ACTIVITY 11

C-REACTIVE PROTEIN
Is a serum protein which is synthesized in the liver
Its rate of synthesis and secretion increases within hours
of an injury or the onset of inflammation and may reach
as high as 20 times the normal level
ONE OF MANY ACUTE PHASE PROTEI NS
o Produced in response to trauma, tissue damage,
infection and inflammation
o Most are made in the liver as a result of increased
synthesis and secretion
o 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
USES:
o Provides simple screening test for organic disorder
o Indicate inflammatory disorder
o Helps in differential diagnosis and management of
neonatal septicemia and meningitis
o Post-operative invariably rise after major surgery but
fall to normal within 7-10 days
CHARACTERISTICS:
o Five identical polypeptide units
o MW 21.5kDa
o Reference Range <10 mg/L
o Half Life 8 hours
o Rises within a few hours of insult or injury
o Detection limit 1.0 mg/L
o Linear to 480 mg/L
o Automated on board dilution of 1 in 5 for
levels >480 mg/L
o Stable for 7 days at 2-8
O
C

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

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




CAUSES OF A RAISED CRP
o Infection
Most microbial infections (serial measurements
are most useful)
Chronic infection (lower than in acute infection)
Uncomplicated virus infections (e.g. Viral
meningitis) will give little or no rise whereas
complex viruses (e.g. Herpes simplex) especially
in immune-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
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

o 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

o 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

o 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

o 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
o Trauma
CRP rises after any significant trauma, surgery
or burns peaking after 2 days. Any alteration in
this pattern may suggest underlying infection
o Other
SLE (auto immune disease)
Leukaemia
graft v host disease
Ulcerative colitis