CRP Flashcards by DANIELA ANAMARIE V. BORDON

Crucial biomarker for inflammation and infections.

CRP ( C-REACTIVE PROTEIN)

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Are responses provided by your immune response if ever there is an encountered infection or inflammation

ACUTE PHASE PROTEIN OR ACUTE PHASE REACTANTS

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Your CRP is also being synthesized in the _______

LIVER

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Primary inducer for your
inflammatory response

IL-1

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Responsible for activating your acute phase protein

IL-6

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Interleukin that is related to Acute phase reactants:

IL-6

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The main interleukin produced in response to pro inflammatory cytokines

IL-1

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Normal Range of CRP:

< 10 mg/L (LESS THAN 10 mg/l)

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If the CRP level is (greater than ) > 10 mg/L:

THE BODY IS HAVING INFLAMMATION OR INFECTION

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(APPS BIOMARKERS)
POSITIVE APPS (8)

C REACTIVE PROTEIN (CRP)
SERUM AMYLOID A (SAA)
HAPTOGLOBIN
CERULOPLASMIN
a2 MACROGLOBULIN
a1 ACID GLYCOPROTEIN (AGP)
FIBRINOGEN
COMPLEMENT (C3,C4)

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(APPS BIOMARKERS)
NEGATIVE APPS (4)

ALBUMIN
TRANSFERRIN
TRANSTHYRETIN
RETINOL BINDING PROTEIN

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Positive APPs = ________ during
inflammation/infection

INCREASE

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Negative APPs = _______ during
inflammation/infection

DECREASE

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The higher the CRP level, the more _______ in your body

INFLAMMATION

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CRP is ________; it isn’t unique to one disease

NOT SPECIFIC

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This test needs to be paired up with other markers to be specific:

CRP

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Most doctors paired your CRP with _____ to assess your liver

LIVER ENZYMES MARKERS

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CRP can also be paired with ____ to assess you kidney

CREATINE

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_____ tests can help monitor disease progress and flares

CRP

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Measures of _____ add to the diagnostic procedure in selected cases (e.g. in the differentiation between a bacterial and a viral infection

CRP

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An extremely elevated CRP is suggestive of a possible_______

BACTERIAL INFECTION

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The CRP level may be useful also for monitoring the effect of ______(1) and for detection of _______(2) or _____(3)

TREATMENT
POSOPERATIVE COMPLICATIONS
INTERCURRENT INFECTIONS

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> 1000 mg/l of CRP levels

BACTERIAL INFECTION

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A blood test marker for inflammation in the body

C-REACTIVE PROTEIN

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Produced in the liver and its level is measure by testing the blood

C-REACTIVE PROTEIN

Classified as an acute phase reactant, which means that its levels will rise in response to inflammation

CRP

CRP GENE:

CRP Gene-chromosome 1, short arm

cytokines especially, ___and ___regulate CRP at transcriptional level:

IL-6 AD IL-1

CRP has highest affinity for: (3)

1. Phosphocholine on bacteria 2. Mixture of sphingomyelin 3. Phosphatidylcholine in eukaryotic membranes

Ability to bind to certain molecules that are NORMALLY found inside the body particularly those exposed during tissue damage or cell death.

CRP can recognize self ligands

self ligands (5)

1. Plasma lipoproteins 2. Damaged cell membrane 3. Several phospholipids 4. Small nuclear ribonucleoprotein components 5. Apoptotic Cells

Cellular components found on certain invading pathogens

CRP also bind to some extrinsic ligands

extrinsic ligands (2)

1. Phospholipid 2. Capsular/Cell body components of bacteria, fungi, and parasite

Kinds of Inflammations (8)

1. TUMOR 2. CANCERS 3. CYST 4. BENIGN 5. MALIGNANT 6. FEVER 7. ABDOMINAL PAINS 8. JOINT PAINS

Both are non-specific to any inflammation or infections

CRP AND ESR

ESR stands for:

Erythrocyte Sedimentation Rate

CRP is _____ produced while ESR is _____

CRP- RAPIDLY ESR- DELAYED

SENSITIVITY: CRP is more _____than ESR ___

CRP- MORE SENSITIVE ESR- MODERATE TYPE OF SENTIVITY

CRP is more ____ than ESR

SPECIFIC

CRP is measured in ___ while ESR is measured by ___

CRP - mg/l ESR- mm/hr

____ more prone to clinical error

ESR

(3) MAIN FUNCTIONS OF CRP:

1. Anti infective 2. Anti inflammatory actions 3. Scavenging Action

 Opsonize particles for phagocytosis  Activate complement via classical pathway

Anti infective

 CRP helps in preventing systemic inflammation  CRP aids in the release of neutrophils from blood vessels, while preventing white cell adhesion to vessel in non - inflamed tissues  Stimulates the release of anti-inflammatory molecules from monocytes

Anti inflammatory actions

CRP DOES NOT BIND TO _____________________

NORMAL CELL MEMBRANE

 Bind avidly to cells that are undergoing apoptosis or necrosis  Activates complement  Initiating an inflammatory reaction  Attracts neutrophils and monocytes to the site

Scavenging Action

(6) PROCESS INDUCED BY CRP:

1. ACTIVATION OF COMPLEMENT CASCADE 2. RAAS ACTIVATION 3. VASCULAR WALL DAMAGE 4. PROTHROMBOTIC STATE 5. Endothelial dysfunction 6. Opsonization of oxidized LDL

VASCULAR WALL DAMAGE (3)

1. Wall gets infiltrated by inflammatory cells 2. Smooth muscle proliferates and migrates to intima 3. Extracellular matrix is synthesized 4. Sensibility to proatherogenic factors is increased

PROTHROMBOTIC STATE (6)

1. activation of complement cascade 2. faster thrombin formation 3. release of tissue factor 4. diminished fibrolysis 5. increased formation of adhesion molecules 6. increased thrombocyte adhesiveness

Endothelial dysfunction (3)

1. decreased nitrogen oxide production 2. vasodilation impairment 3. glycocalyx damage

PRINCIPLE OF CRP:

AGGLUTINATION

Opsonization of oxidized LDL (2)

1. easier uptake by macrophages 2. formation of foam cells

(3) COMPLEMENT PATHWAYS:

1. CLASSICAL PATHWAY 2. LECTIN PATHWAY 3. ALTERNATIVE PATHWAY

Targets: * Antigen- antibody complexes * Material labeled by CRP

CLASSICAL PATHWAY

Targets: * Sugar residues on microbial surfaces

LECTIN PATHWAY

* Spontaneous hydrolysis of C3

ALTERNATIVE PATHWAY

OPSONIZATION BY : C1q

CLASSICAL PATHWAY

OPSONIZATION BY : MBP, FICOLIN

LECTIN PATHWAY

OPSONIZATION BY : C3b

ALTERNATIVE PATHWAY

FACTORS AFFECTING CRP LEVELS (5)

1. GENDER 2. BODY MASS EFFECT 3. ETHNICITY 4. EXERCISE 5. ALCOHOL CONSUMPTION

GENDER: Women have _____ levels than men

HIGHER

BODY MASS EFFECT: Weight Loss - ____ Obesity- ____

Weight Loss - DECREASE Obesity- INCREASE

ETHNICITY: Blacks have ___ levels than whites

HIGHER

EXERCISE: After exercise CRP levels _____

DECREASE

Alcohol Consumption:

Decrease CRP levels

METHODS FOR DETECTION OF CRP (4)

1. ELISA 2. Immunoturbidimetry 3. Rapid immunodiffusion 4. Visual Agglutination

CLINICAL IMPORTANCE OF CRP (7)

1. Elevated CRP levels 2. Mild elevation of CRP levels 3. Normalization of CRP levels 4. Transplant cases 5. Cerebral vein or sinus thrombosis 6. Giant cell arteritis 7. Pancreatitis

Elevated CRP levels (3)

1. Osteoarthritis 2. Predictive coronary events (esp. in stable angina) 3. Proinflammatory or prothrombotic effects

Mild elevation of CRP levels (4)

1. SLE (Systemic Lupus Erhutumatosus) 2. Scleroderma 3. Sjorgen Syndrome 4. Dermatomyositis/ Polymyositis

Normalization of CRP levels:

helpful tool in determining the response to antibiotic therapy and duration of treatment

Transplant cases:  Elevated levels were seen in majority of _____(1) or heart transplant  Highly elevated _____(2)  Changes in levels are not organ specific, like other inflammatory conditions

1. KIDNEY 2. GVHD Graph Versus Host Disease

Cerebral vein or sinus thrombosis * An ____ CRP is associated with a poorer short term prognosis

INCREASE

Giant cell arteritis  Thrombocystosis with platelet counts _____(1) and CRP levels _____(2) mg/dl have been found to be the strongest laboratory predictors of a positive temporal artery biopsy

1. >400,00/uL 2. >2.45 mg/dl

Pancreatitis * Level peaks _____(1) after onset of pain * Level of ____ (2) distinguishes mild from sever disease

1. 3 DAYS 2. 150 mg/l

Similar to CRP, it is also an Acute Phase Reactant More sensitive than CRP especially for cardiovascular injury

High sensitivity C-reactive protein (hs-CRP)

High sensitivity C-reactive protein (hs-CRP) NORMAL RANGE:

LESS THAN <0.3 mg/dL

HS-CRP USES:

1. Performing risk assessment for cardiovascular diseases 2. Determining risk of hypotension

COMPOSITION: CRP Latex Reagent (White Cap 5ml) Latex particles is coated with ________, ph 8.2 containing preservative

GOAT IgG anti human CRP

COMPOSTION: CRP POSTIVE CONTROL (RED CAP 1ML)

1. HUMAN SERUM 2. WITH A CRP CONCENTRATION >20 MG/L CONTAINING PRESERVATIVE

COMPOSITION: CRP NEGATIVE CONTROL (BLUE CAP 1ML)

1. ANIMAL SERUM 2. PRESERVATIVE