Phillip and Roy,

We also have taken over CRP form our Immunology department and although we
do not offer a 24hr/day stat service we have improved TAT compared the
previous service with a subsequent increase in requests especially from our
NICU. Discussions I have had with our neonatologists suggest that they do
use the CRP result in determining antibiotic therapy but only as part of a
group of indicators and that they tend to err on the side of caution if the
CRP is normal and will give antibiotics if there are other indicators of
infection. The more enlightened members of the NICU staff do not order ESR
but other (older??) staff still order it. 

As well, we are currently performing a study with our NICU investigating
the clinical utility of rapid TAT cytokines (IL-8, IL-6 and TNFa on the DPC
Immulite) cf CRP in the management of neonatal sepsis, the aim being to
treat early and thus shorten length of stay with subsequent cost benefits.

Peter Vervaart.

 At 01:54 13/07/98 +0100, Roy Fisher wrote:
>
>-----Original Message-----
>From: Phillip Jordan <[log in to unmask]>
>To: ACB Mailbase <[log in to unmask]>
>Date: 07 July 1998 16:43
>Subject: CRP
>
>
>>Requests for CRP measurement have increased dramatically in recent years,
>>and at the same time there has been associated expectations of faster
>>turn-around and availability.  Laboratories are undoubtedly to blame in
>>part for this due to the introduction of readily accessible technology, but
>>the clinical indications for considered need seem to be increasing
>>inexorably and are of dubious relevance to diagnosis and/or management.
>>Whilst not wishing to re-invent the wheel, has anyone seen published, or
>>would anyone be willing to share, local guidelines on appropriate
>>indications for CRP measurement, repetition intervals, etc., which could be
>>used for the benefit and education of junior medical staff, from whom
>>requests originate.
>>
>>Phillip Jordan
>>Clinical Scientist
>>Royal Devon and Exeter Hospital
>>
>>
>Phillip,
>
>Since April this year we have taken over the CRP service from our
>haematology department and because of the improved turnround time and 24
>hour availability we have already seen a 10% increase in the the workload
>that was about 18,000 requests/year. My impressions are that the level of
>abuse is probably no greater than for other tests but I would agree that
>some form of guidelines on its use would be welcome.  The paediatricians in
>particular are very pleased with the improvements in this service and the
>consultants on the Admissions Unit have found it very helpful in assessing
>some cases.
>
>What I would be interested to know from others is that does a rapid CRP
>service influence the use of or result in changes in antibiotic therapy. Is
>it not also time for the archaic ESR test to be abandoned in favour of CRP
>as it is often requested at the same time?
>
>Dr Roy Fisher
>Consultant Biochemist
>Royal Cornwall Hospital
>Truro
>
>
>
>
>
>
Peter Vervaart BAppSci MAIMS FAACB
Senior Scientist, Gastroenterology and Nutrition
Department of Clinical Biochemistry
Women's and Children's Health Care Network
Flemington Road
Parkville, Victoria, 3052
Australia
Phone: 613-9345 5906
Fax: 613-9349 1819
WWW: www.rch.unimelb.edu.au\biochem\gastro


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