Understanding ESR has 2 Concepts:1)
ESR is sedimentation of Erythrocytes. Normally the erythrocytes have charges ontheir surfaces which make them repel and don't allow formation of roleaux. whenthese charges are abolished Roleaux formation is increased.2)ESR Also depends on viscosity when visco. increases ESR decreases. (Vice Versa)
So applying the concept in a few examples:In Multiple Myeloma:The increased Immunoglobulins cover the charges on the RBCsurface therby increasing Roleaux formation. Now u may ask that viscosity also increaseswith MM but the former is the important component here.In Anaemia there is decrease in viscosity,therefore esr increases. (Except SickleCell,again we can apply the concept that viscosity increases in sickle cell disease)In polycythemia Viscosity increases therefore ESR decreases.
the above chart clearly shows...decrease in ESR in sickle cell anemia great increase in ESR in myeloma