PATHOLOGY
“By helping us to enable local triaging with true POCT, the analysers will beneficially change patient flow across Cornwall. Having these POC analysers during the COVID-19 pandemic will help keep people safe and, by not exposing them to unnecessary risk, we can keep beds available for those who truly need them.”
How POC CRP haematology helps The new POC CRP haematology analysers were originally planned in time for the ‘winter flu’ season in order to improve patient experience and access to pathology testing across the winter. This is because CRP is a common blood test used to support a wide range of clinical decision making, but it is particularly used as a proxy indicator for the presence or absence of bacterial infection. When combined with full blood cell count with white blood cell differentiation CRP can aid the distinction between bacterial and viral illnesses.
A range of factors are used to indicate the presence of bacterial infection, with sepsis, or systemic inflammatory response syndrome (SIRS), traditionally diagnosed based on the occurrence of physiological features such as abnormal body temperature, heart and respiration rate. Blood analysis can also be used as a secondary index to indicate SIRS, with an abnormal white blood cell (WBC) count being a clear indicator. However, CRP is also used as a biomarker to enhance this blood analysis.
Early marker of inflammation As it is secreted by the liver in response to a variety of inflammatory cytokines, levels of
results have been shown to be medically comparable.1
In cases where the CRP level
is only marginally raised, differentiating a viral and bacterial infection can be difficult. Narrowing this grey area by combining CRP with a differential WBC provides more powerful information in order to better guide the decision as to whether or not a patient needs antibiotics (Fig. 3). With CRP’s short half-life, its measurement on an ongoing basis can also be used for progressively monitoring the effectiveness of each treatment regime.
Figure 2: CRP is one of the earliest markers of inflammation or infection in blood, enabling early stage detection and treatment.
CRP in blood provide a significant indicator of inflammation, proving highly useful to guide clinical decisions, particularly as SIRS is indicated if it is present at >2.0 mg/ dl. CRP is one of the earliest markers of inflammation or infection in blood, as shown in Figure 2; a sharp increase in levels is seen almost immediately after the onset of inflammation. Therefore, measuring CRP levels enables early stage determination of treatment, it also presents a definite and dynamic indicator throughout the first week of infection.
The efficacy of combined CRP and WBC
CRP testing is normally performed in the hospital laboratory, and once received there, time to results can take up to 90 minutes. However, the time from needle to result can take considerably longer depending on patient and laboratory locations, as well as road systems which can prove challenging in places such as Cornwall. It is vital to be able to quickly exclude bacterial infections and sepsis in POC clinics, as well as emergency care, in order to obtain swift diagnosis and determination of disease severity for appropriate therapy and patient pathway decisions. In turn, this can also support antimicrobial stewardship, aiding cost savings by reducing antibiotic usage2
as well
as addressing antimicrobial resistance (AMR) challenges.
Fast clinical decisions Being able to carry out CRP and blood cell analyses at the point when triage or treatment decisions are made is ideal. With the surprisingly fast progression of bacterial infections, the ability to make rapid clinical decisions based on laboratory quality diagnostics undertaken at the point-of-care is highly beneficial. Consequently, the Microsemi CRP has been specifically designed to deliver both CRP and haematology tests at the POC and validated for this purpose. The analyser requires just 18 µL of whole blood for the simultaneous measurement of full blood count, including three-part differential, and CRP within four minutes. Validation studies have confirmed that the instrument demonstrates excellent correlation for FBC, differential and CRP when compared to routine laboratory methods. CRP correlation has been shown to be exceptional at 0.996 and it has also been observed that as the analyser’s three level whole blood control integrates CRP, this avoids the need for two separate controls.3
Furthermore, the study confirmed
Figure 3: Treatment decision made depends on the clinical picture, WBC count and risk factors
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the Microsemi CRP’s suitability for use in Primary and Secondary Care, as well as paediatric settings due to its requirement for such a small volume blood sample. The analyser also incorporates a number of additional features, important for POCT when integrating into primary care units for
OCTOBER 2020
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