Good morning

C-reactive Protein
C-reactive protein (CRP) is an acute phase
reactant made mainly in the liver.
Production is controlled by interluekin-6,
an inflammatory cytokine. CRP is
commonly measured to screen for
inflammation or infection. Also, CRP is
produced by cells in the vascular wall such
as endothelial cells, smooth muscle cells,
..and also by adipose tissue
The CRP test is a general test to check
for inflammation in the body. It is not
a specific test. That means it can
reveal that you have inflammation
somewhere in your body, but it
.cannot pinpoint the exact location
:Your doctor may order this test to
Check for flare-ups of inflammatory*
diseases such as rheumatoid arthritis,
lupus, or vasculitis
Determine if anti-inflammatory medicine*
is working to treat a disease or condition
However, a low CRP level does not
always mean that there is no
inflammation present. Levels of CRP may
not be increased in people with
rheumatoid arthritis and lupus. The
. reason for this is unknown
A more sensitive CRP test, called a high-
sensitivity C-reactive protein (hs-CRP) assay, is
available to determine a person's risk for
heart disease. Many consider a high CRP level
to be a risk factor for heart disease. However,
it is not known whether CRP is merely a sign
of cardiovascular disease or if it actually
. plays a role in causing heart problems
What is the difference between CRP and hs-
?CRP tests
Both tests are essentially the same, measuring
the same substance in the blood. However, the
high sensitivity CRP (hs-CRP) test measures
very small amounts of CRP in the blood and is
ordered most frequently for seemingly healthy
people to assess their potential risk for heart
problems. It typically measures CRP in the
range from 0.5 to 10 mg/L. The regular CRP
test is ordered for those at risk for infections or
.chronic inflammatory diseases
 Indications/Applications
CRP: Suspected inflammatory state*
(vasculitis, autoimmune disorders, SLE,
psoriasis, infection)
CRP may sometimes be ordered along with*
.erythrocyte sedimentation rate (ESR)
CRP may be ordered, for example, when a*
newborn shows signs of infection or when an
individual has symptoms of sepsis, such as
fever, chills, and rapid breathing and heart
.rate
CRP may also be ordered to monitor*
conditions such as rheumatoid arthritis and
lupus and is often repeated at intervals to
.determine effectiveness of treatment
hs-CRP can be ordered for patients with*
some established risk factors of coronary
heart disease to determine strategy for
prevention of cardiovascular events and for
follow-up of patients with acute coronary
.syndromes
: Normal Results
Normal CRP values vary from lab to lab.
Generally, there is no CRP detectable in the
.blood
Conditions associated with high CRP levels
:(>10 mg/L) include the following
Inflammation – autoimmune disorders,*
rheumatoid arthritis, vasculitis
Infection -bacterial sepsis or fungal infection*
Acute coronary syndromes*
Your doctor may also use a highly sensitive test
called hs-CRP to help determine your risk of
heart disease as mentioned
According to the American Heart
:Association
You are at low risk of developing*
cardiovascular disease if your hs-CRP level is
lower than 1.0mg/L
You are at average risk of developing*
cardiovascular disease if your levels are
between 1.0 and 3.0 mg/L
You are at high risk for cardiovascular disease if*
CRP, being a marker of acute inflammation, is
elevated 100-1000 fold after infection or
trauma and, thus, for its utility as a
cardiovascular risk marker, it needs to be
measured 2 times at least 2 weeks apart, in a
metabolically stable state, post-infection or
illness, since its half-life is 19 days. Universal
hs-CRP screening is currently not warranted
except in patients with an intermediate-high
.risk score
Method Of Test
Method I (Qualitative)
Bring all reagents, controls and serum. 1
.samples to room temperature
Shake the CRP latex reagent gently before. 2
use. Deliver one drop of reagent to the test
circle. Using the disposable pipettes, add one
drop of the undiluted patient serum onto the
same circle and mix both together with the
.paddle end of the pipette
.source
Positive and negative controls should be run. 3
with each series of test serums in the same
.way as in Step 2
Rotate slide back and forth for 2 minutes. 4
and read result under an indirect oblique light
:Method II (Semi-Quantitative method)
Set up at least 5 test tubes and label 1:2,. 1
.1:4, 1:8, 1:16, 1:32, and etc
Use diluted Glycine-Saline Buffer to serially. 2
dilute sample to be titered according to
.standard laboratory practice
Repeat all steps as in Qualitative Method. 3
.using these new samples
RESULTS
Positive reaction is indicated by agglutination.
Since negative results may be caused by
antigen excess, the test should be repeated
using a diluted serum sample in case prozone
effect is suspected. For the Semi-Quantitative
Method, multiplication of the dilution factor
with 6 mg/L will yield the approximate level of
.CRP in the serum sample
Dilution Concentration mg/l

1:1 6

1:2 12

1:4 24

48 1:8
LIMITATIONS OF THE PROCEDURE
The strength of the agglutination reaction is. 1
not indicative of the CRP concentration. Weak
reactions may occur with slightly elevated or
.markedly elevated concentrations
A prozone phenomena (antigen excess) may. 2
cause false negatives. It is advisable,
therefore, to check all negative sera by
.retesting at a 1:10 dilution
Reaction times longer than specified may. 3
produce apparent false reactions due to a
.drying effect
Strongly contaminated sera can cause false. 4
.positive reactions
.Only serum should be used in this test. 5
Thank You