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C-reactive protein and neutrophil count laboratory test requests from primary care: what is the demand and would substitution by point-of-care technology be viable?
  1. José M Ordóñez-Mena1,2,
  2. Thomas R Fanshawe1,
  3. David McCartney1,
  4. Brian Shine3,
  5. Ann Van den Bruel1,4,
  6. Daniel Lasserson5,
  7. Gail Hayward1
  1. 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2 NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  3. 3 Biochemistry, Oxford University Hospitals, Oxford, UK
  4. 4 Academic Centre for Primary Care, KU Leuven, Leuven, Belgium
  5. 5 Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
  1. Correspondence to Dr José M Ordóñez-Mena, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; jose.ordonezmena{at}


Aims C-reactive protein (CRP) and neutrophil count (NC) are important diagnostic indicators of inflammation. Point-of-care (POC) technologies for these markers are available but rarely used in community settings in the UK. To inform the potential for POC tests, it is necessary to understand the demand for testing. We aimed to describe the frequency of CRP and NC test requests from primary care to central laboratory services, describe variability between practices and assess the relationship between the tests.

Methods We described the number of patients with either or both laboratory tests, and the volume of testing per individual and per practice, in a retrospective cohort of all adults in general practices in Oxfordshire, 2014–2016.

Results 372 017 CRP and 776 581 NC tests in 160 883 and 275 093 patients, respectively, were requested from 69 practices. CRP was tested mainly in combination with NC, while the latter was more often tested alone. The median (IQR) of CRP and NC tests/person tested was 1 (1–2) and 2 (1–3), respectively. The median (IQR) tests/practice/week was 36 (22–52) and 72 (50–108), and per 1000 persons registered/practice/week was 4 (3–5) and 8 (7–9), respectively. The median (IQR) CRP and NC concentrations were 2.7 (0.9–7.9) mg/dL and 4.1 (3.1–5.5)×109/L, respectively.

Conclusions The high demand for CRP and NC testing in the community, and the range of results falling within the reportable range for current POC technologies highlight the opportunity for laboratory testing to be supplemented by POC testing in general practice.

  • c-reactive protein
  • neutrophil count
  • inflammation
  • laboratory testing
  • primary care

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  • Handling editor Tahir S Pillay.

  • Contributors JMO-M, TRF, DMC, AVdB, DL and GH designed the study. BS and JMO-M acquired the data files, which were analysed by JMO-M under the supervision of TRF. JMO-M, TRF, DMC, BS, AVdB, DL and GH contributed to the writing of the manuscript.

  • Funding This article presents independent research funded by the National Institute for Health Research (NIHR) Medtech and In vitro diagnostics Co-operative (MIC) Oxford. The work of JMO-M is partly supported by the NIHR Biomedical Research Centre, Oxford.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.