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Erythrocyte sedimentation rate (ESR) is a timehonoured, simple and inexpensive test. Raised ESR may be due to numerous aetiologies ranging from minor illness to serious disease. But grossly elevated ESR (equal to or more than 100mm in 1 st hour) is an alarming situation and needs prompt diagnosis and treatment. The aetiologies of high ESR are difficult to find out and produce considerable diagnostic dilemma to the physician all over the world. Sometimes underlying pathology may be apparent from careful history, physical examination and simple laboratory investigation. Sometimes invasive and costly investigation is needed to reach the diagnosis. The aetiologies of high ESR may vary from region to region. Such as, Kala-azar is prevalent in this part of the country, and a study done in Rajshahi Medical College Hospital showed that more than 36% of Kalaazar present with an ESR equal to or more than 100 mm in 1 st hour 1,2 . Unfortunately there is no study in our country regarding the aetiology and necessary laboratory tests to reach the aetiology of grossly

Laboratory Tests Required to Reach the Diagnosis in Patients with Grossly Elevated ESR