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OP Kapoor

Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

All over the world, patients of PUO need extensive investigations, and the final diagnosis may be arrived at only in a certain percentage of patients. Such patients will need repeated examinations and investigations. A haematologist plays an important role.

One third patients have malignancy or lymphoma, 1/3 have connective tissue disorder, and the rest have hidden infection in the body which has to be identified.

The modern imaging specialist helps in identifying the first group. ANA (Anti-nuclear antibodies) and similar tests help to identify the 2nd group. The 3rd group is the most difficult to identify because the patient has received so many antibiotics, that clinical picture is altered to a great extent.

If a haematologist can aspirate the marrow, the diagnosis of the patient can be hastened. Following tests are required:

1. Take a marrow aspirate smear and look for MPs to exclude malaria and LD bodies to exclude Kala-Azar.

2. Send the sample for bactec culture test for salmonella.

3. Send another sample for culture to exclude tubercle bacilli, histoplasma. fungus and brucella organisms.

In order to exclude myelofibrosis, myeloid dysplasias, lymphomas, other malignancies, and tuberculosis of the marrow (which may or may not be a part of miliary TB), a `trephine' marrow biopsy, done by a good haematologist is required.

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