ESR is raised in -a) Sickle cell anaemiab) Multiple myelomac) Acute myocardial Infarctiond) Angina pectoris

**Core Concept**
Erythrocyte Sedimentation Rate (ESR) is a non-specific marker of inflammation that measures the rate at which red blood cells settle in a test tube. It is influenced by various factors, including the presence of acute phase reactants, such as fibrinogen and immunoglobulins, which accumulate in the blood during inflammatory processes.

**Why the Correct Answer is Right**
Correct answers B (Multiple myeloma) and C (Acute myocardial Infarction) are both conditions that can raise ESR due to the presence of acute phase reactants. Multiple myeloma, a type of plasma cell dyscrasia, produces large amounts of immunoglobulins, which increase the viscosity of blood and lead to an elevated ESR. Acute myocardial infarction triggers an inflammatory response, resulting in the release of various cytokines and acute phase reactants, including C-reactive protein (CRP) and fibrinogen, which contribute to an elevated ESR.

**Why Each Wrong Option is Incorrect**
**Option A:** Sickle cell anemia is a genetic disorder that affects hemoglobin production, but it does not typically cause an elevated ESR. The abnormal hemoglobin in sickle cell anemia leads to red blood cell deformity and increased hemolysis, but it does not trigger a significant inflammatory response.

**Option D:** Angina pectoris is a condition characterized by chest pain due to reduced blood flow to the heart. While it is a manifestation of coronary artery disease, it is not typically associated with an elevated ESR. The inflammatory response in angina is usually mild and does not lead to significant changes in ESR.

**Clinical Pearl / High-Yield Fact**
It is essential to note that ESR is a non-specific marker of inflammation and can be elevated in a wide range of conditions, including infections, autoimmune diseases, and malignancies. A normal ESR does not necessarily rule out the presence of an underlying disease, and a high ESR requires further investigation to determine its cause.

**✓ Correct Answer: A. bc**