CRP test results - any docs around to explain this?

On its own impossible to make any conclusion on.
I would just file that as normal and move on

Bad cat aids.

Bagsey your bikes.

I would just file that as normal and move on

yeah everything else was fine so not worried as such, more hoping that it was a sign all the things I’m doing to reduce my risk was paying off!

People overthink / over analyse their own individual blood results.  Labs may vary but my wife ran an accredited lab for several years and they are usually good at not reporting misleading results so if they quote 0.4 rather than say <5 then it will be HS CRP.  I wouldn’t expect it to say HS CRP on the results, the person who ordered the test knows what they asked for and why. Ultimately both measure CRP.

0-5 is the range for normal healthy population, so unless they suspected you were likely to be above 5 (eg infection etc) then HS CRP was probably the logical test to request/perform.  In some cases they may perform both and report only the relevant result.

Let the doctor do the thinking about the results though.

I work in an NHS lab, how come you've got your own blood results back? As far as the lab is concerned, the patient shouldn't see the lab results as there's often no interpretation that would make sense to the "man in the street," it's for the clinician to interpret and inform the patient. (Sorry everyone is entitled to see their record if they so wish.)

Edit - not meant to come across as an arsey post, genuinely intrigued how the stuff we do actually gets put out into the real world!

how come you’ve got your own blood results back?

I get mine via the NHS app on my phone, saves phoning the surgery for results etc...

richardkennerley - I think that mode of thinking is probably outdated.  As matrix says many patients have access to the data, and many clinicians think its actually useful for people to have access to data and be empowered about and involved in their clinical decision making.  After all, it was tpbiker's blood, it is tpbiker's personal data why wouldn't he be entitled to see it? Although not all clinicians would agree.

However, I did wonder after posting last night if this was a "thriva" type blood test by post?  I think those present a real headache for the NHS/clinicians.

I work in an NHS lab, how come you’ve got your own blood results back? As far as the lab is concerned, the patient shouldn’t see the lab results

I‘m surprised you’ve not heard about this-

https://www.england.nhs.uk/blog/patient-empowerment- through-online-access-to-gp-records-from-november/

The government have been trying to force this through against the wishes of the profession for some time. It is on hold again at the moment but some practices may have gone along with it. It will allow all results once filed to be viewed online by patients. Along with all letters from hospital, and of course everything I as a gp write in the notes.

I agree completely results need to be interpreted by the clinician that ordered them and explained to the patient in the context of the clinical scenario.
My sister was in hospital with pneumonia a few weeks back and had a follow up X-ray afterwards. The report was sent to her in the post rather than someone explaining it to her over the phone. It contained the words “medical red flag”. She was in bits until I made her ring the nurse in the pneumonia team who explained it was as expected for the stage she was at. Unfettered information without  expert interpretation can be harmful!

the patient shouldn’t see the lab results

I get hospital blood test results in the Apple Health app on my phone. Quite handy as my GP can't see them and the hospital doesn't provide any feedback so it's really up to me to decide whether I need to ask anyone about what they mean. Any blood tests done directly for the GP appear in my health record in the NHS app.

the patient shouldn’t see the lab results as there’s often no interpretation that would make sense to the “man in the street

After each individual result of whatever they have tested for in my blood the NHS app tells me want the expected "normal" range is. So I do get an idea if it is within the acceptable range.

My sister was in hospital with pneumonia a few weeks back and had a follow up X-ray afterwards. The report was sent to her in the post rather than someone explaining it to her over the phone. It contained the words “medical red flag”. She was in bits until I made her ring the nurse in the pneumonia team who explained it was as expected for the stage she was at. Unfettered information without  expert interpretation can be harmful!

but could of course be avoided by just remembering who the patient is and including them properly in their treatment plans / decisions etc.. or spending a little more care on composing the templates used for reporting knowing that the audience includes people other than the clinician who ordered it.

It comes down to communication. Seeing a number in an app is not communication.
of course in this day and age we need to let people have access to their records and results if they want it.

Not wanting to derail this thread and as it’s my birthday and I’m not at work I should really get off the internet and do something else, but the proposals I linked to to just “turn on” access for everyone is potentially really dangerous. What happens to the person in a coercive controlling relationship when their partner accesses their phone and sees that they have been to the gp and disclosed domestic violence?

The resource needed to do this properly for everyone in the country safely so that information doesn’t cause harm in so many different ways is immense. It’s just not possible at the moment but that didn’t stop nhs England/the govt trying to force it through.

I agree about those postal testing kits… no fee if we don’t find anything wrong- yeah right. One of the benefits of working in a deprived area is my parents don’t have money to waste in this rubbish.

edit- back to the OP. The labs at my local hospital don’t even offer high sensitivity crp. I didn’t even know it was an option, after 25 years as an nhs gp. Make of that what you will.

She was in bits until I made her ring the nurse in the pneumonia team who explained it was as expected for the stage she was at. Unfettered information without expert interpretation can be harmful!

Is that not because the whole concept of unfettered information is new to patients? People generally expect everything in their bodies to be totally perfect and nothing to be wrong, as they become better informed will they not start to learn, and importantly accept, that it is quite "normal" for not everything to one hundred percent perfect?

Is not an effective way to challenge over-anxiety about health to get people to accept that the body not functioning exactly as it is supposed to do all the time is quite normal?

Now I picked up on this as I previously got diagnosed with some furrying of the arteries and I’ve read a low Crp means a reduction in heart disease risk, and 0.4mg/l is very good*

I can probably chime in. I'm a doctor, not your doctor. Have worked on cardiovascular research involving risk and CRP levels.

There isn't really such a thing as 'low' CRP, but it clearly isn't pathologically raised. It's a fine result - and in the context of prevention of atherosclerotic disease is a Good Thing. I can't think of a clinical context in which a low/normal CRP might be bad news, but I'm not your doctor and there may be some context I'm missing. It's worth saying that this result, while completely satisfactory, doesn't speak of all the risk factors you may / may not also have so if you need treatment for E.g. high cholesterol then this test shouldn't change that.

Risk stratification via high CRP levels is very 'woolly', because there's 101 things that put your CRP up, and probably only a few of those contribute to cardiovascular risk. Moreover, CRP tends to correlate with established risk factors such as smoking, high BMI and diabetes. In a small subset of patients who don't have those risk factors, a chronically high CRP may indicate vascular inflammation which, in turn, increases the risk of cardiovascular 'events' (basically: strokes and heart attacks). There has been some work addressing risk in these patients via anti-inflammatory treatments, but it hasn't really caught on (yet?). The best way of preventing events in people with high CRP seems to be address the other risk factors appropriately (diet, exercise, smoking, statins).

Sorry. One last thing.

Obviously I could ask the doc, but I’m Not going to set up an appointment just to quiz him on my blood test results

This is the problem. The nhs is in such a shit state that patients go on mtb fora to ask about results of tests done (presumably, it’s not clear) by nhs doctors. I would much prefer my patients ask me about their results than resort to dr Google. Your doctor know why they asked for this test. No-one else does. Results in an app is (one of) the governments cut cost solution(s) to not enough staff in the nhs.

Ask the person who ordered the test what the results mean for you.

Now, I’ve got some jockey wheels to change, I’m off for a bit…

docrobster - a good point about unintended consequences with domestic violence cases but restricting access to some people because some other people may be at risk isn't a great idea either.  Here's two examples where restricting access and acting in the best interests of DV victims is not in everyone's interests:

- I'm in Scotland so we don't have a wonder App to see our data in.  Instead my GP practice orders blood tests and will call you if there is a problem.  They don't call you to say "everything was fine".  I understand that's a workload thing, but you are left wondering if the results ever came back, or the doctor missed them etc.  If you have the audacity to call them you get the "we would call you if there was a problem" attitude (obviously nobody ever made a mistake, and of course whatever I came to see you about has probably not sorted itself so I still need to make an appointment to discuss with the Dr what else it could be!).  Last time my daughter got a blood test they offered to text her the results directly.  Great, except they still only text if there is something abnormal, that was not explained, so you start to wonder - what if she gave them the wrong number or they mistyped it - perhaps the doctor is waiting for us to make an appointment to start treatment.   Its like the people that designed the same have never been anxiously waiting for a test result - of course they haven't, they're in the system!

- My wife was referred to maxillofacial surgeons.  The clinic she was sent to deals with a lot of "battered wives".  They operate a policy - widely promoted all around the waiting room that you are not permitted to bring anyone with you into the consultation room, no warning of this on the invitation letter etc.  My wife has an absolute pathological fear of dentists - like throws up before going for a routine check up fear, took our son once for a filling and I got a phone call to come and collect her because she passed out in the waiting room bad!  So I take her to maxillofacial (about a referral which would very clearly have been about a complicated dental issue that was not in any way linked to trauma).  They don't want me to come in to the appointment, "OK, come and get me when she throws up!".  She's not even made it out the waiting room before she's sheet white and wobbly and they relent.  Neither surgeon nor nurse were happy I was there, but relaxed once they actually started reading her notes / discussing case and realised this was a problem from childhood that has gone undetected not an angry husband.  You can ask my wife 6 years later what was discussed in that room.  She has absolutely zero recollection - although she did get posted a copy of the letter sent back to her dentist*.   Applying a rule which is almost certainly very sensible for DV victims certainly didn't help the "routine but highly stressed" patient. (* presumably if I was controlling DV partner I'd read her mail which undermines the entire point?).  She's supposed to go and see them every 2 years to monitor her issue - there's nothing been added to her notes etc to say "for god sake bring her husband in too - she's a fainter" so we go through this every time!

Thanks for the feedback folks

To clarify it was an nhs test, I went in originally as I had frothy pee and the doc seems to have tested quite a lot of stuff whilst he was at it (all within range, including my cholesterol)

@superficial

It’s a fine result

I think my question was more around how likely it was to be accurate if it’s not an hs Crp test. Obviously if it’s an hs Crp test it’s a great result. If it’s a standard Crp test then my understanding would be that it’s far too insensitive to be accurate to that level so basically an irrelevant result (although nothing to be concerned about )

Poly’s answer last night suggests it could well have been an hs Crp test, which would be a positive for my heart health given my cholesterol is also well in check

Yeah I don't know enough about the ins and outs of whatever lab assay your local centre is using, but the fact that they've reported <0.4ng/ml does suggest to me it might be a high-sensitivity test. But I'm guessing. They're testing for the same molecule, it's only the test that's said to be more accurate.

Our hospital reports CRP (presumably a non-HS assay) as a minimum of <3.0 ng/mL. We can request HS-CRP separately but I gather it's prohibitively expensive currently.

Speak to your doc about (all) the results. Either way, unless you get a positive (high) result it's not really giving you any meaningful information so I don't think it's really worth too much of your brain time. Think of it like going to the GP and discovering that your BP is not sky-high.

@poly

re results and feeding back to patients… well that’s something we have discussed in my practice as long as I can remember. I try to ask people if they want to know the results and will usually send a text even if it’s just to say everything normal. But most results in a gp practice don’t come from an appointment with a gp. Most are routine monitoring type bloods. These are generally filed by the nurses if and only looked at by gps if not. We just don’t have the capacity to contact every patient who has a normal blood result. And don’t get me started on the ones we have to file that were orders by someone at the hospital…

re the max fax clinic. I agree it seems heavy handed. Would be better to have individualised care especially for patients already known to the clinic. One rule for all is seldom the best idea

Think of it like going to the GP and discovering that your BP is not sky-high.

love this!

how likely it was to be accurate if it’s not an hs Crp test

(IANAD but) My work's infection-related so we generally don't care about CRPs that low - not even sure my hospital does 'em but I guess cardiology might be more interested

The general approach to pretty much all results from our labs though is that anything with a "<" or ">" in it means that they've reached the limits of verifiable detection and so can't (or at least shouldn't) report below/above that