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CRP vs ESR Assessing & Measuring the Inflammatory Response

Introduction & Recommendations CRP vs ESR PDF
What is the best test to use in different situations?
CRP as an indicator of Severity
Result interpretation
How do CRP and ESR differ?
The acute phase response
What are ESR and CRP?
Tests should supplement clinical skills
See also CRP vs ESR: Reminder May 2007

The acute phase response

Following injury, trauma or infection of a tissue, a complex series of reactions occur in an effort to prevent ongoing tissue damage, and activate the repair processes. This cumulative homeostatic process is known as inflammation, and the early series of reactions are known as the acute phase response (APR).

The cells that most commonly initiate the APR are tissue macrophages and blood monocytes. These cells release cytokines such as IL-1 and TNF that control the migration of leukocytes into tissue and orchestrate the inflammatory response. Fever and leuckocytosis are among the most obvious consequences. The biosynthetic activity of the liver is profoundly affected. The pro-inflammatory cytokines IL-1 and TNF act on hepatocytes to greatly increase production of acute phase proteins such as CRP and serum amyloid A protein (Figure 2). These proteins are particularly useful for reflecting inflammation because of the increase of up to 1000 fold from resting levels. There are more moderate increases in the level of other proteins such as ferritin which may affect assessment of iron status in the presence of inflammation. There is a corresponding decrease in the synthesis of some other proteins, most notably albumin which may reach low levels in the presence of sustained inflammation.

Figure 2: The acute phase proteins

Figure 2

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