This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pathology
[{'content': 'ESR is increased in - \nSelect and explain. \nA. Sickle cell anemia, B. Multiple myeloma, C. Polycythemia vera, D. Thalassemia', 'role': 'user'}, {'content': "Answer: B \nExplanation: Factors affecting ESR\n1. Plasma\n\nRBCs carry a negative electric charge, whereas plasma carries a postive charge.\nAny condition in plasma that increases its positive charge, increases the rouleaux formation and increases ESR by lengthening stage I.\nFollowing factors increase positive charge and ESR : -\n\ni) Fibrinogen → Any condition which increases fibrinogen level will increase ESR - e.g.,\na)\xa0Infection\nb)\xa0Inflammation\nc)\xa0TB\nii)\xa0 Globulin →\xa0Conditions which increases globulin level will increase ESR.\n\nKala azar\nMultiple myeloma\nSome lymphoproliferative disorders\nRheumatic fever\n\niii) Cholesterol →\xa0Hypercholesterolemia increases ESR.\n\nAny condition in plasma that decreases its positive charge, decreases rouleaux formation and decreases ESR.\n\t(a)\xa0Albumin → Hyperalbuminemia decreases ESR.\n\t(b)\xa0Decreased fibrinogen → In afibrinogenemia, ESR is zero.\n\n2. RBC's\xa0- Increase in blood count as in polycythemia decreases ESR due to the jostling (or pushing one another) effect on the cells.\n- Anemia increases the ESR by opposite effect, there are two exceptions.\ni) Sickle cell anemia\nii) Microcytic hypochromic anemia (iron deficiency, Thalassemia)\nIn the last two types of anemia, ESR decreases because altered red cell shape prevents rouleux formation.\n\n3. Physiological variations\nESR is low in infancy\nESR is high at puberty\nESR is greater in women than man.\n\n4.Ohters\nESR is decreased in congestive heart failure\nESR is increased in acute myocardial infarction", 'role': 'assistant'}]