A medical assistant is reviewing a patient's laboratory results and notes an elevated erythrocyte sedimentation rate (ESR). Which of the following is the primary factor that causes this elevation?
A decreased number of red blood cells
An increased concentration of plasma proteins
A decreased concentration of plasma proteins
An increased number of red blood cells
The correct answer is an increased concentration of plasma proteins. The ESR is primarily influenced by the composition of plasma proteins, particularly acute-phase proteins like fibrinogen, which increase during inflammation. These proteins cause red blood cells to form stacks (rouleaux), which are denser and settle more quickly in the test tube, resulting in an elevated ESR. An increased number of red blood cells (polycythemia) would increase blood viscosity and slow sedimentation, leading to a decreased ESR. A decreased number of red blood cells (anemia) can secondarily increase the ESR, but the primary driver in inflammatory conditions is the change in plasma proteins. A decreased concentration of plasma proteins would lower the ESR.
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