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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.