Acute Phase reactants

Definition
Acute-phase proteins are a class of proteins whose plasma concentrations increase in response to inflammation. This response is called the acute-phase reaction (also called acute-phase response).

 In response to injury, local inflammatory cells (neutrophil granulocytes and macrophages) secrete a number of cytokines into the bloodstream, most of which are the interleukins IL-1, IL-6 and IL8, and TNF- . The liver responds by producing a large number of acute-phase reactants.

Clinical significance
Measurement of acute-phase proteins, especially C-reactive protein, is a useful marker of inflammation . It correlates with the erythrocyte sedimentation rate (ESR).

Erythrocyte sedimentation rate

The erythrocyte sedimentation rate (ESR), is the rate at which red blood cells precipitate in a period of 1 hour. It is a common hematology test that is a non-specific measure of inflammation. To perform the test, anticoagulated blood is placed in an upright tube, known as a Westergren tube, and the rate at which the red blood cells fall is measured and reported in mm/h.

Since the introduction of automated analyzers into the clinical laboratory, the ESR test has been automatically performed

 The ESR is increased by any cause or focus of inflammation. The ESR is increased in pregnancy or rheumatoid arthritis, and

decreased in polycythemia, sickle cell anemia, hereditary spherocytosis, and congestive heart failure.

Uses
It is useful for diagnosing diseases, such as various auto-immune diseases, systemic lupus erythematosus, rheumatoid arthritis, and chronic kidney diseases. In many of these cases, the ESR may exceed 100 mm/hour. It is commonly used for a differential diagnosis for Kawasaki's disease and it may be increased in some chronic infective conditions like tuberculosis and infective endocarditis. Used for assessment of severity of inflammatory bowel disease in children.

Normal level
Newborn: 0 to 2 mm/hr Neonatal to puberty: 3 to 13 mm/hr, but other laboratories place an upper limit of 20.

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