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 speed used by the red blood cells to deposit on the bottom of a special test tube. There ESR is an inflammatory index of poor specificity.
The main ones causes of high ESR they are infectious, autoimmune, rheumatological diseases and everything that increases the state of inflammation of our organism. The main symptoms of high ESR they are fever, joint pains, sweating and all the symptoms related to the underlying pathology that has determined the increase in inflammation indices.
ESR normal 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 between 0-22 mm / h (millimeters per hour) in men, and between 0-29 mm / h in women are considered normal values (Mayo Clinic).
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), an examination 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.
A match by High ESR it is in fact linked to the presence of macromolecules circulating in the blood increases the viscosity of the plasma and reduces the forces that move the red blood cells away from each other.
The ESR 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 is not an examination 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.
Therefore, a finding of high ESR, as well as a finding of a high CRP, 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.
VES how to measure
The measurement of the ESR 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.
There VES arises in the presence of an inflammatory process in our organism.
High values of ESR are considered to be those above 22 mm / h in men, and 29 mm / h in women. They are to be considered moderately increased ESR values that increase by 50-100% (usually in prolonged inflammatory conditions such as rheumatological, immunological diseases, or in the presence of viral infections, or mild bacterial infections, or in any case in the course of chronic diseases).
It is to be considered a very high ESR value that which rises to 4-8 times greater than the maximum allowed values (this happens in acute inflammatory diseases such as acute vasculitis, extensive bacterial infections, often with septicemia).
Causes of high ESR
The main causes of high ESR are:
they can be acute, such as a bacterial or fungal infection, but also as a rheumatic or vasculitic disease at onset. The finding instead of chronic values of High ESR it can be linked to the presence of chronic inflammatory diseases.
The main ones causes of high ESR I'm:
- Bacterial infections:
- Bacterial urinary infections (cystitis, pyelonephritis, urethritis),
- Bacterial airway infections (pneumonia, bronchitis, bronchiolitis, pharyngitis, laryngitis, sinusitis),
- Bacterial dental and oral infections (granulomas, abscesses, tonsillitis),
- Bacterial skin infections (erysipelas, impetigo, cellulitis, fasciitis)
- other typical infections of the young age such as ear infections and scarlet fever.
- Fungal infections: they are less frequent, most are caused by urinary tract infections caused by fungi (fungi), the most common is Candida.
- Chronic inflammatory bowel diseases Such as ulcerative colitis or Crohn's disease.
- Rheumatological pathologies: the most frequent are rheumatic polymilagia, rheumatoid arthritis, systemic lupus erythematosus (SLE)
- Vasculitis of the great vessels:
- Giant cell arteritis
- Takayasu's arteritis
- Vasculitis of medium caliber vessels:
- Polyarteritis nodosa
- Kawasaki disease
- Primary granulomatous vasculitis of the central nervous system
- Small vessel vasculitis:
- ANCA-associated vasculitis
- Microscopic polyangiitis
- Wegener's granulomatosis
- Churg-Strauss syndrome
- Drug-induced and ANCA-associated vasculitis
- Immune complex vasculitis
- Henoch-Schönlein purpura
- Cryoglobulinemic vasculitis
- Lupus vasculitis
- Rheumatoid vasculitis
- Sjögren's syndrome vasculitis
- Hypocomplementemic urticarial vasculitis
- Behçet's disease
- Goodpasture syndrome
- Serum sickness vasculitis
- Drug-induced vasculitis
- Post-infectious immune complex vasculitis
- Paraneoplastic vasculitis
- Vasculitis induced by lymphoproliferative disease
- Vasculitis induced by myeloproliferative diseases
- Vasculitis associated with carcinoma
- Vasculitis from chronic inflammatory bowel diseases
- Primary or secondary neoplasms (metastases): the presence of a tumor in our body leads, for various reasons, to the development of a state of chronic inflammation. The triggering cause of this chronic inflammatory state is our body's attempt to react against cancer cells.
- Ischemic insults (i.e. related to the reduced blood supply in a certain area of the body), such as myocardial infarction, cerebral ischemia (stroke), ischemia due to peripheral vascular disease.
- Hematological diseases: lymphomas and multiple myeloma can be characterized by High ESR is high C reactive protein.
High ESR symptoms
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The main symptoms of high ESR they are the classic inflammatory symptoms, to which the specific symptoms of each disease (infectious, autoimmune, rheumatological, other) must be added. The symptoms of elevated ESR are therefore included in a wide range of manifestations, and for this reason they are not very useful for framing a specific pathology, if not accompanied by other biohumoral and / or radiological tests, which in the first instance could be blood counts with a leukocyte formula. CRP, creatinine, ion, urinalysis, and if respiratory symptoms a chest x-ray (chest x-ray).
In case one High ESR both a synonymous with acute inflammation, the main symptoms may be:
- fever with high body temperature above 37.5 ° C
- joint or muscle pain
- feeling of cold sometimes accompanied by chills, alternating with phases of sweating
- possible signs of infection / inflammation in one or more parts of the body, such as:
- redness or swelling (swelling) of the skin in soft tissue infections such as erysipelas or cellulitis (involving the deeper subcutaneous layers),
- problems with urination such as dysuria (burning when urinating) or stranguria (pain when urinating) if there is a urinary tract infection, such as cystitis or pyelonephritis
- cough produced sometimes accompanied by breathing difficulties in case of an airway infection (pneumonia, bronchitis, bronchopulmonary, bronchiolitis in children)
- abdominal pain, nausea and / or vomiting, jaundice in the case of a biliary tract or gallbladder infection (cholangitis or cholecystitis)
- sensation of swelling, tension and pain in the oral cavity (to exclude the presence of granuloma or abscess at the dental level)
- Pelvic or groin pain that is accentuated with sexual intercourse and at the end of each menstrual cycle: these are typical symptoms of pelvic inflammatory disease.
If one VES high is instead linked to a chronic inflammatory process, the most common symptoms could be:
- mild fluctuating fever (low-grade fever)
- joint pain with or without swelling (swelling), redness and warmth in the joints
- recurrent diarrhea and abdominal pain in the case of chronic intestinal diseases.
- Weight loss (weight loss), loss of appetite (hyporexia) and energy (asthenia): these are symptoms that must be investigated because they are present in the course of cancer.
Factors that can alter the measurement
Here are the main factors that can result in one High ESR even in the absence of an inflammatory process, effectively causing a false positive:
- Anemia (presence of a lower than average number of red blood cells, and therefore of hemoglobin)
- cholesterol high,
- kidney failure
- MCV high (macroticosis, i.e. red blood cells larger than average)
- High temperature
- Old age
- State of pregnancy
Here are the main causes of false negatives, that is of Low ESR even in the presence of an inflammatory pathology in progress.
- 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)
- Low MCV (microcytosis, i.e. smaller than average red blood cells)
- Low temperature