anemia

1. Anemia is a condition in which there are not enough healthy red
blood cells to carry oxygen throughout the body.
Types of anemia include:
Iron deficiency anemia is often easily treated.
Sickle cell anemia results in abnormally-shaped red blood cells
that die quickly.
Vitamin deficiency anemia often stems from low levels
of vitamin B-12.
All types of anemia require treatment. People with anemia typically
feel tired and weak. They may also experience headaches, cold hands
and feet, dizziness, and irregular heartbeats.
a lower

2. • anemia (several)
• bone marrow failure
• erythropoietin deficiency,
which is the primary cause of
anemia in patients with chronic
kidney disease
• hemolysis, or RBC
destruction caused by transfusions
and blood vessel injury
• internal or external
bleeding
• leukemia
• malnutrition
• multiple myeloma, a
cancer of the plasma cells in bone
marrow
• micro-nutritional
deficiencies (iron, copper, folate,
vitamins B-6 and B-12)
• pregnancy
• thyroid disorders
If the number of RBCs is lower than
normal, it may be caused by:

3. • chemotherapy drugs
• chloramphenicol, which treats bacterial infections
• quinidine, which can treat irregular heartbeats
• hydantoins, which are traditionally used to treat epilepsy and
muscle spasms
Certain drugs can also lower your RBC
count, especially:

4. You have erythrocytosis if your RBC count is higher than normal:
a higher
• cigarette smoking
• congenital heart disease
• dehydration
• renal cell carcinoma, (kidney cancer)
• pulmonary fibrosis
• polycythemia vera, a bone marrow disease that causes
overproduction of RBCs and is associated with a genetic mutation

5. When you move to a higher altitude, your RBC count may
increase for several weeks because there’s less oxygen in the
air.
Certain drugs like gentamicin can increase your RBC count.
Gentamicin is an antibiotic used to treat bacterial infections in
the blood. Methyldopa is often used to treat high blood
pressure. It works by relaxing the blood vessels to allow blood
to flow more easily through the body. Be sure to tell your
doctor about any medications you take.
A high RBC count may be as result of sleep apnea, pulmonary
fibrosis, and other conditions that cause low oxygen levels in
the blood. Performance-enhancing drugs like protein injections
and anabolic steroids can also increase RBCs. Kidney disease
and kidney cancers can lead to high RBC counts as well.

6. *Iron deficiency occurs when the body doesn’t have enough of the
mineral iron. This leads to abnormally low levels of red blood cells.
*That’s because iron is needed to make hemoglobin, a protein in red
blood cells that enables them to carry oxygen around the body.
*If your body doesn’t have enough hemoglobin, your tissues and
muscles won’t get enough oxygen and be able to work effectively.
This leads to a condition called anemia.
*Although there are different types of anemia, iron-deficiency anemia
is the most common worldwid.
*Common causes of iron deficiency include inadequate iron intake due
to poor diet or restrictive diets, inflammatory bowel disease,
increased requirements during pregnancy and blood loss through
heavy periods or internal bleeding.
*Whatever the cause, iron deficiency can result in unpleasant
symptoms that can affect your quality of life. These include poor
health, concentration and work productivity.
10 Symptoms of Iron Deficiency

8. *Feeling very tired is one of the most common symptoms of iron
deficiency, affecting more than half of those who are deficient.
*This happens because your body needs iron to make a protein called
hemoglobin, which is found in red blood cells. Hemoglobin helps
carry oxygen around the body.
*When your body doesn’t have enough hemoglobin, less oxygen
reaches your tissues and muscles, depriving them of energy. In
addition, your heart has to work harder to move more oxygen-rich
blood around your body, which can make you tired.
SUMMARY:
Fatigue is one of the most common signs of iron deficiency. This is due
to less oxygen reaching body tissues, depriving them of energy.

9. *Pale skin and pale coloring of the inside of the lower eyelids are
other common signs of iron deficiency.
*The hemoglobin in red blood cells gives blood its red color, so low
levels during iron deficiency make the blood less red. That’s why skin
can lose its healthy, rosy color in people with iron deficiency.
*This paleness in people with iron deficiency can appear all over the
body, or it can be limited to one area, such as the face, gums, inside
of the lips or lower eyelids and even the nails (8).
SUMMARY:
*Paleness in general or in specific areas such as the face, lower inner
eyelid or nails may be a sign of moderate or severe iron deficiency.
This is caused by lower levels of hemoglobin, which gives blood its
red color.

10. *Hemoglobin enables your red blood cells to carry oxygen around the
body.
*When hemoglobin is low in your body during iron deficiency, oxygen
levels will also be low. This means your muscles won’t get enough
oxygen to do normal activities, such as walking.
*As a result, your breathing rate will increase as your body tries to get
more oxygen.
*This is why shortness of breath is a common symptom.
*If you find yourself out of breath doing normal, daily tasks that you
used to find easy, such as walking, climbing stairs or working out,
iron deficiency could be to blame.
SUMMARY:
*Shortness of breath is a symptom of iron deficiency, since low
hemoglobin levels mean the body isn’t able to transport oxygen to
muscles and tissues effectively.

12. *Iron deficiency may cause headaches.
*This symptom seems to be less common than others and is often
coupled with lightheadedness or dizziness.
*In iron deficiency, low levels of hemoglobin in red blood cells mean
that not enough oxygen can reach the brain. As a result, blood
vessels in the brain can swell, causing pressure and headaches.
*Although there are many causes of headaches, frequent, recurrent
headaches and dizziness could be a sign of iron deficiency.
SUMMARY:
Headaches and dizziness could be a sign of iron deficiency. The lack of
hemoglobin means not enough oxygen reaches the brain, causing its
blood vessels to swell and create pressure.

13. *Noticeable heartbeats, also known as heart palpitations, can be
another symptom of iron-deficiency anemia.
*Hemoglobin is the protein in red blood cells that helps transport
oxygen around the body.
*In iron deficiency, low levels of hemoglobin mean the heart has to
work extra hard to carry oxygen.
*This can lead to irregular heartbeats, or the feeling that your heart
is beating abnormally fast.
*In extreme cases, it can lead to an enlarged heart, heart murmur or
heart failure.
SUMMARY:
* In cases of iron deficiency, the heart has to work extra hard to
transport oxygen around the body. This can lead to irregular or fast
heartbeats and even heart murmurs, an enlarged heart or heart
failure.

14. *Dry and damaged skin and hair can be signs of iron deficiency.
*This is because when your body is iron deficient, it directs its limited
oxygen to more important functions, such as organs and other bodily
tissues.
*When skin and hair are deprived of oxygen, it can become dry and
weak.
*More severe cases of iron deficiency have been linked to hair loss.
*It is completely normal for some hair to fall out during everyday
washing and brushing, but if you are losing clumps or much more
than normal, it may be due to iron deficiency.
SUMMARY:
*Because skin and hair receive less oxygen from the blood during iron
deficiency, they can become dry and damaged. In more severe cases,
this can cause hair loss.

15. *Sometimes just looking inside or around your mouth can give you an
indication of whether you are suffering from iron-deficiency anemia.
*Signs include when your tongue becomes swollen, inflamed, pale or
strangely smooth.
*Low hemoglobin in iron deficiency can cause the tongue to become
pale, while lower levels of myoglobin can cause it to become sore,
smooth and swollen.
*Myoglobin is a protein in red blood cells that supports your muscles,
such as the muscle that makes up the tongue.
*Iron deficiency can also cause dry mouth, sore red cracks at the
corners of the mouth or mouth ulcers.
SUMMARY:
*A sore, swollen or strangely smooth tongue can be a sign of iron-
deficiency anemia. Cracks on the corners of the mouth can also be a
sign.

17. *Iron deficiency has been linked to restless leg syndrome.
*Restless leg syndrome is a strong urge to move your legs at rest. It
can also cause unpleasant and strange crawling or itchy sensations in
the feet and legs.
*It is usually worse at night, meaning that sufferers may struggle to
get much sleep.
*The causes of restless leg syndrome are not fully understood.
*However, up to 25% of people with restless leg syndrome are thought
to have iron-deficiency anemia, and the lower the iron levels, the
worse the symptoms.
SUMMARY:
*People with iron-deficiency anemia have a higher chance of
experiencing restless leg syndrome. This is a strong urge to move the
legs when at rest.

18. *A much less common symptom of iron deficiency is brittle or spoon-
shaped fingernails, a condition called koilonychia.
*This often starts with brittle nails that chip and crack easily.
*In later stages of iron deficiency, spoon-shaped nails can occur where
the middle of the nail dips and the edges are raised to give a
rounded appearance like a spoon.
*However, this is a rare side effect and usually only seen in severe
cases of iron-deficiency anemia.
SUMMARY:
*Brittle or spoon-shaped nails can be an indicator of more severe iron-
deficiency anemia.

19. *There are several other signs that your iron could be low. These tend to be
less common and can be linked to many conditions other than iron
deficiency.
*Other signs of iron-deficiency anemia include:
*Strange cravings: A hankering for strange foods or non-food items is called
“pica.” It usually involves cravings to eat ice, clay, dirt, chalk or paper and
could be a sign of iron deficiency. It can also occur during pregnancy.
*Feeling anxious: The lack of oxygen available to body tissues in iron
deficiency may cause feelings of anxiety. However, this tends to improve or
resolve as iron levels are corrected.
*Cold hands and feet: Iron deficiency means less oxygen is being delivered
to the hands and feet. Some people may feel the cold more easily in
general or have cold hands and feet.
*More frequent infections: Because iron is needed for a healthy immune
system, lack of it may cause you to catch more illnesses than usual.
SUMMARY:
*Other more generic signs of iron deficiency may include strange food
cravings, feeling anxious, cold hands and feet and an increased risk of
infections.

20. *If you think you have iron-deficiency anemia, consider the following
advice.
*Talk to Your Doctor
*If you think you’re showing signs or symptoms of iron deficiency, you
should make an appointment to see your doctor. A simple blood test
will confirm whether you have iron-deficiency anemia.
*If your doctor confirms you have iron deficiency, you will likely be
able to treat it fairly easily by increasing your intake of iron from
your diet or with iron supplements.
*The main aim of treatment is to restore hemoglobin levels to normal
and replenish iron stores.
*Try to ensure you are getting enough iron through real food in your
diet. Only take supplements if your doctor recommends them.

21. Eat Iron-Rich Foods
If your doctor thinks your iron deficiency may be caused by a lack
of iron in your diet, think about consuming more iron-rich foods,
such as:
• Red meat, pork and poultry
• Dark green, leafy vegetables, such as spinach and kale
• Dried fruit, such as raisins and apricots
• Peas, beans and other pulses
• Seafood
• Iron-fortified foods
• Seeds and nuts

22. Help Boost Your Iron Absorption
Importantly, eating vitamin C will help your body absorb iron better.
Make sure you eat enough vitamin C-rich foods, such as fruits and
vegetables.
It may also be beneficial to avoid certain foods that can inhibit iron
absorption when eaten in large amounts. These include tea and coffee
and foods high in calcium such as dairy products and whole-grain
cereals.
Take Iron Supplements If Your Doctor Recommends Them
Generally, you should only take an iron supplement as a last resort and
if your doctor recommends it. This will likely be the case if you are
unable to restore your iron levels through diet alone.
If you do take an iron supplement, try drinking orange juice with it to
boost iron absorption.
Keep in mind that there are some unpleasant side effects of taking iron
supplements. These include stomach pain, constipation or diarrhea,
heartburn, nausea and black stools.
However, these side effects usually decrease over time and depend on
the dose of iron you take.

23. SUMMARY
If you think you have iron-deficiency
anemia, talk to your doctor, who will
likely recommend more iron-rich
foods (plus vitamin C to increase your
iron absorption) or possibly iron
supplements.

24. Maximize iron absorption
* Whether you increase your iron intake through food or supplements, it’s also
important to make sure your body can easily process the extra iron you put into it.
Certain things can either increase or decrease the amount of iron your body absorbs.
Things that increase iron absorption
* When you eat something high in iron or take an iron supplement, try eating foods rich
in vitamin C or take a supplement at the same time. Vitamin C may help to increase
the amount of iron your body absorbs.
Foods high in vitamin C include:
* citrus
* strawberries
* dark, leafy greens
Vitamin A and beta-carotene, which helps your body produce vitamin A, can also help
your body absorb more iron. You can find vitamin A in animal food sources, such as fish
and liver. Beta-carotene is usually found in red, yellow, and orange fruits and
vegetables, such as:
* carrots
* winter squash
* sweet potatoes
* mangos
* You can also take vitamin A supplements, but make sure you work closely with your
doctor to figure out a safe dose. Too much vitamin A can lead to a potentially serious
condition called hypervitaminosis A.

25. Things that decrease iron absorption
* Calcium from both supplements and food sources can make it harder for your body to
absorb iron. However, it’s important that you don’t completely eliminate calcium
because it’s an essential nutrient. Just avoid calcium supplements and try not to
eat calcium-rich foods right before or after taking an iron supplement.
Foods high in calcium include:
* dairy
* dark, leafy greens
* soybeans
* seeds
* figs
Phytic acid can also reduce your body’s absorption of iron, especially if you don’t eat
meat. However, it only affects iron absorption during a single meal, not throughout the
day. If you don’t eat meat, try to avoid eating foods high in phytic acid with iron-rich
foods.
Foods high in phytic acid include:
* walnuts
* Brazil nuts
* sesame seeds
* Keep in mind that, like calcium, phytic acid is an essential nutrient that shouldn’t be
completely removed from your diet.

26. Vegetarian Foods With Iron
*Iron is an essential nutrient that plays an important role in many
bodily functions (1).
*A diet lacking in iron can result in low energy levels, shortness of
breath, headaches, irritability, dizziness or anemia.
*For instance, men and post-menopausal women generally require
around 8 mg of iron per day. This amount increases to 18 mg per day
for menstruating women and to 27 mg per day for pregnant women.
*And, since non-heme iron tends to be less easily absorbed by our
bodies than heme iron, the RDI for vegetarians and vegans is 1.8
times higher than for meat eaters.

27. Here is a list of plant foods that are high in iron:
* 1–3: Legumes
* Legumes, including beans, peas and lentils, are great sources of iron.
* Listed below are the varieties containing the most iron, from highest to lowest.
* 1. Tofu, Tempeh, Natto and Soybeans
* Soybeans and foods derived from soybeans are packed with iron.
* In fact, soybeans contain around 8.8 mg of it per cup, or 49% of the RDI. The same
portion of natto, a fermented soybean product, offers 15 mg, or 83% of the RDI (3, 4).
* 2. Lentils
* Lentils are another iron-filled food, providing 6.6 mg per cup cooked, or 37% of the RDI
(7).
* Lentils contain a significant amount of protein, complex carbs, fiber, folate and
manganese as well.
* 3. Other Beans and Peas
* Other types of beans contain good amounts of iron as well.
* White, lima, red kidney and navy beans closely follow soybeans, offering 4.4–6.6 mg of
iron per cup cooked, or 24–37% of the RDI (8, 9, 10, 11).
* However, chickpeas and black-eyed peas have the highest iron content. They provide
around 4.6–5.2 mg per cup cooked, or 26–29% of the RDI (12, 13).
* In addition to their iron content, beans and peas are excellent sources of complex carbs,
fiber, folate, phosphorus, potassium, manganese and several beneficial plant compounds.

28. SUMMARY
Beans, peas and lentils are rich in
iron. These legumes also contain
good amounts of protein, fiber,
vitamins, minerals and beneficial
plant compounds that may reduce
your risk of various diseases.

29. * 4–5: Nuts and Seeds
* Nuts and seeds serve as two more iron-rich plant sources.
* Those who wish to increase their total daily iron intake should add the following varieties to
their diet, as they contain the highest amounts.
* 4. Pumpkin, Sesame, Hemp and Flaxseeds
* Pumpkin, sesame, hemp and flaxseeds are the seeds richest in iron, containing around 1.2–4.2
mg per two tablespoons, or 7–23% of the RDI (18, 19, 20, 21).
* Products derived from these seeds are also worth considering. For instance, two tablespoons of
tahini, a paste made from sesame seeds, contain 2.6 mg of iron — which is 14% of the RDI (21).
* Similarly, hummus made from chickpeas and tahini provides you with around 3 mg of iron per
half cup, or 17% of the RDI (22).
* Seeds contain good amounts of plant protein, fiber, calcium, magnesium, zinc, selenium,
antioxidants and other beneficial plant compounds, too (23).
* They're also a great source of omega-3 and omega-6 fatty acids. Hemp seeds, in particular, seem
to contain these two fats in the ratio considered optimal for human health (24).
* 5. Cashews, Pine Nuts and Other Nuts
* Nuts and nut butters contain quite a bit of non-heme iron.
* This is especially true for almonds, cashews, pine nuts and macadamia nuts, which contain
between 1–1.6 mg of iron per ounce, or around 6–9% of the RDI.
* Similarly to seeds, nuts are a great source of protein, fiber, good fats, vitamins and minerals, as
well as antioxidants and beneficial plant compounds (23).
* Keep in mind that blanching or roasting nuts may damage their nutrients, so favor raw and
unblanched varieties (25).
* As for nut butters, it's best to choose a 100% natural variety to avoid an unnecessary dose of
added oils, sugars and salt.

30. SUMMARY
Nuts and seeds are good sources of
non-heme iron, as well as an array of
other vitamins, minerals, fiber,
healthy fats and beneficial plant
compounds. Add a small portion to
your menu each day.

31. *6–10: Vegetables
*Gram per gram, vegetables often have a higher iron content than foods
typically associated with high iron, such as meat and eggs.
*Though vegetables contain non-heme iron, which is less easily absorbed,
they are also generally rich in vitamin C, which helps enhance iron
absorption (1).
*6. Leafy Greens
*Leafy greens, such as spinach, kale, swiss chard, collard and beet greens
contain between 2.5–6.4 mg of iron per cooked cup, or 14–36% of the RDI.
*For example, 100 grams of spinach contains 1.1 times more iron than the
same amount of red meat and 2.2 times more than 100 grams of salmon (26,
27).
*This is also 3 times more than 100 grams of boiled eggs and 3.6 times more
than the same amount of chicken (28, 29).
*7. Tomato Paste
*At 0.5 mg per cup, raw tomatoes contain very little iron. However, when
dried or concentrated, they offer a much greater amount (33).
*For instance, half a cup (118 ml) of tomato paste offers 3.9 mg of iron, or
22% of the RDI, whereas 1 cup (237 ml) of tomato sauce offers 1.9 mg, or
11% of the RDI (34, 35).
*Sun-dried tomatoes are another iron-rich source, providing you with 1.3–2.5
mg per half cup, or up to 14% of the RDI (36, 37).

32. *8. Potatoes
*Potatoes contain significant amounts of iron, mostly concentrated in
their skins.
*More specifically, one large, unpeeled potato (10.5 ounces or 295 grams)
provides 3.2 mg of iron, which is 18% of the RDI. Sweet potatoes contain
slightly less — around 2.1 mg for the same quantity, or 12% of the RDI
(40, 41).
*Potatoes are also a great source of fiber. Additionally, one portion can
cover up to 46% of your daily vitamin C, B6 and potassium requirements.
*9. Mushrooms
*Certain varieties of mushrooms are particularly rich in iron.
*For instance, one cooked cup of white mushrooms contains around 2.7
mg, or 15% of the RDI (42).
*10. Palm Hearts
*Palm hearts are a tropical vegetable rich in fiber, potassium, manganese,
vitamin C and folate.
*A lesser-known fact about palm hearts is that they also contain a fair
amount of iron — an impressive 4.6 mg per cup, or 26% of the RDI (46).

33. SUMMARY
Vegetables often contain significant amounts of
iron. Their generally large volume-to-weight
ratio explains why eating them cooked may
make it easier to meet your daily requirements.
Coconut milk, dark chocolate, blackstrap
molasses and dried thyme are
less known, yet undoubtedly rich, sources of
iron.

34. Lifestyle changes
Lifestyle changes can affect your RBC count. Some of these changes include:
*• maintaining a healthy diet and avoiding vitamin deficiencies
*• exercising regularly, which requires the body to use up more oxygen
*• avoiding aspirin
*• avoiding smoking
Dietary changes
*Dietary changes can play a major part in home treatment by increasing or
lowering your RBC count.
*You may be able to increase your RBC with the following dietary changes:
*adding iron-rich foods such as spinach to your diet
*increasing copper in your diet with foods like shellfish, poultry, and nuts
*getting more vitamin B-12 with foods like eggs, meats, and fortified cereals

35. How is anemia diagnosed?
1) order blood tests to check your blood cell levels and platelet
levels,
2) also order a bone marrow biopsy
Because low hemoglobin levels, such as:
*• iron deficiency anemia
*• pregnancy
*• liver problems
*• urinary tract infections
In addition, some people have naturally low hemoglobin counts
without any underlying cause. Others have low hemoglobin, but
never have any symptoms.

36. •liver and
organ meats
•shellfish
•beef
•broccoli
•kale
•spinach
•green beans
•cabbage
Eat foods high in iron and folate
Iron plays an important role in hemoglobin production. A protein called
transferrin binds to iron and transports it throughout the body.
The first step toward raising your hemoglobin level on your own is to start
eating more iron. Foods that are high in iron include:

37. •beef
•spinach
•black-eyed peas
•lettuce
•rice
•kidney beans
•peanuts
Folate is a B vitamin that your body uses to produce heme, the part of your
red blood cells that contains hemoglobin. Without enough folate, your red
blood cells can’t mature. This can lead to folate deficiency anemia and low
hemoglobin levels.
You can add folate to your diet by eating more:

38. Take iron supplements
If you need to raise your hemoglobin level by a lot, you may need to
take oral iron supplements. However, too much iron can cause a
condition called hemochromatosis. This can lead to liver diseases such
as cirrhosis, and other side effects, such as constipation, nausea, and
vomiting.
Iron supplements should always be kept carefully out of reach of
children. If you child needs an iron supplement, make sure you choose
one that’s safe for children. They have a lower blood volume, which
makes them much more vulnerable to iron poisoning.

40. *Aplastic anemia is a severe form of anemia.
*If you have leukemia, cancerous blood cells can crowd out healthy
blood cells.
*Both leukemia and the treatment for it can lead to anemia.
*If you have leukemia and experience symptoms such as extreme
fatigue, dizziness, or paleness, you may also have anemia. Anemia is
a condition in which you have unusually low levels of red blood cells.
Here’s more about the link between leukemia and anemia.
*Bone marrow is a spongy material found in the middle of some of
your bones. It contains stem cells, which develop into blood cells.
Leukemia occurs when cancerous blood cells form in your blood
marrow and crowd out healthy blood cells.

41. *The type of blood cells that are involved determines the type of
leukemia. Some types of leukemia are acute and progress quickly.
Others are chronic and grow slowly.
*The most common type of anemia people experience is iron-
deficiency anemia. Low iron levels in the body can cause this.
Aplastic anemia is a severe form of anemia that can occur due to
exposure to:
Did You Know?
*Although leukemia occurs most often in children under 15 or adults
over 55, it can happen at any age.
*• a wide variety of drugs and chemicals
*• ionizing radiation
*• some viruses
*• an autoimmune disorder
It may also be linked to leukemia and cancer treatments

42. •fatigue
•shortness of breath
•dizziness
•lightheadedness
•a fast or irregular
heart rate
•pale skin
•frequent infections
•easy bruising
•nosebleeds
•bleeding gums
•headaches
•cuts that bleed
excessively
What are the symptoms of anemia?

43. Red blood cells and blood cancers
Blood cancers can affect the production and function of red blood cells. They can
also result in unusual RBC levels.
Each type of blood cancer has a unique impact on RBC count. The three main types
of blood cancer are:
• leukemia, which impairs the bone marrow’s ability to produce platelets
and red blood cells
• lymphoma, which affects the white cells of the immune system
• myeloma, which prevents normal production of antibodies

44. The erythrocyte sedimentation rate (ESR) determination
- is a commonly performed laboratory test with a time-honored
role. The test remains helpful in the specific diagnosis of a few
conditions, including temporal arteritis, polymyalgia rheumatica
and, rheumatoid arthritis. It is useful in monitoring these
conditions and may predict relapse in patients with Hodgkin's
disease.
An extreme elevation of the ESR is strongly associated with serious
underlying disease, most often infection, collagen vascular disease
or metastatic malignancy. When an increased rate is encountered
with no obvious clinical explanation.
Physiologic Basis for the Test
Reference ranges for the ESR are provided in Table 1. As with other
laboratory tests, the actual reference range used for the ESR should
be established by the laboratory performing the test. Women tend to
have higher ESR values, as do the elderly.2 For unknown reasons,
obese people have also been noted to have slightly elevated ESRs,
although this is not thought to have clinical significance. Other
factors that may influence the ESR.

45. ADULTS
UPPER LIMIT OF REFERENCE
RANGE (MM/HR)
Age < 50 years
Men 0 to 15
Women 0 to 20
Age > 50 years
Men 0 to 20
Women 0 to 30

46. Old age
Female
Pregnancy
Anemia
Red blood cell
abnormalities
Macrocytosis
Technical factors
Dilutional problem
Increased temperature
of specimen
Tilted ESR tube
Elevated fibrinogen
level
Infection
Inflammation
Malignancy
Factors that increase
ESR

47. Extreme leukocytosis
Polycythemia
Red blood cell abnormalities
Sickle cell disease
Anisoctyosis
Spherocytosis
Acanthocytosis
Microcytosis
Technical factors
Dilutional problem
Inadequate mixing
Clotting of blood sample
Short ESR tube
Vibration during testing
Protein abnormalities
Hypofibrinogenemia
Hypogammaglobulinemia
Dysproteinemia with
hyperviscosity state
Factors with no clinically significant
effect or questionable effect
Obesity
Body temperature
Recent meal
Aspirin
NSAIDs
Factors that
decrease ESR