On Sun, 21 Feb 1999, Dogwood Ridge wrote: > Matt- This was a really interesting question that I did not know the answer > to. Did you get any private responses that you might share with us. Do > hemoglobinopathies such as SS cause such a discrepancy in CPR and ESR? > Thanks- Kim Burlingham, MD > -----Original Message----- > > >I've recently seen two children who have had ESRs greater than 100 while > >at the same time CRP levels within normal limits. Any thoughts? Kim, this certainly is a stumper. I did receive one post (not sure if it went to pedtalk general) noting the difference between the responsiveness of these two acute phase reactants. The point was that CRP falls much quicker than ESR would in the same patient, which theoretically could explain this finding. Another collegue mentioned that way back in the back of his mind he remembered this type of scenario is seen in pts with immunoglobulin elevations, e.g. multiple myeloma. I also noted that a recent NEJM article addresses this issue. The article is from Feb 11,199: Acute-phase Proteins and Other Systemic Responses to Inflammation. The upshot of the article is that different acute phase reactants are modulated by different cytokines, and therefore should not be expected to rise and fall in tandem. A heme-onc fellow friend of mine knows of no "classic" finding in this way for SS patients. "We never check, though," was his response. BTW, no new updates re: the patients' diagnoses, either. Thanks for your thoughts, Matt