ESR/CRP

Re: ESR/CRP

David Mills — Sun, 30 Oct 2011 20:23:08 GMT

Discussions still ongoing about acute phase proteins in cattle - they are measurable in milk - and how this may be used to add value to the product - e.g. 'high welfare' milk where APPs are lower than a cut off (ARPs raised in mastitis, metritis, lameness etc). Interesting idea.

Re: ESR/CRP

Julian Earl — Sun, 30 Oct 2011 19:23:06 GMT

ESR and CRP are used in humans to monitor rheumatoid arthritis and similar auto-immune arthritises. They are checked monthly to judge both the severity and the response to treatment, and I think that the CRP is the more important of the two in this area. Severe rheumatoid cases can have values up to 150 or so, the normal being below 2. Maybe it is less important in dogs because rheumatoid arthritis is pretty unusual?

Re: ESR/CRP

Alex Gough — Sun, 30 Oct 2011 19:10:06 GMT

CRP is something we are using more and more frequently. Axiom and Idexx run it. It is a sensitive marker for inflammation, although not specific. Can be useful for monitoring response to treatment eg of PUOs, steroid responsive meningitis arteritis, or in the work up of cases where you don't know whether inflammation is playing a role.

alex

Re: ESR/CRP

Laurence Webb — Sat, 29 Oct 2011 22:51:31 GMT

[quote user="SteveOwen"]Laurence, you have my sincere sympathy. Human IBD is horrible. Well done for surviving in practice with it.

[/quote]Actually I have responded wonderfully to my meds, after a few months of fiddling around, and am now almost completely symptom free. So much so that I tried without anything for a day last week. That didn't work too well! It was a good (but mild) reminder of how things were before it was under control and for those who don't respond as well I feel truely sorry.

Even when things were pretty bad my ESR was normal and CRP only marginally elevated.

Re: ESR/CRP

Nicola Lawlor — Sat, 29 Oct 2011 22:35:09 GMT

CRP was measured by the doctors when my daughter was seriously ill with septicaemia earlier this year. It was interesting in that they assumed meningitis when she was admitted from her symptoms and started what appears to be a pretty standard course of testing and treatment. When they received her first blood results a couple of hours later all of a sudden things notched up a whole level and it clearly meant a lot to them that her CRP was sky high. At that point a paediatric intensive care retrieval team were called and she was rushed up to a specialist PICU in London. (She actually had Strep A septicaemia as we found out 24hrs later).

I'm not sure entirely what relevance this has to uses in dogs/animals, but I think from the reading I did at the time (Dr Google) that it tends to only shoot up very high in quite acute serious illness/inflammation situations. I am happy to be corrected on this though, I didn't do much detailed reading about it. I wonder though given the above if the time it takes for a commerical lab to turn this around would be of much use for those patients who are that sick in the first place, though of course it can be monitored to show response to treatment too I would think if we are able to get our patients that far. An interesting topic.

Re: ESR/CRP

SteveOwen — Sat, 29 Oct 2011 20:28:32 GMT

Laurence, you have my sincere sympathy. Human IBD is horrible. Well done for surviving in practice with it.

Re: ESR/CRP

Laurence Webb — Sat, 29 Oct 2011 19:26:40 GMT

I think TDDS offer CRP commercially and I keep meaning to to ask them about indications for its use.

I have IBD and both ESR and CRP were used in my initial work-up (normal so they obviously have their limitations!). ESR is one of tests used for immune mediated diseases such as lupus although I wouldn't be surprised if species differences (rouleaux were mentioned above) would limit it's use. Might CRP have uses in the monitoring of the efficacy of treatment for ongoing inflammatory/immune mediated diseases?

Re: ESR/CRP

Anonymous — Sat, 29 Oct 2011 16:58:15 GMT

[quote user="SteveOwen"]Interesting, thanks David. So why did you run it? Polyarthritis maybe? Ibd?[/quote]

Can't really remember, to be honest, but have run acute phase proteins (APPs) in dogs on few (definitely less than half a dozen) occasions and must have seemed a good idea at the time! Probably chronic unidentified pyrexia cases like polyarthritis etc with unremarkable haematologies?

As a specific test in a specific case it's hard to get too excited about running them, but equally as a general test incorporated into a general 'blood profile' it would be hard to think why not run them in any case where you feel indicated to do a wbc count/differential/morphology assessment? (Other than additional cost and inconvenience)

I think some of the commercial labs may offer some acute phase proteins like serum amyloid A, while others will point you in the direction of serum protein electrophoresis which they provide. My understanding is that in the dog, CRP is probably the most useful 'major' APP, but the measurement of a 'major' and 'moderate/minor' APP is usually suggested as a sensible combination.

Seems to be more accepted in cats where APPs often make up part of a 'FIP profile'.

I guess we all use albumin which is a negative acute phase protein amongst other things - I believe this is the logic behind Alb:Glob ratios for increased suspicion of FIP etc.

Lot of 'experimental' literature, but for suggestions on clinical use, try:

Acute phase proteins: biomarkers of infection and inflammation in veterinary medicine.: Eckersall, P. D.; Bell, R.; Mobasheri, A.; Cassidy, J. P.; Elsevier Ltd, Oxford, UK, Veterinary Journal, 2010, 185, 1, pp 23-27, many ref.; Or, for a conference proceeding that might be freely available online, try:; Tools to detect and evaluate inflammation: WBCs and some other friends. Cerón, J.; The North American Veterinary Conference, Gainesville, USA, Small animal and exotics. Proceedings of the North American Veterinary Conference, Orlando, Florida, USA, 16-20 January 2010, 2010, pp 322-324, 2 ref.

Re: ESR/CRP

SteveOwen — Sat, 29 Oct 2011 13:08:58 GMT

Interesting, thanks David. So why did you run it? Polyarthritis maybe? Ibd?

Re: ESR/CRP

Anonymous — Sat, 29 Oct 2011 11:40:45 GMT

I have run CRP in dogs before and there is some published literature on the subject of acute phase proteins in dogs (and cats).

I used ReactivLab in Glasgow.

They seem to have been taken over by more commercial enterprise:

http://www.avacta.com/avacta_health/animal_health/reactivlab for more details.

I think CRP has its uses and probably would be of use if incorporated into 'standard' biochem and haematology?

Re: ESR/CRP

Hannah Wynne Richards — Sat, 29 Oct 2011 10:45:49 GMT

Steve-at least you knew what CRP was-I didn't. When I was a student we were taught to measure fibrinogen particularly when deciding whether a colic was medical or surgical-presumably this is one of the Creactive proteins-and it'sa case ofmodern-speak

Wynne

Re: ESR/CRP

SteveOwen — Sat, 29 Oct 2011 10:37:38 GMT

Hmm I have done a bit of googling now. Would appear ESR less useful in animals as rouleaux can be normal in some of our species...maybe that's part of it? Where is the resident vetsurgeon clin path man? Is his name Richard?

Re: ESR/CRP

SteveOwen — Sat, 29 Oct 2011 10:25:51 GMT

C reactive protein...like ESR...a general indicator of inflammation. But each has their relative adv and disadv, including 'half-life' (eg usefulness for monitoring treatment of inflammatory disease), sensitivity, etc. Phew - glad it's not just me then...intriguing as they are both bread and butter stuff to docs...

Re: ESR/CRP

Hannah Wynne Richards — Sat, 29 Oct 2011 10:19:46 GMT

ESR is erythrocyte sedimentation rate-but what on earth is CRP ?????????????????

Wynne

Re: ESR/CRP

SteveOwen — Sat, 29 Oct 2011 10:07:19 GMT

It's certainly not something I was taught about at vet school...