Geri Pt. Elevated CRP, normal ESR

[sazz9]

Hey all.
Getting pimped out on this right now by my attending and for the life of me I can not figure out what he is looking for.

Pt is 70yo WF with DM2. CAme in feeling "horrible" (very vague with explanation), review of systems normal, PE normal. Labs showed elevated CRP at 15, normal ESR, normal CBC/CMP.

He is asking me why he chose to do both the CRP and ESR for this patient, why the CRP was high and ESR was not, and what is the next step.... (PS. we are in an Outpatient IM clinic)

ANy help!!??

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[qwaszx69]

CRP generally goes up quicker than ESR.. maybe that has to do with it?

 

[jdh71]

It's aids.

Clearly.

Tell him that patient has aids and you want a stat viral load.

 

[obiwan]

so does he always check esr/crp for all patients who feel like s**t?

 

[drfunktacular]

Tell your attending he is over-relying on very non-specific tests if he thinks that one or the other being high is indicative of anything at all absent other, more specific clinical findings (GCA symptoms, for example: headache, jaw claudication, polymyalgia rheumatica, etc)

He is probably thinking something along the lines of what qwaszx69 mentioned... ESR is "supposed" to reflect more chronic inflammation while CRP is "supposed" to reflect more acute inflammation. But in general I find this distinction to be completely bogus and without any clinical applicability... and I order and interpret a LOT of ESR/CRP's every week.