05403278001V5.

CRPLX
C-reactive protein (latex)
Order information
Analyzer(s) on which kit(s) can be used
05401615 190 C-reactive protein (latex) (2 × 100 tests) cobas c 111
11355279 216 C.f.a.s. Proteins (5 × 1 mL) Code 656
11355279 160 C.f.a.s. Proteins (5 × 1 mL, for USA) Code 656
10557897 122 Precinorm Protein (3 × 1 mL) Code 302
10557897 160 Precinorm Protein (3 × 1 mL, for USA) Code 302
11333127 122 Precipath Protein (3 × 1 mL) Code 303
11333127 160 Precipath Protein (3 × 1 mL, for USA) Code 303
05117003 190 PreciControl ClinChem Multi 1 (20 × 5 mL) Code 391
05947626 190 PreciControl ClinChem Multi 1 (4 × 5 mL) Code 391
05947626 160 PreciControl ClinChem Multi 1 (4 × 5 mL, for USA) Code 391
05117216 190 PreciControl ClinChem Multi 2 (20 × 5 mL) Code 392
05947774 190 PreciControl ClinChem Multi 2 (4 × 5 mL) Code 392
05947774 160 PreciControl ClinChem Multi 2 (4 × 5 mL, for USA) Code 392
04774230 190 NaCl Diluent 9 % Code 951
11930630 001 Chimneys

English
System information
CRPLX: ACN 019
Intended use
In vitro test for the quantitative determination of C-reactive protein in human
serum and plasma on the cobas c 111 system.
Summary1,2
Most tissue-damaging processes such as infections, inflammatory diseases
and malignant neoplasms are associated with a major acute phase
response of the C‑reactive protein (CRP) and other acute phase reactants
(e.g. AAT, AAGP, C3C, C4, HAPT). The CRP response frequently precedes
clinical symptoms, including fever. In normal healthy individuals CRP is a
trace protein with a range up to 5 mg/L. After onset of an acute phase
response the serum CRP concentration rises rapidly and extensively.
Alterations are detectable within 6 to 8 hours and the peak value is reached
within 24 to 48 hours. Levels of up to thousandfold the normal value are
associated with severe stimuli such as myocardial infarction, major trauma,
surgery, or malignant neoplasms. CRP activates the classical complement
pathway. CRP has a half-life of only a few hours, making it an ideal tool for
clinical monitoring. Postoperative monitoring of CRP levels of patients
indicates either the normal recovery process (decreasing levels to normal)
or unexpected complications (persisting high levels). Measuring changes in
the concentration of CRP provides useful diagnostic information about how
acute and how serious a disease is. It also allows the assessment of
complications during the disease and judgements about the disease
genesis. Persistence of a high serum CRP concentration is usually a grave
prognostic sign which generally indicates the presence of an uncontrolled
infection. CRP determination may replace the classical determination of
Erythrocytes Sedimentation Rate (ESR), due to its prompt response to
changes in disease activity and its good correlation to ESR.
Test principle3,4,5
Particle enhanced turbidimetric assay
Human CRP agglutinates with latex particles coated with monoclonal anti-
CRP antibodies. The precipitate is determined turbidimetrically.
Reagents - working solutions
R1 TRIS buffer with bovine serum albumin and immunoglobulins
(mouse); preservative
SR Latex particles coated with anti-CRP (mouse) in glycine buffer;
preservative
Precautions and warnings
For in vitro diagnostic use.
Exercise the normal precautions required for handling all laboratory
reagents.
Disposal of all waste material should be in accordance with local guidelines.
Safety data sheet available for professional user on request.
For USA: For prescription use only.
Reagent handling
R1 Ready for use.
SR Ready for use.
Carefully invert reagent bottle several times prior to use to
ensure that the reagent components are mixed. Avoid the
formation of foam.
Under conditions of extreme humidity, condensation may lead to a dilution
of the reagent that affects the measurements. Hence under environmental
conditions in which temperature and humidity are equal to, or in excess of
25 °C/80 %, 28 °C/70 %, 30 °C/60 % or 32 °C/55 % a chimney
(Cat. No. 11930630 001) should be used to reduce the condensation rate.
Place a white chimney in R1 and a black chimney in SR. The chimneys can
be reused for reagent bottles within the same kit. However, to avoid
contamination of the reagent with detergent or dilution of the reagent with
water it is not permitted to wash the chimneys before reuse.
Storage and stability
CRPLX
Shelf life at 2‑8 °C: See expiration date
on reagent
On-board in use and refrigerated on the analyzer: 5 weeks
NaCl Diluent 9 %
Shelf life at 2‑8 °C: See expiration date
on reagent
On-board in use and refrigerated on the analyzer: 4 weeks
Specimen collection and preparation
For specimen collection and preparation only use suitable tubes or
collection containers.
Only the specimens listed below were tested and found acceptable.
Serum: Separate immediately from clot and analyze promptly.
Plasma: Li-heparin, K3-EDTA plasma.
The sample types listed were tested with a selection of sample collection
tubes that were commercially available at the time of testing, i.e. not all
available tubes of all manufacturers were tested. Sample collection systems
from various manufacturers may contain differing materials which could
affect the test results in some cases. When processing samples in primary
tubes (sample collection systems), follow the instructions of the tube
manufacturer.

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CRPLX
C-reactive protein (latex)

Centrifuge samples containing precipitates before performing the assay. Calculation

The cobas c 111 analyzer automatically calculates the analyte
Stability:6 11 days at 15‑25 °C concentration of each sample.
2 months at 2‑8 °C
Conversion factors: mg/L × 9.52 = nmol/L mg/dL × 95.2 = nmol/L
3 years at (‑15)‑(‑25) °C
mg/L × 0.1 = mg/dL mg/dL × 10 = mg/L
Materials provided mg/dL × 0.01 = g/L g/L × 100 = mg/dL
See “Reagents – working solutions” section for reagents.
Limitations - interference
Materials required (but not provided)
Criterion: Recovery within ± 10 % of initial value at a CRP concentration of
See “Order information” section < 5 mg/L (MDL).
General laboratory equipment Icterus:8 No significant interference up to an I index of 55 for conjugated
Assay bilirubin and 60 for unconjugated bilirubin (approximate conjugated bilirubin
For optimum performance of the assay follow the directions given in this concentration: 941 µmol/L or 55 mg/dL; approximate unconjugated bilirubin
document for the analyzer concerned. Refer to the appropriate operator’s concentration: 1026 µmol/L or 60 mg/dL).
manual for analyzer‑specific assay instructions. Hemolysis:8 No significant interference up to an H index of 700
The performance of applications not validated by Roche is not warranted (approximate hemoglobin concentration: 435 µmol/L or 700 mg/dL).
and must be defined by the user. Lipemia (Intralipid):8 No significant interference up to an L index of 700.
There is poor correlation between the L index (corresponds to turbidity) and
Application for serum and plasma triglycerides concentration.
cobas c 111 test definition Drugs: No interference was found at therapeutic concentrations using
common drug panels.9,10 Exception: Significantly decreased CRP values
Measuring mode Absorbance may be obtained from samples taken from patients who have been treated
Abs. calculation mode Kinetic with carboxypenicillins.
Reaction direction Increase Rheumatoid factors up to 1200 IU/mL do not interfere.
High dose hook‑effect: No false result occurs up to a CRP concentration of
Wavelength A 552 nm 3100 mg/L.
Calc. first/last 17/25 In very rare cases, gammopathy, in particular type IgM (Waldenström’s
Antigen excess check No macroglobulinemia), may cause unreliable results.11
For diagnostic purposes, the results should always be assessed in
Unit mg/L conjunction with the patient’s medical history, clinical examination and other
Reaction mode R1-S-SR findings.
ACTION REQUIRED
Pipetting parameters Special Wash Programming: The use of special wash steps is mandatory
Diluent (H2O) when certain test combinations are run together on the cobas c 111
analyzer. For information about test combinations requiring special wash
R1 82 µL 48 µL steps, please refer to the latest version of the carry over evasion list found
with the CLEAN Method Sheet and the operator’s manual for further
Sample 2.5 µL 30 µL instructions.
SR 28 µL 14 µL Where required, special wash/carry-over evasion programming must
be implemented prior to reporting results with this test.
Total volume 204.5 µL
Limits and ranges
Calibration Measuring range
Calibrator Calibrator f.a.s. Proteins 1‑200 mg/L (0.1‑20 mg/dL)
Calibration dilution ratio 1:0.5, 1:1, 1:1.5, 1:2.86, 1:10 and 0 mg/L Determine samples having higher concentrations via the rerun function.
Dilution of samples via the rerun function is a 1:10 dilution. Results from
performed automatically by the instrument. samples diluted using the rerun function are automatically multiplied by a
Deionized water is used automatically by the factor of 10.
instrument as the zero calibrator. Lower limits of measurement
Calibration mode Linear interpolation Lower detection limit of the test:
1.0 mg/L (0.1 mg/dL)
Calibration interval Each lot and as required following quality control
procedures The lower detection limit represents the lowest measurable analyte level
that can be distinguished from zero. It is calculated as the value lying
Enter the assigned lot-specific CRP value for all 6 calibrator points indicated 3 standard deviations above that of the lowest standard (standard 1 + 3 SD,
in the package insert for Calibrator f.a.s. Proteins. repeatability, n = 21).
Traceability: This method has been standardized against the reference Expected values
preparation of the IRMM (Institute for Reference Materials and
Measurements) BCR470/CRM470 (RPPHS - Reference Preparation for Adults12 < 5 mg/L (< 0.5 mg/dL)
Proteins in Human Serum).7
Newborns13 0 days < 0.6 mg/L (< 0.06 mg/dL)
Quality control 1 day < 3.2 mg/L (< 0.32 mg/dL)
For quality control, use control materials as listed in the “Order information” 1 week < 1.6 mg/L (< 0.16 mg/dL)
section. In addition, other suitable control material can be used.
Roche has not evaluated reference ranges in a pediatric population.
The control intervals and limits should be adapted to each laboratory’s
individual requirements. Values obtained should fall within the defined Each laboratory should investigate the transferability of the expected values
limits. Each laboratory should establish corrective measures to be taken if to its own patient population and if necessary determine its own reference
values fall outside the defined limits. ranges.
Follow the applicable government regulations and local guidelines for
quality control.

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C-reactive protein (latex)

Specific performance data 11 Bakker AJ, Mücke M. Gammopathy interference in clinical chemistry
Representative performance data on the cobas c 111 analyzer are given assays: mechanisms, detection and prevention.
below. Results obtained in individual laboratories may differ. Clin Chem Lab Med 2007;45(9):1240-1243.
Precision 12 Schumann G, Dati F. Vorläufige Referenzbereiche für 14 Proteine im
Serum (für Erwachsene) nach Standardisierung immunchemischer
Precision was determined using human samples and controls in an internal Methoden unter Bezug auf das internationale Referenzmaterial CRM
protocol with repeatability (n = 21) and intermediate precision (3 aliquots 470. Lab Med 1995;19:401-403.
per run, 1 run per day, 10 days). The following results were obtained:
13 Schlebusch H, Liappis N, Kalina E, et al. High Sensitive CRP and
Repeatability Mean SD CV Creatinine: Reference Intervals from Infancy to Childhood. J Lab Med
mg/L (mg/dL) mg/L (mg/dL) % 2002;26:341-346.
Precinorm Protein 18.3 (1.83) 0.2 (0.02) 0.8 14 Bablok W, Passing H, Bender R, et al. A general regression procedure
for method transformation. Application of linear regression procedures
Precipath Protein 37.7 (3.77) 0.2 (0.02) 0.6 for method comparison studies in clinical chemistry, Part III. J Clin
Human serum 1 4.2 (0.42) 0.1 (0.01) 2.0 Chem Clin Biochem 1988 Nov;26(11):783-790.
A point (period/stop) is always used in this Method Sheet as the decimal
Human serum 2 23.4 (2.34) 0.3 (0.03) 1.3 separator to mark the border between the integral and the fractional parts of
a decimal numeral. Separators for thousands are not used.
Intermediate precision Mean SD CV
mg/L (mg/dL) mg/L (mg/dL) % Symbols
Roche Diagnostics uses the following symbols and signs in addition to
Precinorm Protein 18.6 (1.86) 0.4 (0.04) 2.1 those listed in the ISO 15223‑1 standard.
Precipath Protein 38.4 (3.84) 0.6 (0.06) 1.6
Contents of kit
Human serum 1 4.7 (0.47) 0.1 (0.01) 2.7
Reagent
Human serum 2 23.3 (2.33) 0.6 (0.06) 2.6
Volume after reconstitution or mixing
Method comparison
GTIN Global Trade Item Number
CRP values for human serum and plasma samples obtained on the
cobas c 111 analyzer using the Roche CRPLX reagent (y) were compared
with those determined using the same reagent on a COBAS INTEGRA 400 FOR US CUSTOMERS ONLY: LIMITED WARRANTY
analyzer (x). Roche Diagnostics warrants that this product will meet the specifications
Sample size (n) = 63 stated in the labeling when used in accordance with such labeling and will
be free from defects in material and workmanship until the expiration date
Passing/Bablok14 Linear regression printed on the label. THIS LIMITED WARRANTY IS IN LIEU OF ANY
y = 0.995x + 1.33 mg/L y = 0.975x + 2.86 mg/L OTHER WARRANTY, EXPRESS OR IMPLIED, INCLUDING ANY IMPLIED
WARRANTY OF MERCHANTABILITY OR FITNESS FOR PARTICULAR
τ = 0.970 r = 0.997
PURPOSE. IN NO EVENT SHALL ROCHE DIAGNOSTICS BE LIABLE
The sample concentrations were between 1.0 and 185 mg/L (0.1 and FOR INCIDENTAL, INDIRECT, SPECIAL OR CONSEQUENTIAL
18.5 mg/dL). DAMAGES.
References COBAS, COBAS C, COBAS INTEGRA, PRECINORM, PRECIPATH and PRECICONTROL are trademarks of
Roche.
1 Pepys MB, Baltz MC. Acute phase proteins with special reference to C- All other product names and trademarks are the property of their respective owners.
reactive protein and related proteins (pentaxins) and serum amyloid A Significant additions or changes are indicated by a change bar in the margin.
protein Adv Immunol 1983;34:141-212.
© 2014, Roche Diagnostics
2 Bowman BH. In: Hepatic Plasma Proteins. San Diego: Academic Press
1993:47-95.
3 Senju O, Takagi Y, Gomi K, et al. The quantitative determination of
CRP by latex agglutination photometric assay. Jap J Clin Lab Roche Diagnostics GmbH, Sandhofer Strasse 116, D-68305 Mannheim
Automation 1983;8:161-165. www.roche.com
Distribution in USA by:
4 Price CP, Trull AK, Berry D, et al. Development and validation of a Roche Diagnostics, Indianapolis, IN
particle-enhanced turbidimetric immunoassay for C-reactive protein. J US Customer Technical Support 1-800-428-2336
Immunol Methods 1987;99:205-211.
5 Eda S, Kaufmann J, Roos W, et al. Development of a New
Microparticle-Enhanced Turbidimetric Assay for C-reactive Protein with
Superior Features in Analytical Sensitivity and Dynamic Range. J Clin
Lab Anal 1998;12:137-144.
6 Use of Anticoagulants in Diagnostic Laboratory Investigations. WHO
Publication WHO/DIL/LAB/99.1 Rev. 2: Jan 2002.
7 Johnson AM. A new international reference preparation for proteins in
human serum. Arch Pathol Lab Med 1993;117:29-31.
8 Glick MR, Ryder KW, Jackson SA. Graphical Comparisons of
Interferences in Clinical Chemistry Instrumentation.
Clin Chem 1986;32:470-475.
9 Breuer J. Report on the Symposium “Drug effects in Clinical Chemistry
Methods”. Eur J Clin Chem Clin Biochem 1996;34:385-386.
10 Sonntag O, Scholer A. Drug interference in clinical chemistry:
recommendation of drugs and their concentrations to be used in drug
interference studies. Ann Clin Biochem 2001;38:376-385.

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