interpretation of lab tests - crp, tumor markers, serum ferritin
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INTERPRETATION OF LABORATORY TESTS
CRPTUMOR MARKERS
SERUM FERRITIN
Dr. Jyothi Reshma S
C-reactive protein
• Acute phase reactant - liver• Binding to C polysaccharide of Pneumococcus• Tillet and Francis 1930• Pentraxin – 23kDa• T ½ 19hours• Raised in infections, inflammatory disorders
and malignancies
Activation of complement – classical pathway IL6, IL1, TNFαHelps in opsonisation
Glucocorticoids ++Insulin --
• Normal < 0.3mg/dL• Clinically significant >1mg/dL• <1 : increasing age, low level of physical
activity, vigorous exercise, obesity, pregnancy, sleep deprivation, depression, insulin resistance, DM, seizures
INFECTIONS MALIGNANCY• High at onset: bacterial• Rise on day 3-4:
superimposed bacterial infection
• Elevated in systemic fungal infection – immunocompromised
• Marker of sepsis – 300mg/dL
• Ca lung, liver, skin, kidney, bladder, lymphoma, leukaemia
• Tumor necrosis and local tissue damage ++ CRP
• Opsonization and removal of tumor cells
Inflammatory disorders• Evaluation- extent or severity of inflammation• Monitoring- disease activity• Prognostic value• RA: 2-3 (moderate)to >10 (severe) – synovitis, erosions,
normal in 40%• SLE: serositis, synovitis ++• PMR, GCA: CRP > ESR, GCA with vison loss - CRP• Still’s disease, vasculitis, ankylosing spondylitis, erosive
OA, gout, reactive arthritis, sarcoidosis, scleroderma, PsA• Inflammatory bowel disease: CD(70-100%) UC(50-60%)• Patients with ++ CRP respond better to biological therapy
Cardiovascular disease• Proatherogenic- binds to LDL-C- monocyte adhesion,
transmigration, macrophage polarization• 2013 guidelines- ACC and AHA: hs-CRP : statin therapy• 1) 40-75yr, nonDM, without clinical ASCVD, LDL C
70-189mg/dL, 5 year risk of ASCVD <5%: hsCRP ≥2- statin COR IIb, LOE C
• 2) <40/>75yr, nonDM, without clinical ASCVD, LDL C 70-189mg/dL, hsCRP ≥2- statin COR ILb, LOE C
• 3) DM without clinical ASCVD, <40/>75yr, LDL C <70mg/dL, hsCRP ≥2- statin COR ILb, LOE C
ASCVD: atherosclerotic cardiovascular disease COR: class of recommendation LOE:level of evidence
• CRP: 0.7 – 0.9: 22 wk till delivery, 1.3: onset of labor
• Higher levels – 1st TM, early 2nd TM: preterm delivery
TUMOR MARKERS
Biomolecules secreted by cancer cells – diagnosis, treatment response, early recognition of recurrenceOncofetal antigens: AFP, CEATumor associated antigen: CA125, CA 19-9, CA 15-3, CA72-4Hormones: beta-HCG, PSA, calcitoninEnzymes: LDH, PAP, NSE, PLAP, TDTSerum and tissue proteins: beta-2 microglobulin, GFAP, ferritin, FDP
AFP (Alpha-feto protein)
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED • USUAL SAMPLE
• Liver, germ cell cancer of ovaries or testes
• Also elevated during pregnancy
• Help diagnose, monitor treatment, and determine recurrence
• Blood
B2M (Beta-2 microglobulin)
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED • USUAL SAMPLE
• Multiple myelomaand lymphomas
• Crohn's disease and hepatitis
• Determine prognosis
• Blood
CA 15-3 (Cancer antigen 15-3)
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED • USUAL SAMPLE
• Breast cancer and lung, ovarian
• Also elevated in benign breast conditions
• Stage disease, monitor treatment, and determine recurrence
• Blood
CA 19-9 (Cancer antigen 19-9)
• CANCERS
• WHAT ELSE?
WHEN/HOW USED
USUAL SAMPLE
• Pancreatic, sometimes colorectal and bileducts
• Pancreatitis and inflammatory bowel disease
• Stage disease, monitor treatment, and determine recurrence
• Blood
CA-125 (Cancer antigen 125)
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED • USUAL SAMPLE
• Ovarian
• endometriosis, some other benign diseases
• Help diagnose, monitor treatment, and determine recurrence
• Blood
Calcitonin
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED • USUAL SAMPLE
• Thyroid medullary carcinoma
• pernicious anemia and thyroiditis
• Help diagnose, monitor treatment, and determine recurrence
• Blood
CEA (Carcino-embryonic antigen
• CANCERS
WHAT ELSE?
WHEN/HOW USED
• USUAL SAMPLE
• Colorectal, lung,breast, thyroid, pancreatic, liver, cervix, and bladder
• hepatitis, COPD, colitis, pancreatitis, and in cigarette smokers
• Monitor treatment and determine recurrence
• Blood
Chromogranin A (CgA)
• CANCERS
WHAT ELSE?
• WHEN/HOW USED • USUAL SAMPLE
• Neuroendocrine tumors (carcinoid tumors, neuroblastoma)
• May be most sensitive tumor marker for carcinoid tumors
• To help diagnose and monitor
• Blood
Estrogen receptors
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED • USUAL SAMPLE
• Breast
• Increased in hormone-dependent cancer
• Determine prognosis and guide treatment
• tissue
hCG (Human chorionic gonadotropin)
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED • USUAL SAMPLE
• Testicular and trophoblastic disease
• Elevated in pregnancy, testicular failure
• Help diagnose, monitor treatment, and determine recurrence
• Blood, urine
Her-2/neu
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED • USUAL SAMPLE
• Breast• Oncogene that is
present in multiple copies in 20-30% of invasive breast cancer
• Determine prognosis and guide treatment
• Tissue
Monoclonal immunoglobulins• CANCERS
• WHAT ELSE?
• WHEN/HOW USED
• USUAL SAMPLE
• Multiple myeloma and Waldenstrom’s macroglobulinemia
• Overproduction of an immunoglobulin or antibody, usually detected by protein electrophoresis
• Help diagnose,monitor treatment, and determine recurrence
• Blood, urine
Progesterone receptors
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED • USUAL SAMPLE
• Breast
• Increased in hormone-dependent cancer
• Determine prognosis and guide treatment
• Tissue
PSA (Prostate specific antigen), total and free
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED
• USUAL SAMPLE
• Prostate
• benign prostatic hyperplasia, prostatitis and with age
• Screen for and help diagnose, monitor treatment, and determine recurrence
• Blood
Thyroglobulin
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED • USUAL SAMPLE
• Thyroid
• Used after thyroid is removed to evaluate treatment
• Determine recurrence
• Blood
BTA (Bladder tumor antigen)
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED • USUAL SAMPLE
• Bladder
• Not widely available, but gaining acceptance
• Help diagnose and determine recurrence
• Urine
CA 72-4 (Cancer antigen 72-4)
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED • USUAL SAMPLE
• Ovarian
• No evidence that it is better than CA-125 but may be useful when combined with it; still being studied
• Help diagnose• Blood
Des-gamma-carboxy prothrombin • CANCERS
• WHAT ELSE?
• WHEN/HOW USED
• USUAL SAMPLE
• Hepatocellular carcinoma (HCC)
• New test; often used along with an imaging study plus AFP and/or AFP-L3% to evaluate if someone with
• To evaluate risk of developing HCC; to evaluate treatment; to
• Blood
NMP22 (nuclear matrix protein)
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED • USUAL SAMPLE
• Bladder
• Not widely used
• Help diagnose and determine recurrence
• Urine
Prostate-specific membrane antigen (PSMA)
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED • USUAL SAMPLE
• Prostate
• Not widely used; levels increase normally with age
• Help diagnose• Blood
Prostatic acid phosphatase (PAP)
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED • USUAL SAMPLE
• Metastatic prostate cancer, myeloma, lung cancer
• Not widely used anymore; elevated in prostatitis and other conditions
• Help diagnose
• Blood
SERUM FERRITIN
• Ferritin – iron storage protein• Iron sequestration – ferroxidase- Fe2+ to Fe3+• Ferritin captures and buffers intracellular iron
pool• Normal – 50-200µg/L
• Low- <12 – iron depletion• Elevated : iron overload, acute inflammatory
conditions, liver disease, alcohol excess• Iron overload: primary: hemochromatosis,
wilson’s disease ; secondary: transfusion overload, excess dietary iron, PCT, ineffective erythropoiesis
High serum ferritin without iron overload
Liver disease (NASH), viral hepatitisAlcohol excess, chronic inflammatory conditions (RA/IBD)Bacterial infections, malignancyThyrotoxicosis Familial hyperferritinemia and cataract syndrome
• Acute phase reactant : inflammatory conditions
• ++ : increaded risk of MI and CAD• Prognostic marker : allogenic stem cell implant
THANK YOU
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