ESR is increased in -

Factors affecting ESR 1. Plasma RBCs carry a negative electric charge, whereas plasma carries a postive charge. Any condition in plasma that increases its positive charge, increases the rouleaux formation and increases ESR by lengthening stage I. Following factors increase positive charge and ESR : - i) Fibrinogen → Any condition which increases fibrinogen level will increase ESR - e.g., a) Infection b) Inflammation c) TB ii)  Globulin → Conditions which increases globulin level will increase ESR. Kala azar Multiple myeloma Some lymphoproliferative disorders Rheumatic fever iii) Cholesterol → Hypercholesterolemia increases ESR. Any condition in plasma that decreases its positive charge, decreases rouleaux formation and decreases ESR. (a) Albumin → Hyperalbuminemia decreases ESR. (b) Decreased fibrinogen → In afibrinogenemia, ESR is zero. 2. RBC's - Increase in blood count as in polycythemia decreases ESR due to the jostling (or pushing one another) effect on the cells. - Anemia increases the ESR by opposite effect, there are two exceptions. i) Sickle cell anemia ii) Microcytic hypochromic anemia (iron deficiency, Thalassemia) In the last two types of anemia, ESR decreases because altered red cell shape prevents rouleux formation. 3. Physiological variations ESR is low in infancy ESR is high at puberty ESR is greater in women than man. 4.Ohters ESR is decreased in congestive heart failure ESR is increased in acute myocardial infarction