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OP Kapoor
 

In the past I have written on the subject of very high ESR1-7 (around 100 or more at 1 hour), which is seen in patients of HIV, extrapulmonary TB, multiple myeloma and allied conditions. Though in most of these conditions there is anaemia, it is never very severe. In case the patient has severe anaemia with haemoglobin of less than 6 gm and if ESR is elevated more than 100 at the end of 1 hour, the most likely diagnosis is acute leukaemia.

Recently, I saw a patient running fever, who got his haemogram and ESR done. His Hb on haemogram was 5 gm and ESR 140 at the end of 1 hour, and there was no mention of abnormal white cells. This report was from an average laboratory and since I was not happy with this report, I sent the patient to one of the bigger laboratories.

The report confirmed that the patient had acute leukaemia and plenty of young abnormal leucocytes were seen, which were obviously missed by the previous laboratory, which was also using automated machines for reporting.

References

  1. Kapoor OP. The erythrocyte sedimentation rate (ESR). BHJ April 1989; 31 (2) : 115.
  2. Kapoor OP. Importance of very high ESR (Around 150 mms). BHJ April 1996; 38 (2) : 378.
  3. Kapoor OP. Blood ESR by Wintrobe Method should be abolished in private practice. BHJ April 1997; 39 (2) : 359.
  4. Kapoor OP. Four blood tests which are much superior to X-rays to diagnose bone conditions. BHJ April 1998; 40 (2) : 267.
  5. Kapoor OP. Why off and on ESR report is normal when you expected it to be high? BHJ Oct. 1999; 41 (4) : 757.
  6. Kapoor OP. Why is ESR more informative than ASO titre ANA levels and presence of rheumatoid factor in a patient who complaints of joint pains? April 2001; 43 (2) : 308.
  7. Kapoor OP. Value of routine blood count and ESR in the diagnosis of arthritis. BHJ Oct. 2001;
    43 (4) : 567.

ABSORBABLE CORONARY STENTS

At 12 months stents were safe, in that there was no stent thrombosis, myocardial infarction, or death in any of the 63 patients. However, angiographic restenosis developed in 47.5% of patients, and 27 (45%) of the 60 patients available at 12 months follow-up needed repeat revascularisation by 12 months. These rates are similar to, or higher than, those reported with balloon angioplasty alone.

The Lancet, 2007; 369 : 1840.

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

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