be less than [(60 + 10) / 2], that is, less than 35.

For a 20 year old boy, on the other hand, the ESR values must be less than (20/2), therefore less than 10.

 What is ESR and what is it for

The ESR is, together with the PCR (C reactive Protein), a test that detects the presence of an inflammatory state in our body. To understand what ESR is, the concept of rouleaux, which is a stack of cells (comparable to a stack of coins) in which the various elements are linked together thanks to attractions between the surfaces, and not as a result of bonds with antibodies or chemical bonds.

Blood is made up of a liquid part called plasma in which there are numerous substances, such as amino acids and proteins, enzymes, mineral salts, hormones circulating in the blood stream, carbohydrates (sugars), vitamins. The solid part of the blood, called corpuscle or cellular, it is instead made up of erythrocytes (red blood cells), leukocytes (white blood cells) and platelets.

Red blood cells tend to remain in suspension in the plasma; under normal conditions, the ability to aggregate together is low because there are repulsion forces between red blood cells, negative charges between membrane and membrane, which keep them separate and suspended in the plasma.

Therefore, under normal conditions, the red blood cells infrequently form rouleaux.

If the concentration of inflammatory proteins in the blood increases, with the finding of high C reactive protein and an increase in proteins such as globulins or fibrinogen: in this condition the negative repulsive charges between the red blood cells decrease, the rouleaux are formed more easily, and the ESR increases.

If, on the other hand, the number of red blood cells (erythrocytes) in the blood increases, or the concentration of blood proteins decreases, the Erythrocyte sedimentation rate is reduced, meaning that red blood cells take longer to settle to the bottom of the laboratory tube that is usually used for testing.

A match by Low ESR it is in fact linked to the decrease of macromolecules circulating in the blood (erythrocytes + proteins) which usually increases the viscosity of the plasma and reduces the forces that move the red blood cells away from each other.

There VES is measured for two main reasons:

  • identify the presence of an inflammatory process
  • monitor the course and activity of a known disease

These indications make us understand that the ESR examination is not a test that is altered during specific diseases, but rather it is a "signal" that an inflammatory process is taking place in our body. ESR is a non-specific test, i.e. it is sometimes high even in the absence of inflammation). Furthermore, the ESR is also an analysis devoid of sensitivity, that is, we will not always find high values during an inflammatory (inflammatory) process.

Hence, a finding of High ESR, as well as the finding of one High PCR, it cannot be traced with certainty to a specific disease.

Nonetheless, it is a widely used exam because it is cheap and easy to perform. In other words, it does not cost much to do it and it can be a "spy" examination of some inflammatory process not yet known, which can give an indication to carry out second level examinations, that is more in-depth.

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VES how to measure

There ESR measurement it is carried out on the blood, made incoagulable and placed in a graduated small-caliber pipette in a vertical position, determining the speed with which the red blood cells separate from the plasma and settle on the bottom. After 60 minutes, the height of the column that has formed is measured in millimeters.

Currently the most used method is Westergren's method, which consists in putting the blood in contact with sodium citrate (anticoagulant substance) in a graduated pipette 20 cm long, and then measuring the sediment after 60 minutes.

The previous method used, the Wintrobe method, consisted in putting whole blood treated with anticoagulant and then rendered incoagulable, in a graduated pipette 10 cm long and 2.8 mm wide, leaving it in a vertical position for 60 minutes. With this method, ESR values up to 8 mm / h for men and up to 15 mm / h for women were considered normal (therefore values lower than those considered normal with the current measurement method). Wintrobe's method, however, was more influenced by hematocrit values, that is, the concentration of red blood cells in the blood.


What is the meaning of a Low ESRis what does it mean? What are the causes and symptoms of reduced ESR?

There VES decreases in the presence of a reduction in the viscosity of the blood in our body.

ESR values below 1 mm / h are considered low in both men and women. In other words, a low ESR is an ESR with a value of 0.

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Low ESR causes

What are the main causes of Reduced ESR?

The finding of a low erythrosemidnetation rate it is infrequent, and is often linked to the presence of blood or liver disease.

The main ones causes of low ESR I'm:

  • Blood hyperviscosity: increase in blood viscosity, resulting in a reduction in the rate at which red blood cells settle.
  • True polycythemia: blood disease resulting in an increase in the number of red blood cells,
  • Secondary polycetemia: increase in the number of erythrocytes linked to non-haematological causes, such as COPD (chronic obstructive pulmonary disease), a chronic lung disease that stimulates the overproduction of red blood cells due to a reduction in the circulating concentration of oxygen.
  • Hypoproteinemia from malnutrition: reduction in blood protein concentration, secondary to a reduced intake of proteins and amino acids with the diet.
  • Hypoproteinemia from liver disease: reduction of blood protein concentration, linked to a malfunction of the liver, such as that which can occur in liver cirrhosis.
  • Sickle cell anemia: Sickle cell or drainocytic anemia is a disease in which red blood cells take on a particular sickle shape. The ESR is reduced due to the particular shape of the red cells which slows down their sedimentation.
  • Disseminated Intravascular Coagulation (DIC): disseminated intravascular coagulation is a serious complication of other diseases such as infections or acute inflammatory states. It causes the formation of many small clots (thrombi) in the blood vessels throughout the body. In this situation due to the consumption of fibrinogen, the ESR slows down considerably.
  • Hypofibrinogemia: reduction of the amount of circulating fibrinogen, is often accompanied by low ESR.
  • Anticoagulant therapy: can contribute to the detection of reduced ESR values.
  • Spherocytosis: presence of red blood cells with a rounded shape, they are deposited with much more difficulty.
  • Microcytic anemia: the presence of small red blood cells, that is, erythrocytes with a MCV low, often accompanied by reduced ESR.
  • Heart failure: the heart pump deficiency, and the consequent accumulation of fluids in the body tissues, reduces the protein concentration and contributes to the finding of reduced Erythrocyte sedimentation rate values.

Low ESR symptoms

What are the main ones symptoms of reduced ESR?

The main symptoms of low ESR  are the symptoms that accompany the pathologies described above, and therefore:

  • Tiredness and weakness (asthenia)
  • General malaise
  • Shortness of breath (dyspnea) even with minimal effort
  • Skin rashes as a result of microvascular thrombosis
  • Skin pallor (fair skin)
  • Accumulation of fluid in the legs and abdomen in the presence of heart failure or advanced cirrhosis
  • Yellow skin (jaundice) in the presence of liver disease
  • Thinness
  • Weight loss (weight loss)

Factors that can alter the measurement

Here are the main factors that can result in one Low ESR even in the presence of an inflammatory process, effectively causing a false negative:

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  • Polycythemia (presence of a higher than average number of red blood cells, and therefore of hemoglobin)
  • cholesterol bass,
  • Anticoagulant therapy with warfarin or other factor X inhibitors
  • Polyglobulism (presence of an above average number of red blood cells)
  • Presence of spherocytes (spherocytosis, spherical red blood cells instead of the classic discoidal shape)
  • MCV low (microcytosis, i.e. smaller than average red blood cells)
  • Low temperatures

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