2. 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
3. Activation of complement – classical pathway IL6, IL1, TNFα
Helps in opsonisation
Glucocorticoids ++
Insulin --
5. 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
6. 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
7. 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
8. • CRP: 0.7 – 0.9: 22 wk till delivery, 1.3: onset of
labor
• Higher levels – 1st TM, early 2nd TM: preterm
delivery
9. TUMOR MARKERS
Biomolecules secreted by cancer cells – diagnosis,
treatment response, early recognition of recurrence
Oncofetal antigens: AFP, CEA
Tumor associated antigen: CA125, CA 19-9, CA 15-3,
CA72-4
Hormones: beta-HCG, PSA, calcitonin
Enzymes: LDH, PAP, NSE, PLAP, TDT
Serum and tissue proteins: beta-2 microglobulin, GFAP,
ferritin, FDP
10. 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
11. B2M (Beta-2 microglobulin)
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED
• USUAL SAMPLE
• Multiple myeloma
and lymphomas
• Crohn's disease and
hepatitis
• Determine prognosis
• Blood
12. 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
13. 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
14. 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
15. Calcitonin
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED
• USUAL SAMPLE
• Thyroid medullary
carcinoma
• pernicious anemia and
thyroiditis
• Help diagnose, monitor
treatment, and
determine recurrence
• Blood
16. 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
17. 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
18. Estrogen receptors
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED
• USUAL SAMPLE
• Breast
• Increased in hormone-
dependent cancer
• Determine prognosis
and guide treatment
• tissue
19. 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
20. 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
21. 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
22. Progesterone receptors
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED
• USUAL SAMPLE
• Breast
• Increased in hormone-
dependent cancer
• Determine prognosis
and guide treatment
• Tissue
23. 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
24. Thyroglobulin
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED
• USUAL SAMPLE
• Thyroid
• Used after thyroid is
removed to evaluate
treatment
• Determine recurrence
• Blood
25. 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
26. 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
27. 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
28. NMP22 (nuclear matrix protein)
• CANCERS
• WHAT ELSE?
• WHEN/HOW USED
• USUAL SAMPLE
• Bladder
• Not widely used
• Help diagnose and
determine recurrence
• Urine
29. 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
30. 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
31. SERUM FERRITIN
• Ferritin – iron storage protein
• Iron sequestration – ferroxidase- Fe2+ to Fe3+
• Ferritin captures and buffers intracellular iron
pool
• Normal – 50-200µg/L
