Speed of subsidence of erythrocytes
Speed of subsidence of erythrocytes (SOE), the indicator which is also known as the effect of Fahr?us-Lindqvist’a, is one of the oldest nonspecific markers of quantitative definition of the inflammatory process caused by an infection, an inflammation or new growth development.
At women in norm of SOE makes 2-15 mm/h, at men of 1-10 mm/h. at children its norm depends on age.
In 1918 the Swedish pathologist and гематолог Robert (Robin) Sanno Fahr?us found out that increase in SOE at pregnant women, and in 1931 together with the therapist of Torsten Lindqvist published article in the American Magazine of the Physiology (The viscosity of the blood in narrow capillary tubes), devoted to studying of passing of erythrocytes through thin capillaries in which authors pointed to change of this indicator at a number of diseases.
Thus, clinical use of this laboratory dough is based on almost century experience. Before emergence of specific markers of an inflammation, the increase in an indicator of SOE was considered as almost doubtless indirect sign of an inflammation. However it is possible to consider results of definition of SOE authentic only if no other parameters, except assumed, influence a studied indicator. Now a sufficient large number of the factors influencing results of dough in this connection its clinical value is reconsidered is defined. Nevertheless, though the inflammation also is the most frequent reason of acceleration of subsidence of erythrocytes, the increase in SOE also can be caused and others, including not always pathological, conditions.
The main influence on speed of subsidence of the erythrocytes weighed in plasma, renders extent of their aggregation, that is ability to stick together together. In norm erythrocytes bear a negative charge and make a start from each other.
There are 3 main factors influencing aggregation of erythrocytes: superficial energy of cages, charge of cages and dielectric constant. The last indicator is the plasma characteristic, connected with concentration of asymmetric molecules. The increase in the content of these proteins leads to increase of durability of communications between the erythrocytes, bringing to agglutination and a slipaniye (formation of columns) erythrocytes and higher speed of subsidence.
Thus, extent of aggregation (so and SOE) raises at increase in concentration in plasma of so-called proteins of a sharp phase, first of all extremely asymmetrical фибриногена and moderately asymmetrical molecules of antibodies, a little smaller influence renders increase in concentration of C-jet protein and церулоплазмина. At increase in concentration альбуминов there is a decrease in SOE.
At an assessment of the clinical importance of dough it is necessary to consider that besides existence and expressiveness of inflammatory process exists a large number of other factors capable (quite often in different directions) to change values of this indicator.
Reasons of lozhnopolozhitelny increase in SOE
- Anemia with normal morphology of erythrocytes. This effect speaks change of a ratio of erythrocytes and the plasmas, to promoting formation of columns of erythrocytes in independence of concentration фибриногена.
- Increase in plasma of concentration of all proteins, except фибриногена (A M-protein, macroglobulins and agglutinins of erythrocytes).
- Nephritic insufficiency. The compensated patients have a nephritic insufficiency, possibly, is connected with increase in level фибриногена in plasma.
- Geparin. A dihydrate цитрата sodium and EDTA do not influence SOE.
- Extreme degree of obesity. The increase in SOE is probably connected with level increase фибриногена.
- Pregnancy (SOE definition initially used for pregnancy establishment).
- Advanced age. By approximate calculations, at men the top level of normal SOE makes the figure which is turning out at division of age on 2, for women – age plus 10, and divided on 2.
- Technical errors. The test tube deviation from vertical situation in the parties increases SOE. Erythrocytes settle at the bottom of a test tube, and plasma rises in the top part. Respectively, the braking effect of plasma weakens. The corner in 3 ° from the vertical line can lead to increase in SOE to 30 units.
Reasons of lozhnopolozhitelny decrease in SOE
The following factors can lead to decrease in SOE:
- Morphological changes of erythrocytes. Most often meeting forms of erythrocytes can lead to change of agregatsionny properties of erythrocytes that, in turn, will affect SOE. Erythrocytes of an abnormal or unusual form, such as crescent, with a form interfering formation of columns, lead to decrease in SOE. Sferotsita, анизоциты and пойкилоциты also render influence aggregation of erythrocytes, reducing SOE.
- Politsitemiya. Influences, opposite to what anemia renders on aggregation of erythrocytes.
- Substantial increase of level of leukocytes.
- DVS-sindrom (because of a gipofibrinogenemiya).
- Disfibrinogenemiya and afibrinogenemiya.
- Significant increase in level of bilious salts in blood plasma (owing to change of properties of a membrane of erythrocytes).
- Stagnant warm insufficiency.
- Valproyevy acid.
- Low-molecular dextran.
- Feeding by a breast.
- Technical errors. In view of that SOE increases at the environment temperature increase, the cooled samples of blood cannot be used at carrying out dough. In case samples after all were frozen, before definition of SOE it is necessary to heat up a test tube with blood to room temperature. It is not less important, that definition of SOE was made with use of samples of the blood received for 2 h before carrying out dough. If the test tube with blood is for a long time left on a laboratory table, erythrocytes accept a spherical form that leads to decrease in ability to formation of columns.
Unlike a set of the factors influencing such indicator as SOE, level of S-jet protein (SRB) is not influenced by any of known factors, except existence and degree of expressiveness of an inflammation. The period of semi-removal from plasma and level of a catabolism of SRB are constants almost under any conditions. Therefore, the maintenance of SRB in plasma is defined only by level of its synthesis which, in turn, depends only on existence and weight of inflammatory process. SRB belongs to the III group of the ostrofazny proteins which contents increases from 100 to 1000 times during an inflammation. Fibrinogen belongs to the II group of proteins and its concentration increases from 2 to 4 times. These factors testify in favor of SRB definition for an assessment of expressiveness of the inflammatory answer. SRB level in serum also increases and decreases quicker, than level фибриногена in serum, in this regard definition of S-jet protein as a marker of an inflammation has chronological advantages.
Really, SOE definition quicker and more simply (about 1 h for SOE definition is required), for definition of level of S-jet protein is necessary to carry out IFA or isotope immunological research. However, the doctors using in practice definition of SOE, rely on traditions of medicine, than on scientific justification of a method and simple logic more.
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