Background: TB and HIV form a lethal combination, as each fuels the progress of the other in the infected patients. This study assessed the haematological parameters of pulmonary tuberculosis (PTB) patients with and without HIV infection attending the shyam shah medical college, Rewa. Aims: To study hematological parameter namely Hb (Hemoglobin), total RBC count, Total WBC count, ESR (Erythrocyte Sedimentation Rate) and platelets in pulmonary tuberculosis. Methods: To analytical study of all 120 (TB with HIV 60 / TB without HIV 60) TB patients who were attending Department of Medicine, Shyam Shah Medical College, Rewa (M.P.). And patientsrefered from Anti-retroviral therapy centre, with sputum positivity for AFB (acid fast bacillius).Results: In our study, 83.3% were males and 16.6 % were females in the TB with HIV group. 70% of patients were in the age group of 25 – 45 years in the TB with HIV group, whereas 86.6% of patients were in age group of 25 – 45 years in the TB without HIV. 90% of patients were underweight with BMI less than 18.5, in TB with HIV group, and 73.3% of patients were underweight in TB without HIV group. 80% were anemic in the TB with HIV and 66.6% were anemic in TB without HIV group. 63.4% of patients with TB and HIV had thrombocytopenia, whereas only 10% of patients had thrombocytopenia in TB without HIV group. Patients with tuberculosis per se have increased ESR count, whereas TB-HIV coinfection has drastically reduced the ESR count. Among patients with TB and HIV 83.3% of patients had ESR less than 60 mm/hr., whereas 96.6% of TB without HIV patients had ESR greater than 60 mm/hr. since, ESR is a marker of chronic inflammatory states like TB and HIV is a immunosuppressive state, the co-infection of TB with HIV has drastically reduced ESR values in these patients.Conclusion:ESR values are drastically reduced in TB patients with HIV, rather TB patients per se. hence, an ESR less than 60mm / hr in pulmonary tuberculosis patients should arouse a suspicion of underlying immunocompromised state.