CRP

1. CRP Heidi Luck

2. CRP One of many Acute Phase Proteins • Produced in response to trauma, tissue damage, infection and inflammation • Most are made in the liver as a result of increased synthesis and secretion • The monitoring of an acute phase response can reflect the extent and activity of an ongoing problem and can be used to monitor response to therapy

3. CRP • 3 main group of APP 1. Those that show a 50% increase in levels Eg. Caeruloplasmin 2. Those that show a 2-4 fold increase Eg. Fibrinogen, haptoglobin a A1T 3. Those that show a several hundred fold increase Eg. CRP

4. CRP • Five identical polypeptide units • MW 21.5kDa • Reference Range <10 mg/L • Half Life 8 hours • Rises within a few hours of insult or injury

5. CRP • Neonates tend to a peak at 2 days ?due to necrosis of the umbilical cord • 10 – 40 mg/L suggest mild inflammation or ? Viral infection • 40 – 200 mg/L acute inflammation or bacterial infection • >300 mg/L extensive trauma, burns and severe bacterial infection

6. CRP • Detection limit 1.0 mg/L • Linear to 480 mg/L • Automated on board dilution of 1 in 5 for levels >480 mg/L • Stable for 7 days at 2-8 OC

7. CRP • Why measure CRP ? • On its own non-specific but very sensitive • ? works by binding to exposed DNA in damaged or dead cells • ? scavenger to clear damaged tissue from the circulation • needs to be interpreted with full clinical information to be useful • Can reflect the extent and activity of an injury/insult and response to treatment

8. CRP Causes of a raised CRP • Infection • Most microbial infections (serial measurements are most useful) • Chronic infection (lower than in acute infection)

9. CRP • Uncomplicated virus infections (e.g. Viral meningitis) will give little or no rise whereas complex viruses (e.g. Herpes simplex) especially in immuno compromised patients may lead to major elevations in serum CRP • CRP changes occur in all ages and in all stages of health e.g. AIDS, Steroid therapy, irradiation and may be useful as other clinical signs and symptoms may be lacking or masked

10. CRP • CRP may precede clinical signs of infection by up to 24-48 hours • CRP levels can be used to monitor antibiotic therapy and further rises can indicate recurrence of infection • N.B Bacterial meningitis will produce a much higher level of CRP than viral meningitis

11. CRP Causes of a raised CRP • Inflammatory Disease • Chronic inflammatory disease associated with elevated CRP e.g. RA and monitoring serially reflects the extent and activity of the disease • Persistent elevation of CRP in the absence of clinical signs and symptoms may indicate relapse of an underlying inflammation requiring additional treatment

12. CRP Causes of a raised CRP • Allograft rejection post transplant • post transplant monitoring can help prempt possible rejection (must exclude possibility of infection) • return to normal followed by a rise can indicate rejection • consistent modest elevation may suggest chronic rejection that may require graftectomy

13. CRP Causes of a raised CRP • Malignancy • Most malignant tumours cause APP response especially Hodgkins Lymphoma and Renal Carcinoma • Some anecdotal evidence suggests CRP levels correlate to prognosis in prostate and bladder carcinoma

14. CRP Causes of a raised CRP • Necrosis • any tissue necrosis causes a rise in CRP • MI will cause a rise in CRP as will any embolytic lesion • Angina does not cause a raised CRP but pericarditis, PE and pleurisy do. • CRP cam be used monitor pancreatitis

15. CRP Causes of a raised CR • Trauma • CRP rises after any significant trauma, surgery or burns peaking after 2 days. Any alteration in this pattern may suggest underlying infection

16. CRP Causes of a raised CRP • Other • SLE (auto immune disease) • Leukaemia • graft v host disease • Ulcerative colitis

17. CRP • Neonates • Very useful as a good early indicator of infection • The use of other APP is also useful • Useful in the prompt and appropriate treatment regimen for very vulnerable patients