ClinLab Navigator Logo
September 2014 Newsletter 
In This Issue
Visit our Facebook Page
Seroprevalence of Herpes Simplex Virus Types 1 & 2
Mobile App Updates
Website Updates
--------------------------------------------

New Articles This Month
 


.......................................................... 
--------------------------------------------

Updated Articles This Month
 
..........................................................
--------------------------------------------

Visit Our Sponsor
Professional Co-op logo


--------------------------------------------

Featured Interview
An Interview with Dr  Fred Plapp, Author of www.ClinLabNavigator.com
An Interview with Dr Fred Plapp, Author of www.ClinLabNavigator.com

-------------------------------------------

 

Essentials of Transfusion Medicine
by Fred V. Plapp MD PhD by BookSurge Publishing
Paperback ~ Release Date: 2008-08-18
List Price: $25.95
Our Price: $20.83
Buy Now

 

-------------------------------------------

 

Know Someone Who Might Enjoy Our Mailing List?


-------------------------------------------

 

Interact With Us

Find us on Facebook

Follow us on Twitter


View our profile on LinkedIn 
ClinLab Navigator Logo


facebook Page!
Facebook Like
Find us on facebook
Never miss an update or new article!

Click on the image to the right to visit our facebook page and like ClinLab Navigator.


About Us
For the latest information and updates, please visit our website at:  www.clinlabnavigator.com.

 

Sincerely,

 

Chris Plapp

ClinLab Navigator LLC

 

iBook Available
iBook

Our well received book is now available in the iBook format for your iPad.

Click on the image to the right to view the book in the iTunes store.
 
New Lower Price:
$9.99



Thank you for your interest in ClinLab Navigator.  You are receiving this e-mail because you registered on our web site. 
 
We hope you will find this monthly newsletter helpful.  Please send us any suggestions or feedback.

C Reactive Protein versus Erythrocyte Sedimentation Rate 

Erythrocyte sedimentation rate (ESR) is one of oldest laboratory tests in use. When anticoagulated whole blood is allowed to stand, red blood cells settle out. The rate at which they fall is known as the erythrocyte sedimentation rate and is a rough measure of abnormal concentrations of acute phase proteins and immunoglobulins. The acute phase proteins that affect ESR are fibrinogen, C-reactive protein, alpha-1 antitrypsin, and haptoglobin.  Acute phase proteins increase with acute tissue damage and inflammation such as occurs in myocardial infarction, collagen vascular disease, malignancy and chronic infection.  Elevated immunoglobulins, including monoclonal gammopathy, also increase ESR.This property makes ESR a sensitive, but nonspecific, indicator of tissue damage and inflammation.  Historically, an elevated ESR has been recommended as an important diagnostic criterion for polymyalgia rheumatica and temporal arteritis, because these two diseases have few other laboratory markers. 

 

C-reactive protein (CRP) is an acute phase protein synthesized in hepatocytes and alveolar macrophages in response to cytokines, particularly IL-6. It is a general marker of inflammation that begins to rise four to six hours after tissue injury. This is much earlier than other acute phase reactants, which do not begin to increase until 24 hours or more. CRP also increases to much higher levels than other acute phase proteins, making it the most sensitive indicator of small inflammatory stimuli.

 

Even though both ESR and CRP levels reflect similar pathologies, discordance between ESR and CRP has been documented and is thought to depend, in part, on serum albumin concentration, renal insufficiency, anemia and non-infectious inflammatory disorders.

 

ESR is a manual test, whereas CRP is performed on an automated chemistry analyzer. In this age of laboratory automation and cost containment, some laboratories have replaced ESR with CRP.  A recent study has clearly demonstrated that ESR still has important clinical utility and should be retained.

 

Dr. Gurmuhk Singh, The Shepeard Professor of Pathology and Chief of Clinical Pathology at Georgia Regents University, compared ESR and CRP values in 4527 instances when both tests were ordered (Adv Biol Chem: 2014; 4:5-9; DOI:10.4236/abc.2014.41002). He found 150 instances, involving 97 patients, where ESR was elevated more than twice the upper limit of normal (60 mm/h) but CRP was normal (≤1.0 mg/L). Average age of the patients was 55.5 years, and the sample included 71 women and 26 men. Medical records of these cases were reviewed to discern the cause of disparity between the ESR and CRP results. Of these patients, 39 had skin lesions, 33 joint lesions, 27 bone lesions and 11 colon disease.

 

Skin lesions were grossly visible and included cellulitis, vasculitis, gangrene, and lupus. The most common bone disease was osteomyelitis, often without any discharge or break in skin. Other bone and joint diseases included, gangrene, lytic bone lesions from myeloma, septic arthritis following joint replacement surgery, necrosis of bone implant and rheumatoid arthritis.  Many patients had co-existing degenerative joint disease with or without synovitis and tendinitis. Colon lesions included inflammatory bowel disease due to ulcerative colitis, Crohns disease, and diverticulitis. A relevant negative finding was the lack of instances of pneumonia, acute appendicitis, and non-osseous pyogenic lesions in any of the patients with elevated ESR and normal CRP.

 

This study demonstrated that clinical laboratories should continue to offer ESR. ESR was particularly valuable in detecting inflammatory disorders that may not be obvious by clinical examination or CRP results. ESR is particularly useful in diagnosing bone disease in general and osteomyelitis in particular.

 

In many cases it is appropriate to order both CRP and ESR in the initial diagnostic workup. If both are elevated, the course of the disease should be followed with serial CRP levels since CRP responds more quickly to changing clinical conditions than ESR. 

 

ClinLab Navigator
Mobile

Near Completion:
  • Brand new user interface and design coming next!
 
 
Click on the App Store Badge below to view all four apps in the iTunes Store.
iTunes App Store
 
Have Any Suggestions?
 
If you have any suggestions to make our apps even better, please don't hesitate to contact us at:  [email protected]

 

News
ClinLab Navigator
Site Updates
 
Click on the image below to view our site.
Visit our new site!
 
Have Any Suggestions?
 
If you have any suggestions to make our site even better, please don't hesitate to contact us at:  [email protected]

 


(Sponsor this newsletter)