The Value of Immediate Determination of C-Reactive Protein in the Hematology-Oncology Clinic.

CRP is named such for its ability to precipitate the somatic C-polysaccharide of Streptococcus pneumoniae. This polypeptide acute phase reactant is a sensitive systemic marker of inflammation, malignancy and tissue damage. ABX Diagnostics developed a hematology analyzer (Micros CRP), which rapidly measures 16 routine hematological parameters plus whole blood CRP. The CRP value, determined by specific antigen-antibody induced optical turbidity, is available within 5 minutes with sensitivity to 0.10 mg/dl. Normal whole blood values range between 0.0 to 0.2 mg/dl. We evaluated the added clinical benefit of immediate CRP determinations in an outpatient cancer clinic in 155 patients undergoing observation and aggressive chemotherapy. Blood was obtained from all patients each visit and routine CBC, Platelet count and CRP were recorded, immediately provided to the physician in the presence of the patient and automatically stored in a database (HemaLink). Correlations were made between changes of CRP, WBC, AGC, and clinical condition. Routine measurement of CRP and its immediate availability for clinical interpretation was found to add a valuable new diagnostic dynamic for cancer patient care. Elevated CRP and its relative change were found to be a leading indicator of serious and frequently subclinical infection and were the earliest clues when compared to WBC or AGC. Relative changes of CRP were found to be indicative of clinical course. Diagnostic value of the WBC in cancer patients was lost in those undergoing myelosuppressive therapy and in those receiving leukocyte colony stimulating factors. The immediate availability of CRP allowed for preemptive diagnostics and therapy. Real-time knowledge of CRP either changed or significantly influenced therapy in 38% of patients. Study supported in part by ThinkTwice Technologies.