SUMMARY Serial monitoring of the serum C-reactive protein (CRP) concentration was performed, using a one-hour laser-immunonephelometric assay, during 29 episodes of infection in 22 neutropenic patients with acute leukaemia. Serum CRP increased to above a diagnostic level of 100 mg/l in all 29 episodes and continued to rise progressively until appropriate antibiotics, or granulocytes, were given when it fell with a half-life of approximately three days. Serial study of the serum concentration was of value in detecting occult or unresolved bacterial infection and provided an objective means of monitoring the response to antibiotic and granulocyte therapy.Infection, when unrecognised or treated ineffectively, is the commonest cause of death in neutropenic patients with acute leukaemia. Because of the lack of granulocytes, clinical and radiological signs of infection are often inadequate and the diagnosis of potentially-fatal infection may be delayed. Empirical treatment with a broad-spectrum antibiotic combination, given intravenously, may be life saving but there are few objective guidelines to indicate when bacterial infection is responding and for how long intravenous antiobiotics should be continued. An objective method for quantifying the inflammatory response might therefore be of clinical value in guiding antibiotic policy and indicating when granulocytes should be given. ' Acute infection, and other causes of an inflammatory response, will induce hepatic synthesis2 of C-reactive protein (CRP) and other acutephase reactant proteins so that a rise in serum concentration occurs within a few hours or days.3 C-reactive protein has been widely studied as an acute-phase reactant4 and the rise in serum concentration may be detected within one hour of experimentally-induced endotoxaemia.5 Rapid measurement of CRP is now possible using laser immunonephelometric6 or rate immunonephelometric7 assays and the present study was designed to investigate the value of the one-hour laser immunonephelometric assay as a guide to the effectiveness of antibiotic therapy in acute leukaemia.
SUMMARY C-reactive protein and four other acute phase reactant proteins of non-cardiac origin (orosomucoid, alphal-antitrypsin, haptoglobin, and alpha2-macroglobulin) were studied serially by laser immunonephelometric assay in sera from 17 patients with myocardial infarction. A similar comparison was made in 57 patients undergoing surgery and 72 patients with acute infection. C-reactive protein was consistently the most sensitive acute phase reactant in all three conditions. After myocardial infarction, a raised serum C-reactive protein level was found on admission in four patients before a rise in creatine kinase MB isoenzyme (CK MB). The peak C-reactive protein level was reached on the third post-infarct day and it then declined over seven days with a half-life similar to myocardial tropomyosin. Serial monitoring of serum C-reactive protein, in parallel with cardiac proteins of short half-life (CK MB) and long half-life (tropomyosin), provides maximal information for diagnosis and for detecting post-infarct complications.Acute phase reactant proteins are synthesised by the liver in response to acute tissue damage. Serial estimation of these proteins, C-reactive protein in particular,' has been used to monitor the progress of a variety of clinical disorders and the recent introduction of rapid assays, using laser ixmunonephelometric,2 rate immunonephelometric,3 and immunoradiometric4 techniques, will increase their clinical application.The original observation5 that C-reactive protein could be detected in serum after myocardial infarction was followed by a number of studies using semiquantitative immunoprecipitation techniques6-9 and, later, electroimmunoprecipitation'0 and radial immunodiffusion"I assays. These studies, and a more recent immunoradiometric assay,4 indicate the potential clinical value of measuring acute phase reactants in serum after myocardial infarction. There is, however, a need to determine whether C-reactive protein estimation has advantages over other acute phase proteins for cardiac studies and to investigate the time course of its rise and fall in serum after myocardial infarction in comparison with proteins of cardiac origin. Laser immunonephelometric assays ofC-reactive protein and
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