Can be upgraded. ESR (ROE, erythrocyte sedimentation rate): norm and deviations, why it rises and falls. help yourself

Creatinine is one of the metabolites of biochemical reactions of amino acid-protein metabolism in the body. The formation of this compound occurs constantly and is associated with metabolic processes in muscle tissue. Since muscles constitute one of the main massifs of the human body, and contraction requires a constant energy substrate, powerful energy carriers must be laid in their structure. This is necessary in order to meet emergency energy needs.

The main donor of ATP for muscle tissue is creatine phosphate, a phosphorylated non-essential amino acid creatine. After synthesis in the liver, it enters the muscles, where it is dephosphorylated by the enzyme creatine phosphokinase. The result of these processes is the formation of energy and creatinine. ATP is consumed by the muscles to meet energy needs, and the kidneys excrete creatinine in the urine after filtration.

Creatinine, as the final product of decomposition reactions, is not consumed in the body for other metabolic processes. This is a compound harmful to tissues, which should be removed from the body as much as possible. Violation of creatinine metabolism can occur at the stages of its intake, metabolism and excretion!

Creatinine norm

All creatinine cannot be filtered and excreted by the kidneys. This is due to the fact that it is constantly released into the blood while the muscle tissue is viable. Blood plasma should contain a relatively stable concentration of creatinine, which may vary depending on age, muscle activity and nutrition. Therefore, there are maximum and minimum limits for the norm of creatinine, which take into account all these points and speak of the normal functioning of organs.

To eliminate errors in the results of a biochemical blood test for creatinine levels, it is imperative to adhere to the general rules for blood sampling. The study must be carried out in the morning on an empty stomach. It is advisable to avoid strong muscle loads and overheating or hypothermia before direct blood sampling.

For clarity, the variations in creatinine standards are shown in the form of a table:

The norm of creatinine in women

Plasma creatinine concentration in women should be lower than in men. This is due to the physiological mechanisms of its formation, distribution and circulation in the blood.

The mechanisms behind this phenomenon are:

The muscle mass of a woman is less than that of a man;

Less muscle stress;

The activity of metabolic processes in the female body is reduced;

Food products of the female diet contain less exogenous creatinine entering the body;

Influence of sex hormones and pregnancy.

The norm of creatinine in men

The creatinine of the male body should almost always be higher than that of women of the same age group. This is due to the peculiarities of lifestyle and differences in the functioning of organs and systems. Age characteristics also affect the process of creatinine metabolism, both upward and downward. Recently, many men visit gyms and use doping containing creatine to increase muscle performance. This must be taken into account when assessing the norm of creatinine.

The norm of creatinine in children

The concentration of creatinine in the plasma of a child is more dependent on his age. The main fluctuations of this indicator are associated with growth activity and the degree of increase in muscle mass over a certain period of time. Newborns, due to the high loads that their body had to experience during childbirth, have creatinine levels the same as in adults. The same feature is typical for adolescents, which is explained by the active growth of the body. School-age children grow relatively steadily, so their creatinine levels are slightly lower than those of adults.

When assessing creatinine metabolism, most often, one has to deal with an increase in the concentration of this metabolite. It is very important to correctly interpret the obtained indicators, taking into account the possibility of a physiological and pathological increase, age and gender standards. The condition in which an increase in plasma creatinine is recorded is called hypercreatinemia.

Hypercreatininemia does not cause severe abnormalities in the body, since creatinine itself has low toxicity. Its harmful effects on tissues can manifest themselves only with sharp deviations from the norm of its concentration. This metabolite is more related to the consequences of various conditions and diseases, signaling their presence. Therefore, isolated hypercreatininemia practically does not cause manifestations.

It is usually combined with other pathological symptoms that may suggest the need for this study:

Muscle pain;

Rapid fatigue and muscle weakness;

Increase or sharp decrease in the amount of daily urine;

Pathological changes in the general analysis of urine (protein, leukocytes, erythrocytes).

The pathogenesis of hypercreatinemia can be associated with any of the stages of creatinine metabolism and circulation in the body. The nature of nutrition, the mode of physical activity, the amount of liquid consumed, the intake of medications, the anatomical features of the muscle tissue and its condition, the functional abilities of the excretory system and the liver are able to influence it.

What does elevated creatinine mean?

An increase in the concentration of creatinine in a biochemical blood test may indicate:

Increased intake of creatine-containing substances from the environment into the body with enhanced protein nutrition;

Excessive or very rapid increase in muscle mass;

Destruction of muscle tissue;

Redistribution of blood and violation of water balance in the body;

Impaired kidney function for the neutralization and excretion of creatinine;

Toxic effects on the body;

Endocrine disorders that regulate metabolic processes in the body.

In some cases, one has to deal with a relative increase in the level of creatinine, which is not due to its excess production or retention in the body. It is associated with a decrease in the volume of circulating plasma as a result of its redistribution, blood loss or dehydration. Relative hypercreatininemia is combined with other signs of hemoconcentration and blood clotting, which helps in its correct assessment. It never reaches high values.

An increase in creatinine levels can be physiological, not due to diseases, and pathological. In the second case, the main cause of hypercreatinemia is renal failure in any type of kidney damage, in which creatinine numbers can increase several times. Physiological hypercreatinemia can never be represented as a big deviation from the norm!

Causes of increased creatinine

The immediate causes of hypercreatinemia, taking into account the severity of the increase in creatinine, are presented in the table.

How to lower blood creatinine?

After a detailed examination and clarification of the cause of hypercreatinemia, the following recommendations can be given:

Hospitalization in medical institutions according to the profile in case of detection of diseases. These can be general therapeutic hospitals and specialized departments for the treatment of renal or other types of pathology;

taking drugs to normalize protein metabolism and remove toxic products of protein metabolism (ketosteril, lespeflan, lespenefril);

Normalization of water metabolism by selecting the optimal volumes of fluid consumed for a particular case, taking into account the capabilities of the kidneys. If hypercreatinemia is due to physiological mechanisms, then an increase in the daily volume of pure high-quality water will lead to a decrease in the concentration of creatinine and accelerate its excretion by the kidneys;

Normalization of the diet in qualitative and quantitative terms. It involves the complete exclusion or restriction of the use of protein foods and salt, which contribute to an increase in nitrogenous compounds or retain fluid in the tissues. This, in addition to the absolute increase in creatinine, causes its relative increase due to hemoconcentration;

Correction of lifestyle and physical activity. They must be brought into line with the actual capabilities of the body. If no pathological causes of an increase in creatinine have been identified and the only option for this condition is excessive physical activity, they are minimized as much as possible;

Folk remedies (rice infusion and decoction, medicinal plants and fees);

Extracorporeal detoxification procedures (hemodialysis and its analogues). The use of an artificial kidney is advisable only in severe types of hypercreatinemia caused by decompensated renal pathology or intoxication.

In no case should you even try to cope with an increased level of creatinine in the blood on your own. This symptom may be the small tip of a large iceberg of illness. Any corrective and therapeutic measures should be supervised by a specialist!

Diet for high creatinine

One of the most important measures to reduce creatinine levels is diet therapy. Its general characteristics are to limit the intake of protein foods, salt and potassium, enrich the diet with antioxidants and products that cleanse the body.

Excluded:

Fatty varieties of animal and poultry meat (pork, duck, goose);

Fatty varieties of fish;

Whole milk;

Spicy dishes and spices;

Coffee and strong tea;

Dishes from rich yeast dough;

Fried foods and smoked meats.

Restricted:

Dietary meats (chicken, rabbit, turkey, young beef). You can enter meat days twice a week, when they are included in a small amount in the composition of the dishes;

Eggs - up to 2-3 per week;

Fish. Fish days are organized by analogy with meat days;

Salt and sugar. With a pronounced increase in creatinine, they are generally excluded;

Fresh or boiled vegetables and fruits in any quantity;

Berries, fruit drinks and compotes based on them;

Nuts and dried fruits. They are limited or completely excluded only in renal failure, when the level of potassium is sharply increased;

Dairy products (yogurt, kefir, fermented baked milk);

Cheese and cottage cheese;

Butter and vegetable oil;

Cereals and cereals based on them. Rice is especially useful in this regard;

Wholemeal bread with bran and pasta;

Mineral and purified plain water at least one liter per day. Water loads are minimized only in renal failure.

Dishes allowed:

• steamed;

• In the form of soup, puree, cream soup, salad, jelly, cereal, casseroles, cutlets, meatballs;

Conditions in which a decrease in plasma creatinine levels are recorded are extremely rare. Their appearance indicates a violation of metabolic processes, accompanied by profound disorders of protein metabolism in the body in general, or in isolation in muscle tissue. If hypercreatinemia mainly depends on the functional ability of the kidneys, then in the case of hypocreatinemia (decrease in creatinine), their condition does not play a role. Consequently, the main mechanism should be such a depletion of energy reserves in the body that protein resources are used to redeem them, which are most in the muscles. A decrease in creatine phosphate reserves naturally leads to a decrease in the concentration of its metabolites in the blood, which is creatinine.

Causes of low creatinine

The immediate causes of hypocreatinemia can be:

Cachexia against the background of chronic diseases and starvation;

Depletion of the body with a vegetarian diet or strict diets;

Weight loss due to inconsistency of physical activity with the nature of nutrition;

Muscle dystrophy against the background of their diseases;

Atrophy of large muscle masses with their disability;

Treatment with glucocorticoids;

First trimester of pregnancy.

A decrease in the level of blood creatinine is not a diagnostic criterion for any pathology. This is a sign that is an absolute regularity in typical cases, does not require special therapeutic measures!

About the doctor: From 2010 to 2016 practicing physician of the therapeutic hospital of the central medical unit No. 21, the city of Elektrostal. Since 2016, she has been working at the diagnostic center No. 3.

One of the indicators studied in the course of a clinical blood test (general analysis) is the erythrocyte sedimentation rate, denoted by the short abbreviation ESR, or ROE. Its significance for the diagnosis of diseases, although not specific, is quite large, since an increased ESR in the blood is a reason for further diagnostic search. The main reasons for this kind of deviation from the norm are given in this article.

In what case is it said to accelerate the ESR

The generally accepted norm for the erythrocyte sedimentation rate is:

• For adult males - 1-10 mm / h;
• For adult females - 2-15 mm / h;
• For persons over 75 years old - up to 20 mm / h;
• Small children, regardless of the gender of the child - 3-12 mm / h.

The unit of measurement sounds like the number of millimeters that red blood cells settle in one hour. Such a diagnostic test is based on the study of the ability of erythrocytes to precipitate under the influence of their own weight when they stay in a vertical thin glass vessel in conditions of deprivation of the blood's ability to coagulate. Therefore, the ESR value determines the content of erythrocytes and the composition of the plasma, as well as their functional abilities and usefulness.

Important to remember! An increase or acceleration of ESR is said when the age norm of the indicator is exceeded. This increase can be both insignificant (a few millimeters) and pronounced (tens of mm/h). The more pronounced the deviation from the norm, the higher the diagnostic value of this indicator!

Physiological acceleration

There are a number of conditions in which a high ESR has the right to be regarded as a variant of the norm. Reasons for this kind of increase:

• Any terms of pregnancy, especially against the background of toxicosis;
• lactation and breastfeeding;
• Taking drugs containing hormonal substances (sex hormones, oral contraceptives);
• Anemia of any kind and origin;
• Weight loss due to malnutrition (diet or fasting);
• Overweight with obesity and an increase in the amount of cholesterol fractions in the blood;
• Formation of immunity against the background of transferred infectious processes or vaccinations.

ESR as a signal of the presence of infection in the body

Inflammatory reactions

Inflammation in any part of the human body, sooner or later, will lead to an increase in ESR. This is due to the fact that during inflammation there is a constant release into the blood of specific substances that change the charge of the erythrocyte membrane or the qualitative composition of the blood plasma. The more intense the inflammation in the body, the more the ESR will accelerate. Specificity in relation to the localization of the process cannot be determined by this indicator. These can be inflammatory processes in the brain and its membranes, soft tissues of the limbs, internal organs and intestines, lymph nodes, kidneys and bladder, heart and lungs. Therefore, when assessing an elevated ESR in the blood, attention is necessarily drawn to the patient's clinical symptoms and signs of the disease.

Suppurative processes

Most cases of diseases accompanied by purulent tissue breakdown are diagnosed not so much by the ESR indicator. They are characterized by a vivid clinical picture and do not require a large diagnostic search. But sometimes, by assessing the ability of erythrocytes to settle, one can suspect the presence of suppurative processes. This is most typical for people with reduced immunity. In such people, in the presence of large abscesses (abscesses, phlegmon, furunculosis, sepsis), even leukocytes may not go beyond the normal range.

Autoimmune diseases

The ESR increases very strongly and remains at a high level for a long time in autoimmune diseases. These include various vasculitis, thrombocytopenic purpura, lupus erythematosus, rheumatic and rheumatoid arthritis, scleroderma. Such a reaction of the indicator is due to the fact that all these diseases change the properties of blood plasma so much that it is oversaturated with immune complexes, making the blood defective.

An increase in the erythrocyte sedimentation rate, combined with an increase in the number of leukocytes, indicates the presence of acute inflammatory diseases.

Malignant neoplasms

Moderate but persistent acceleration of ESR in persons after 40 years of age without visible signs of any pathology should be alarming regarding the potential for cancer. Malignant neoplasms of any localization are equally capable of affecting the ability of erythrocytes to settle. That is why it is not considered a specific marker for certain types of cancer. Such patients are required to undergo a preventive oncological examination, which can be extended by additional methods if indicated. ESR is especially increased in cancerous transformation of the bone marrow - leukemia and any type of disease associated with hematopoietic tissue.

Important to remember! Assessing the ESR, be sure to pay attention to the cellular composition of the blood. It is unacceptable to make final conclusions about the presence of diseases only on the basis of the characteristics of this indicator!

tissue destruction

Any destructive changes in aseptic tissues can also cause an increase in ESR. It usually occurs some time after the problem occurs. Such conditions include myocardial infarction and the post-infarction period, impaired blood supply to the lower extremities, major injuries and burns, surgical interventions, and any poisoning.

There are many reasons for increasing ESR. Therefore, the assessment of this indicator can only be entrusted to a truly knowledgeable specialist. You should not do something yourself that cannot be correctly determined with certainty.

Lymphocytes are types of leukocytes responsible for cellular and humoral immunity, and they also counteract the development of malignant tumors. Often they are called "memory cells", "helpers", etc. Once they encounter a pathogen, they can store information about it in their blood for the rest of their lives, this is how immunity works. Normal parameters of these cells vary widely. Therefore, the deviation from the permissible limits is significant for the body and in most cases indicates a serious pathology. Is it possible to take blood tests, including for lymphocytes, during menstruation? Will this lead to a deliberately incorrect interpretation of the result?

Read in this article

Lymphocytes are important blood cells

Lymphocytes are formed mostly in the thymus (thymus gland), bone marrow, as well as in the lymph nodes, spleen, and some intestinal structures.

There are three main varieties:

• T cells. They provide cellular immunity. There are many varieties of this group: helpers, suppressors, killers, etc. The names reflect their main functions. Figuratively, when a pathogen appears, some cells signal to others about "strangers", the next batch arrives and destroys, or they report something else. And so the whole chain of interconnection. Like this process, all cells of the body are recognized. Simply put, a part of T-lymphocytes constantly circulates throughout the body, identifying cells as "friends and foes." In case of malfunctions, the human body's own cells are regarded as pathogenic. This is how autoimmune diseases occur.
• B cells. Provide humoral immunity. They act through "intermediaries" - immunoglobulins. Each stage of the inflammatory response is characterized by an increase in certain fractions. As a result, by determining the level of immunoglobulins, one can judge whether the organism has ever encountered this pathology. So Ig G indicates a person who has undergone an infectious pathology, Ig M indicates an acute period of the disease, Ig A indicates a subacute, etc. All of them are also referred to generically as antibodies. Conducting, the doctor aims the immune system to create precisely these "memory cells" in relation to a specific pathology. Then, when a truly pathogenic agent enters the body, the reaction to it is already clear and directed.
• NK cells. These are the "guardians" of the development of malignant tumors. Having found abnormal cells in the human body, they immediately destroy them. With a defect in this link, an uncontrolled growth of oncological pathologies occurs.

The lifespan of lymphocytes can vary from a few minutes to tens of years. It all depends on their function. So, the cells responsible for storing information are active throughout almost the entire life of a person. And T-killers, for example, upon meeting with a pathogen, can die at the same minute. That is why the limits of the norm for lymphocytes are quite wide.

Normal performance

The limits of acceptable values ​​of lymphocytes are quite large.

An increase in the number of these cells is called lymphocytosis, a decrease is called lymphopenia.

The following values ​​are considered optimal:

• in relative terms - 18 - 40%,
• in absolute terms - 0.8 - 4 * 10 9 / l.

If the percentages change, they speak of relative lymphocytosis and lymphopenia, if the number of cells is absolute.

Boundaries for children are different from those for adults. There are also physiological changes in these indicators in pregnant women. Normally, slightly elevated lymphocytes can be detected during menstruation, which should not be particularly embarrassing.

What will the deviation from the norm tell about

Changes in the number of lymphocytes may indicate the body's response to some changes in the environment or its own body. Most often, deviations are observed in various diseases, but a slight increase or decrease in the level may be normal under some conditions.

Raise

Lymphocytosis is less dangerous than a decrease in the amount of these blood elements. Physiological increase can be observed in the following conditions:

• after intense tanning in the salon or on the beach;
• after drinking a significant amount of alcohol and fatty foods, which most often happens after all kinds of feasts;
• after intensive sports training;
• during stressful situations and psycho-emotional stress;
• during the period of gestation, the normal limits are also higher than usual (the detection of a large number of lymphocytes in peripheral blood in pregnant women is due to a general decrease in immunity, which is required for the normal development of a baby that is half alien to a woman according to the genetic material of the baby);
• heavy smokers also have lymphocytosis, which is associated with an increased reaction of the body to tar and other harmful substances regularly entering the lungs;
• lymphocytes before menstruation, during and immediately after critical days can also be slightly increased, due to changes in the uterine cavity.

But if a significant lymphocytosis is detected, various diseases should first be excluded, and only after a complete clinical and laboratory examination can we talk about a physiological increase.

Infectious pathology

If neutrophils (a group of leukocytes) are responsible for entering the body of pathogenic bacteria, then lymphocytes take full responsibility for the viral invasion. They destroy "strangers", form a "memory" for many years in relation to them. Therefore, their absolute increase is an undoubted sign of the presence of some kind of viral infection. Most often you have to deal with the following diseases with characteristic lymphocytosis:

• mononucleosis,
• rubella,
• chickenpox,
• measles,
• whooping cough,
• parotitis,
• adenovirus,
• SARS and flu.

Most of these pathologies are vaccinated in childhood, so the risk group is those who, for some reason, did not undergo these procedures at a young age.

Also, lymphocytosis is observed in syphilis, tuberculosis, malaria, diphtheria, typhoid fever and some other pathologies.

Ascertaining the increase in these blood elements, first of all, it is necessary to exclude various acute respiratory infections and influenza.

Malignant tumors

Chronic lymphocytic leukemia and various hyperplastic processes of lymphoid tissue lead to lymphocytosis in girls after 14-16 years of age. For some time, these diseases can be almost asymptomatic.

Chronic lymphocytic leukemia is characterized by the fact that lymphocytes are formed and go through all their stages of differentiation, but for some reason they cannot perform their functions. As a result, the body tries to compensate for the defect in immunity by constantly increasing their number, but, as a rule, to no avail.

Chronic lymphocytic leukemia is characterized by an increase in many groups of lymph nodes, the appearance of unmotivated weakness, lethargy, increased fatigue. Due to the inferiority of immunity, various viral diseases constantly occur, often with a severe course. Blood clotting may be disturbed, the liver and spleen increase.

The clinical picture of hyperplastic processes in lymphoid tissue is similar, but these diseases are more difficult to diagnose, and they are much less common.

Autoimmune pathology

With certain failures, own tissues are perceived by lymphocytes as dangerous. As a result, organs begin to break down by their own cells. Accordingly, the number of lymphocytes responsible for this process increases in the blood.

Most often, autoimmune thyroiditis develops - a pathology of the thyroid gland. In addition to changes in hormones, a specific ultrasound picture, blood lymphocytosis is observed. Also, similar changes can be seen in rheumatoid arthritis, Crohn's disease and other pathologies. The indicator of lymphocytes during menstruation, after or on the eve of them will not differ, always being above the norm in these diseases.

Drug poisoning

When ingested, some heavy metals and drugs can cause a decrease in the number of neutrophils. As a result, relative lymphocytosis is formed at normal absolute values.

After removal of the spleen

The spleen is involved not only in the formation of lymphocytes, but it is also the place where they are destroyed. When an organ is removed for some reason (after an injury or as a result of an illness), blood cells have to look for another place. As a result, most of the lymphocytes circulate in the blood longer than usual, as if it were in the normal process of their formation. And their number is increasing. Over time, compensatory changes occur, and lymphocytes return to normal.

decline

If the number of these blood cells is determined below 1.0 * 10 9 /l, this condition is always very alarming and hides a serious pathological condition in 99% of cases.

Infectious pathology

If the inflammatory process takes a long time in the body, it is poorly amenable to drug therapy, at some point the defenses are depleted, the number of blood lymphocytes decreases. In the absence of proper treatment, sepsis can develop with a severe, sometimes fatal, outcome.

bone marrow pathology

The bone marrow is the site of production of lymphocytes and other blood cells. With a pathological effect on it, this process can be disturbed, as a result, the number of blood cells decreases.

Such conditions can occur against the background of radiation exposure, with long-term use of certain drugs, for example, cytostatics.

Oncological diseases

Some malignant pathology is also characterized by a decrease in the number of lymphocytes. For example, Hodgkin's lymphoma. At the same time, against the background of an enlarged group of lymph nodes, weakness, lethargy, and fatigue appear. Anemia and other pathological conditions develop. For a long time, the disease can proceed unnoticed, but with a thorough examination, deviations can always be detected.

Immunodeficiency states

All immunodeficiencies, congenital or acquired, are characterized by lymphopenia. It is not always possible to detect pathology in time. The main symptom of immunodeficiency is persistent viral and bacterial infections.

For example, HIV belongs to this group. In this disease, the work of the T-cell link is disrupted. The higher the stage, the brighter the clinical manifestations. Ultimately, even bacteria that normally live in the human body begin to cause pathological processes.

Is it worth it to take an analysis during menstruation?

Can lymphocytes be increased during menstruation, and when is it better to take a blood test? Yes, indeed, on the eve of critical days and during them, the changes that occur in the endometrium cause some changes in the blood test. Aseptic inflammation (a special type without the participation of pathogens) leads to an increase in the level of lymphocytes. Sometimes the indicator is at the level of 50 - 55%.

Therefore, in controversial situations or in order to control the disease, blood should be donated on days 7-14 of the menstrual cycle.

But it should be understood that not everyone and not always has changes in lymphocytes. Therefore, in case of emergency, you can take tests at any convenient time. In case of any deviations, it will simply be possible to do everything again.

Lymphocytes are the "guardians" of immunity in the human body. Their significant deviations in one direction or another in most cases indicates some kind of pathology. Of course, there is an effect of menstruation on lymphocytes, pregnancy and some other conditions, but only a doctor can finally understand the indicators.

Among laboratory diagnostic methods, perhaps the most common blood test for ESR is sedimentation rate of erythrocytes.

It is prescribed by each doctor after the first consultation. This can be explained by the simplicity of implementation and insignificant financial costs.

As for the information content of the ESR, the indicator only indicates possible presence of infection and inflammation in the body, but the cause remains unknown without further investigation.

At the same time, the analysis for ESR is good. initial diagnosis method allowing to determine the further course of medical actions.

So, the deviation of this parameter from the norm, especially upward, in most cases indicates some trouble in the body, but sometimes ESR is increased for reasons not related to diseases.

That is, the disease can proceed even with a normal erythrocyte sedimentation rate, and a person can be completely healthy with an increased ESR in the blood. This blood test parameter very individual, and its deviation from the norm in a big way has many reasons.

Normal values ​​​​of ESR in the blood vary in different people depending on gender, age, and even individual characteristics. So, in men this indicator is normally in the range of 2-12 mm / h, among women- 3-20 mm/h. With age, ESR tends to increase, therefore in the elderly this figure is within the normal range at values ​​up to 40-50 mm / h.

In children in newborns, the ESR is 0-2 mm / h, at the age of 2 to 12 months - 2-10 mm / h, from 1 year to 5 years - 5-11 mm / h, and in older children - 4- 12 mm/h.

Deviation from the norm is much more often observed in the direction of increase than decrease. Sometimes the analysis gives an inaccurate result, for example, if the rules for conducting it were violated (blood must be donated before breakfast in the morning), or the person ate too much the day before or, on the contrary, was starving. In such a situation it makes sense retake analysis after some time.

Why is the ESR in the blood elevated

If the ESR value does not fit within the normative framework, then this does not necessarily mean that the person is sick, especially if other items of the general blood test are normal. To natural causes ESR increases include:

• An individual feature of an organism. It is known that in 5% of people, erythrocytes settle in the blood at an accelerated rate;
• Taking certain pharmaceuticals;
• Pregnancy. In women who are expecting a baby, the ESR is always elevated, and almost never drops below 20 mm / h; the maximum can reach 75-80 mm/h. The number of leukocytes also increases;
• Iron deficiency in the body, poor absorption of this element;
• Age 4-12 years. In children, more often boys, in this age interval, an increase in the indicator is sometimes observed in the absence of pathologies and inflammation.

The value of ESR itself is influenced in turn other blood parameters. The erythrocyte sedimentation rate depends on their number, the concentration of albumin in the blood, immunoglobulin and fibrinogen proteins, bile acids and pigments.

And these components are very sensitive to any changes in the body.

Elevated ESR in the blood

The most common pathological cause of elevated ESR is presence infections in the body, this is observed in almost 40% of cases of all diseases of an infectious nature, and the indicators go off scale for 100 mm / h.

Followed by the presence of tumors(23%) - both benign and malignant. Moreover, the number of leukocytes is normal. However, elevated ESR and normal leukocytes are both version of the norm for children and in no way indicate oncology.

Approximately in a fifth of all cases of increased ESR, intoxication organism and rheumatic diseases. With such pathologies, blood thickens, and, accordingly, red blood cells begin to settle faster.

Often, ESR goes beyond the limits of the norm upwards with kidney disease and dysfunction of the urinary tract. Rarely is high ESR observed as a symptom collagen diseases in particular lupus. But this is more likely due to the relative rarity of the diseases of this type themselves.

So, most often, an increase in ESR is due to such a number diseases:

• Caused by infections - acute respiratory infections, acute respiratory viral infections, influenza, pneumonia, bronchitis, viral hepatitis, fungal infections, pyelonephritis, cystitis;
• Rheumatic - arthritis, arthrosis, rheumatism, phlebitis, lupus, scleroderma;
• Blood diseases - anisocytosis, sickle anemia, hemoglobinopathies;
• Pathologies of metabolism and endocrine sphere - thyrotoxicosis, hypothyroidism, diabetes mellitus;
• Diseases accompanied by tissue destruction, including cancer - heart attack, stroke, cancer of the lungs, prostate, kidney, liver, brain, multiple myeloma, tuberculosis, leukemia;
• Severe conditions in which blood viscosity increases - intestinal obstruction, diarrhea and vomiting, food poisoning;
• dental granulomas.

Analysis of ESR in the blood only demonstrates the likelihood of one or the other diseases at the patient. For accurate diagnosis, it is necessary to conduct a large number of other tests and examinations.

Subsequent repeated repetition of the ESR analysis allows trace the dynamics treatment and its effectiveness. Indeed, with proper therapy, the indicators gradually begin to decline, and after recovery they soon return to normal.

It is a yellow-green pigment formed after the breakdown of hemoglobin. Bilirubin is found both in bile and in blood serum. An organ such as the liver plays a significant role in the metabolic processes of bilirubin. With an increase in the bilirubin pigment in the blood, jaundice may begin, accompanied by yellowing of the sclera of the eyes and skin of the body, as well as mucous membranes. Liver diseases, in particular hepatitis, as well as various kinds of anemia, can also be triggered by an increase in the degree of bilirubin.

How is bilirubin formed?

Red blood cells, called erythrocytes, contain hemoglobin, which carries oxygen directly to the tissues from the lungs. Damaged erythrocytes, just like old ones, decompose in the liver and spleen cells intended for this, as well as in the bone marrow. In the process of destruction of the erythrocyte substance, hemoglobin is released, which, after some time and a stage of chemical reactions, turns into a substance-bilirubin. The bilirubin that was just formed from hemoglobin (indirect bilirubin) is extremely harmful to the body, in particular to the central nervous system. Therefore, right in the liver, some substances seem to bind bilirubin, thereby neutralizing it. Such bilirubin is called direct. It is secreted into bile by the liver and exits the human body along with feces through the intestines. If the feces are dark, then we can say that bilirubin (altered) is present in it. There are such diseases with the biliary tract and liver, when the process of secreting bilirubin directly into the intestine is difficult, disturbed, and the feces become colorless, like clay.

Characterization of direct (connected) and indirect bilirubin

As mentioned above, direct and indirect bilirubin are the two main fractions of this substance. It all depends on how the laboratory reaction with the diazo reagent goes.

Indirect bilirubin is a poisonous and toxic bilirubin that was recently formed from hemoglobin and which could not bind to the liver.

Direct or bound bilirubin is the substance that has been detoxified in the liver. Here, bilirubin is prepared for withdrawal from the body, therefore there is no toxicity in it.

What indicators are considered normal

Determine the bilirubin level in the process of blood tests. In this case, it is necessary to take a biochemical analysis. In order for its results to be reliable, it is necessary to carry out the analysis only in the morning, and, of course, on an empty stomach. It is very important not to eat anything for about eight hours before the analysis itself. Biochemical analysis is carried out from a vein.

So, the norm of bilirubin (both direct and indirect) is its indicator in blood serum from 8.5 to 20.5 µmol per liter. So, the norm of bilirubin of the indirect fraction is 17.1 μmol per liter, while for the direct fraction, up to 4.3 col per liter is considered normal.

Signs of elevated bilirubin in the blood

Considering the fact that the liver plays the main role in the level of bilirubin, it becomes clear that jaundice will be the main symptom of an increase in the indicator. This symptom occurs both when there is a violation of the binding of excess substances, and when there are difficulties with the excretion of bile.

Important: the severity of jaundice may be less in overweight people and in the presence of edema.

Jaundice has its own characteristics. First of all, there is a change in the sclera. Further, yellowness appears on the oral mucosa and on the skin of the palms. Only then, in the absence of treatment, jaundice spreads to the whole body. Concomitant symptoms will depend on the underlying cause of the change in the level of bilirubin, that is, on the underlying disease.

In what diseases does the level of bilirubin increase?

A presumptive diagnosis can be determined already by what kind of bilirubin is elevated. So, direct bilirubin often increases with the following diseases:

• Hepatitis of a viral and bacterial nature, including chronic.
• Food poisoning (usually mushrooms).
• Intoxication with illiterate medication (hormonal contraceptives, NSAIDs, anticancer drugs).
• Tumors of liver tissues.
• Cirrhosis.
• Hereditary pathologies - Rotor syndrome, Dabin-Jackson.

Indirect bilirubin is more often observed in pathologies such as:

• Congenital hemolytic anemia.
• Hemolytic anemia that arose against the background of SLE, lymphocytic leukemia, lymphogranulomatosis.
• Sepsis, .
• Long-term course of cephalosporins, penicillins, insulin and NSAIDs.
• Toxic anemia on the background of poisoning with metals, arsenic, salts, as well as after a snake bite.
• Syndrome of Gilbert, Lucy-Driscoll.

What can cause an increase

There are three main reasons that can provoke a jump in the level of bilirubin up.

1. Accelerated rate of destruction of red blood cells
2. Violations in the process of processing bilirubin directly in the liver
3. Disorders in the bile duct

If there is an increased rate of erythrocyte destruction, then, accordingly, hemoglobin and bilirubin increase sharply. The main reason for this accelerated destruction of red blood cells is anemia of the hemolytic type, which is the destruction of the blood. Hemolytic anemias can be both congenital and acquired. If anemia is congenital, it can develop with some defects in the erythrocyte structure or, in hemoglobin disorders. It can be hereditary microspherocytosis and thalassemia, as well as sickle cell anemia. Acquired anemia results from autoimmune processes. Here the immune system begins to fight with its own red blood cells. Malaria and the use of certain medications can also cause acquired anemia.

As a rule, indirect bilirubin may increase in the presence of hemolytic anemia. With this anemia, there may be discomfort under the left rib caused by an enlarged spleen. With hemolytic anemia, body temperature rises and urine darkens. So, the shades of urine can reach up to dark brown and black, which will indicate that red blood cells are being destroyed inside the vessels. Such destruction of red blood cells can be found with a defect in cell membranes in the blood - Marchiafava-Micheli disease. So, the membranes become unstable and entail the destruction of red blood cells.

During such anemia, a person may feel very tired and frequent, as well as pain in the heart.

As mentioned, the liver plays an important role in the metabolic processes of bilirubin. So, in case of liver diseases, indirect bilirubin cannot be detoxified in the liver cells. Diseases may occur: viral hepatitis A, B, C, D and E types, hepatitis of a drug nature and alcoholic hepatitis. Cirrhosis of the liver develops, and, subsequently, liver cancer. So, you can observe sharp jumps in the degree of bilirubin, which can manifest itself in jaundice and other symptoms. These symptoms include "bitter" belching and nausea, discomfort may occur after eating food, in particular, fatty. Efficiency decreases, as well as appetite, which is accompanied by a sharp increase in overall body temperature.

There are other causes of elevated bilirubin. So, it can be heredity when the body lacks a liver enzyme. This process is called glucuronyl transferase. The missing enzyme is involved in the metabolic processes of bilirubin. This syndrome is called Gilbert's syndrome. Here, an increased, and significantly, level of bilirubin is manifested. This can manifest itself in the yellowness of the skin and eye sclera, as well as the mucous membranes of the body.

It is possible to detect elevated bilirubin in violation of bile outflows from the liver or from the gallbladder. This can occur with cholelithiasis and with cancer of the pancreas or gallbladder. If the bile outflow is disturbed, then direct bilirubin may be elevated in the blood. What might such an increase lead to? First of all, this is the development in an acute form of jaundice. However, other symptoms may also occur, such as hepatic colic, which usually precedes the development of jaundice in gallstone disease. Hepatic colic is accompanied by an attack of acute pain under the right rib.

Bilirubin irritates the nerve endings of the skin; therefore, itching of the skin may occur, and quite pronounced.

Bloating or constipation and frequent diarrhea may occur.

Violations also occur in the stool - it acquires a shade of white clay, almost discolored. This indicates violations in the bile outflows.

Urine can change its consistency and shades up to dark, brown and black.

Special attention requires an increase in the level of bilirubin in newborns. In general, elevated bilirubin for infants is the norm. The fact is that immediately after birth, the child begins the rapid destruction of the erythrocyte. In the process of developing a baby inside the womb, in red blood cells, he has fetal hemoglobin, which, of course, differs from ordinary hemoglobin. Erythrocytes, which contain such hemoglobin, are easily destroyed.

Accordingly, the rapid destruction of most of the red blood cells can lead to a jump in bilirubin up, after which the newborn may develop jaundice, which is normal for him. For a newborn, the rate of bilirubin four days after birth is 256 micromoles per liter in children who are considered full-term. If the baby is premature, for him the indicator will be 171 micromoles per liter.

With a strong increase in the level of hemoglobin in a child, pathological jaundice may begin to develop, indicating a hemolytic disease of the newborn.

Diagnostics

First of all, it is determined by how much the indicator has changed. For this purpose, Harrison's test is prescribed. The technique is based on the ability of bilirubin to be oxidized under the influence of reagents to biliverdin. Additional tests are given already on the basis of a preliminary diagnosis. More often, a biochemical blood test is prescribed.

Features in women and men

It should immediately be noted that the normal indicators for men and women do not differ. The same applies to the reasons for the increase in the indicator - they will be similar. But there is one difference. According to statistics, men are 10 times more likely to experience Gilbert's syndrome.

Separately, an increase in bilirubin during pregnancy should be considered. In addition to the above reasons for changing the level of the indicator, when carrying a child, the following conditions can provoke a sign:

• Fatty degeneration of the liver in acute form.
• Formation of stones in the gallbladder.
• The expressed toxicosis of the early period.
• Intrahepatic cholestasis of pregnancy.
• Eclampsia and preeclampsia.

In addition to the above, the indicator can change during pregnancy if the woman is a carrier of the Epstein-Barr virus, cytomegalovirus, or there is an exacerbation of chronic liver pathologies.

Important: a slight increase in bilirubin against the background of normal general well-being may be the result of the stress of the expectant mother.

A growing fetus can also cause an increase in bilirubin. This is due to the fact that it displaces and compresses the organs, in particular, the ducts of the gallbladder, which causes stagnation of bile.

How can bilirubin be reduced?

Before treating an elevated bilirubin level in the blood, it is necessary to make sure that the reasons for its increase are established correctly. Initially, you need to determine the cause of the destruction of red blood cells and start from it.

If elevated bilirubin is caused by liver diseases, then the phenomenon of elevated bilirubin here is only a symptom. It may disappear immediately after the patient recovers. If the cause is stagnation of bile, then it is important to remove all obstacles that interfere with the high-quality outflow of bile. Yes, bilirubin will go down.

To reduce bilirubin in a newborn, you need to use special activators - inducer drugs for liver enzymes.

Any increase in bilirubin requires a nutritional correction. This will help reduce stress on the liver. First of all, you should reduce your salt intake as much as possible. Cooking is better without it. The daily norm will be 10 g. Naturally, marinades, pickles, smoked meats and canned food are excluded. The ban also includes pastries, especially those containing soda. Mushrooms, fatty broths, sour fruits and berries, spices, seafood and alcohol are unacceptable.

The menu is compiled using the following products:

• Kasha cooked in water.
• Lean meat.
• Dairy products of low fat content.
• Vegetable oils.
• Juices, but not sour.
• Honey and sugar.

All products must undergo heat treatment, preferably boiled or baked. It is especially important to observe the drinking regime, which implies the use of two or more liters of water. Decoctions of herbs, compotes, mineral waters without gas are acceptable.