Faecal haemoglobin: Measurement, applications, and future potential

Fraser, Callum G.

doi:10.1016/j.bpg.2023.101833

Cited by 3 publications

(1 citation statement)

References 83 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Missing data for IDA and SII may also have affected the results of the model, although to a lesser extent since more than 75% of patients had FBC data available. A further caveat is that numerical f‐Hb results vary between different FIT systems and therefore the risk score thresholds stated in this study may not be transferable [36, 37]. Data on the use of oral anticoagulants or nonsteroidal anti‐inflammatory drugs (NSAIDs), which may stimulate bleeding from colonic lesions and therefore potentially act as a confounder to elevated f‐Hb, were not available.…”

Section: Discussionmentioning

confidence: 99%

Do risk scores improve use of faecal immunochemical testing for haemoglobin in symptomatic patients in primary care?

Digby,

Fraser,

Clark

et al. 2024

Colorectal Disease

Self Cite

View full text Add to dashboard Cite

AimFaecal immunochemical testing (FIT) is used in the detection of colorectal cancer (CRC). FIT is invariably used at a single faecal haemoglobin (f‐Hb) concentration threshold. The aim of this observational study was to explore risk scoring models (RSMs) with f‐Hb and other risk factors for CRC in symptomatic patients attending primary care, potentially speeding diagnosis and saving endoscopy resources.MethodRecords of patients completing FIT were linked with The Scottish Cancer Registry and with other databases with symptoms, full blood count and demographic variables, and randomized into derivation and validation cohorts. Stepwise multivariable logistic regression created RSMs assessed in the validation cohort.ResultsOf 18 805 unique patients, 9374 and 9431 were in the derivation and validation cohorts, respectively: f‐Hb, male sex, increasing age, iron deficiency anaemia and raised systemic immune inflammation index created the final RSM. A risk score threshold of ≥2.363, generating the same number of colonoscopies as a f‐Hb threshold of ≥10 μg Hb/g gave improved sensitivity for CRC in both cohorts. A RSM which excluded f‐Hb was used to investigate the effect of raising the f‐Hb threshold from ≥10 to ≥20 μg Hb/g in those with a low risk score. This approach would have generated 234 fewer colonoscopies but missed four CRCs.ConclusionThe RSM conferred no significant benefit to patients with very low f‐Hb and CRC. Alternative strategies combining FIT with other variables may be more appropriate for safety‐netting of symptomatic patients. Further work to develop and investigate the value of RSM for significant bowel disease other than CRC may also be beneficial.

show abstract

Section: Discussionmentioning

confidence: 99%

Do risk scores improve use of faecal immunochemical testing for haemoglobin in symptomatic patients in primary care?

Digby,

Fraser,

Clark

et al. 2024

Colorectal Disease

Self Cite

View full text Add to dashboard Cite

show abstract

Colorectal cancer: From prevention to treatment

Cubiella,

Regueiro-Expósito

2023

Best Practice & Research Clinical Gastroenterology

View full text Add to dashboard Cite

Colorimetric correcting for sample concentration in stool samples

Delanghe,

Van Elslande,

Godefroid

et al. 2024

Clinical Chemistry and Laboratory Medicine (CCLM)

View full text Add to dashboard Cite

Objectives Fecal immunochemical tests (FIT) for hemoglobin are currently considered the screening investigation of choice for colorectal cancer and are worldwide recommended. Similarly, fecal calprotectin is a widely used test for monitoring intestinal inflammation. The pre-analytical issues regarding stool samples have hardly been dealt with and are difficult to solve. Currently, there are no reference analytes available which allow to correct test results for the variable water content of the stool sample. Studies on preanalytics of stool samples have generally focused on sample preparation and sample storage, but generally have paid little attention to the variability in sample hydration and sample composition. Methods Stercobilin is a stable heme metabolite which is abundant in stool. Stercobilin concentration can be simply assayed in stool extracts using colorimetry (determination of the I index). Serum indices (H, I and L) and bilirubin concentration of fecal extracts were determined on a Atellica Platform (Siemens). Results The inter-individual variation of stercobilin was found to be high. Assaying stercobilin allows to correct for stool sample dilution. The median value of the I-index was used as a reference for correcting the data. Correcting fecal blood results for sample dilution resulted in a significant increase in positive tests (from 9.3 to 11.7 %). For calprotectin, correction resulted in 3.1 % extra positive results and 7.7 % negative results. Conclusions Except in the case of obstructive jaundice, this correction can be applied. Correcting test results of common fecal analytes like FIT and calprotectin may result in a better tailored test interpretation.

show abstract

Faecal haemoglobin: Measurement, applications, and future potential

Cited by 3 publications

References 83 publications

Do risk scores improve use of faecal immunochemical testing for haemoglobin in symptomatic patients in primary care?

Do risk scores improve use of faecal immunochemical testing for haemoglobin in symptomatic patients in primary care?

Colorectal cancer: From prevention to treatment

Colorimetric correcting for sample concentration in stool samples

Contact Info

Product

Resources

About