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Erythrocyte sedimentation rate (ESR) is the most common test done for diagnosis and follow up treatment in patients suffering from autoimmune disorders and chronic illness. It is imperative for clinicians to understand the methodology, limitations and variations in testing platforms for ESR from ICSH standardized Westergreen method to various automated testing techniques. We conducted a retrospective study of 150 patients who were tested for ESR using Westergreen method and new automated Alifax Roller 20LC. The data was analyzed by applying Pearsons coefficient of correlation and Bland Altman analysis. It was observed that the automated Alifax Roller 20LC system tends to estimate ESR with positive bias. The maximum agreement between two methods was observed for ESR values between 20-40 mm/hr. As the likelihood of two similar results between two methods is uncertain, the difference between values should be acceptable clinically before replacing the ICSH Westergreen method with any new automated system.

Palliative care is an approach that improves the quality of life of patients and their families facing problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and treatment of pain and associated problems as physical, psychosocial and spiritual. In India it is relatively a new concept so to understand and practice it is challenging thus small steps progressive to a big result will be achieved if determined .Thus the policies must be made and implemented by government of India which must be taken care by Health sciences and economics as at present, there is no uniform health-care system followed in India like in some developed countries. The universal health insurance system in government and private sector is still in its infancy and most of the population remains uninsured because of great expanses due to inequalities which are related to socioeconomic status, geography, and gender and are compounded by high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households.

Leukemoid reaction (LR) refers to a reactive, excessive leukocytosis outside the bone marrow in the absence of hematological malignancy and has been described in response to inflammation, severe infection, malignancies, hemorrhage, acute hemolysis, or bone marrow stimulants. There is a significant increase in mature neutrophils in the peripheral blood and a differential count showing neutrophilia with varying degree of left shift.