Understanding ESR has 2 Concepts: 1) ESR is sedimentation of Erythrocytes.

Normally the erythrocytes have charges on their surfaces which make them repel and don't allow formation of roleaux. when these 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 RBC surface therby increasing Roleaux formation. Now u may ask that viscosity also increases with MM but the former is the important component here. In Anaemia there is decrease in viscosity,therefore esr increases. (Except Sickle Cell,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

Elevated ESR is an important diagnostic criterion for polymyalgia rheumatica and temporal arteritis, because these two diseases have few laboratory markers other than ESR elevation.

The most common causes of an elevated ESR in outpatients are infection, malignancy, and renal disease. The most common causes of extremely elevated ESR (>100 mm/hr) are infection, collagen vascular disease, metastatic cancer, and myeloma. ESR usually decreases within a few days after initiating corticosteroid therapy, but usually remains at a higher level than normal, even when the patient's clinical status has dramatically improved. Sickle cells interfere with rouleaux formation and retard sedimentation. Elevated immunoglobulins, including monoclonal gammopathy, also increase ESR.

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