<prompt> ESR is increased in -Sickle cell anemiaMultiple myelomaPolycythemia veraThalassemia  <response>: Factors affecting ESR1. PlasmaRBCs 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 Infectionb Inflammationc TBii Globulin Conditions which increases globulin level will increase ESR.Kala azarMultiple myelomaSome lymphoproliferative disordersRheumatic feveriii 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. RBCs - 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 anemiaii Microcytic hypochromic anemia iron deficiency, ThalassemiaIn the last two types of anemia, ESR decreases because altered red cell shape prevents rouleux formation.3. Physiological variationsESR is low in infancyESR is high at pubertyESR is greater in women than man.4.OhtersESR is decreased in congestive heart failureESR is increased in acute myocardial infarction 