A 39-year-old woman was admitted for a cholecystectomy. She had a history of chronic cholecystitis; recent x-ray studies revealed stones in the gallbladder and a large stone in the biliary duct. During surgery a large stone was removed from the duct, and a cholangiogram showed no further obstructions of the hepatic or common bile ducts.
The patient became febrile 1 day after surgery. A 48-hour postoperative complete blood count and CRP were ordered with a repeat CRP on day 5 post surgery. On the seventh postoperative day, she had abdominal pain and began vomiting. A CBC, ESR, CRP, and blood culture were ordered at that time. The patient was started on a broad-spectrum antibiotic and discharged on the thirteenth hospital day.
Laboratory Data
At 48 hours after surgery, the CBC was within normal limits and the CRP was 11 mg/dL. A repeat CRP on the fifth day after surgery was 7 mg/dL.
Results after the episode of abdominal pain (on the 7th postop day) showed a normal CBC and ESR. The CRP measured 15 mg/dL. The blood culture was positive for Pseudomonas species.
Questions
1. What does CRP stand for and what is the normal blood concentration?
2. Give examples of disorders that will result in elevated CRP levels.
3. Other than monitoring of inflammation, what are other biological functions of CRP?
4. What caused the elevated CRP at 48 hours post-surgery?
5. On the 5th day after surgery the CRP did not return to normal levels. Discuss the reason for this continued elevated level.
6. Using the information in this case, explain why the CRP test has replaced the ESR in the monitoring of inflammation.
A 39-year-old woman was admitted for a cholecystectomy. She had a history of chronic cholecystitis; recent x-ray studies revealed stones in the gallbladder and a large stone in the biliary duct. During surgery a large stone was removed from the duct, and a cholangiogram showed no further obstructions of the hepatic or common bile ducts.
The patient became febrile 1 day after surgery. A 48-hour postoperative complete blood count and CRP were ordered with a repeat CRP on day 5 post surgery. On the seventh postoperative day, she had abdominal pain and began vomiting. A CBC, ESR, CRP, and blood culture were ordered at that time. The patient was started on a broad-spectrum antibiotic and discharged on the thirteenth hospital day.
Laboratory Data
At 48 hours after surgery, the CBC was within normal limits and the CRP was 11 mg/dL. A repeat CRP on the fifth day after surgery was 7 mg/dL.
Results after the episode of abdominal pain (on the 7th postop day) showed a normal CBC and ESR. The CRP measured 15 mg/dL. The blood culture was positive for Pseudomonas species.
Questions
1. What does CRP stand for and what is the normal blood concentration?
2. Give examples of disorders that will result in elevated CRP levels.
3. Other than monitoring of inflammation, what are other biological functions of CRP?
4. What caused the elevated CRP at 48 hours post-surgery?
5. On the 5th day after surgery the CRP did not return to normal levels. Discuss the reason for this continued elevated level.
6. Using the information in this case, explain why the CRP test has replaced the ESR in the monitoring of inflammation.
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