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What does "C" in CRP stand for? (AIIMS NOV 2009) (Latest Questions)



A C- polysaccharide of Pneumococcus

B Chondroitin Sulfate in series with ARP, BRP

C Concanavalin A

D Cellular

Ans. C polysaccharide of Pneumococcus

I. C-reactive protein was originally discovered by Tillett and Francis in 1930 as a substance in the serum of patients with acute inflammation that reacted with the C polysaccharide of pneumococcus. Q

II. Its physiological role is to bind to phosphocholine expressed on the surface of dead or dying cells (and some types of bacteria) in order to activate the complement system via c1q. Q

III. CRP is synthesized by the liver in response to factors released by fat cells (adipocytes). It is a member of the pentraxin family of proteins.

IV. CRP rises up to 50,000-fold in acute inflammation, such as infection. It rises above normal limits within 6 hours, and peaks at 48 hours. Its half-life is constant, and therefore its level is mainly determined by the rate of production

V. There are two types of CRP assays. One measures a wide range of CRP levels to include those found in patients with acute infections.

VI. The second is a high-sensitivity CRP (hs-CRP) assay. The latter can detect a lower level of CRP to include those that may be of value in measuring the risk for a cardiac event. The hs-CRP is useful, there­fore, for assessment of risk for developing myocardial infarction in patients presenting with acute coronary syndromes.

Reference Values Normal

I. <1.0 mg/dL, or <l0 mg/L by rate nephelometry for CRP Q

II. <0. 1 mg/dL or < 1 mg/L by immunoturbidimetric assay for hs-CRP

Clinical Implications

A. The traditional test for CRP has added significance over the elevated erythrocyte sedi­mentation rate (ESK), which may be influenced by altered physiologic states. CRP tends to increase before rises in antibody titers and ESR levels occur. CRP levels also tend to decrease sooner than ESR levels.

B. The traditional test for CRP is elevated in rheumatic fever Q, RA Q, myocardial infarction Q, malignancy, bacterial and viral infections, and postoperatively (declines after fourth post­operative day).

C. A single test for hs-CRP may not reflect an individual patient's basal hs-CRP level; there­fore, follow-up tests or serial measurements may be required in patients presenting with increased hs-CRP levels.

D. CRP levels may predict future cardiovascular events Q, diabetes, & hypertension and can be used as a screening tool.

E. One of the minor criteria of Modified Jones criteria Q

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