Faecal calprotectin can be raised in blood containing stool. In the laboratory setting, >=5% of whole blood in stool (by weight) has been found to noticeably increase calprotectin. However, for individual clinical samples, the degree of blood contamination, and thus the degree of interference, cannot be easily ascertained. Unless there is gross blood contamination, the magnitude of calprotectin rise is not expected to be more than 30%.
A. For diagnosis of inflammatory bowel diseases
:
ADULTS
Faecal calprotectin test helps to differentiate inflammatory bowel disease (IBD) from irritable bowel syndrome with lower gastrointestinal symptoms more than 6 weeks duration when specialist referral is being considered. Testing those with less than 6 weeks symptoms has a poorer specificity for IBD. It is not the test of choice for colon cancer. It cannot distinguish ulcerative colitis from Crohns disease
.
CHILDREN
Faecal calprotectin helps to differentiate inflammatory bowel disease from non-inflammatory bowel disease who have been referred to specialists for investigation.
In children less than 4 years old there is significant overlap of normal children with those having different paediatric gastrointestinal pathologies, rendering a positive test (greater than 50 ug/g) very nonspecific especially if the result falls within that crude age related range. Suggest interpret the result with caution.
|
Age
|
Faecal calcprotectin level in healthy children
|
|
Less than 6 months
|
Faecal calprotectin >250ug/g is not uncommonly encountered in healthy neonates/young infants.
However, the upper limit that can be attained in these children from the new Liaison XL method can only be established after sufficient data is available.
For serial monitoring, re-baselining may be required using the new method. Any queries please contact on call Chemical Pathologist at Labplus lablink 09-3074949 ext 22000 or e-mail :
ChemicalPathologist@adhb.govt.nz
.
|
|
6 months to 2 years
|
Up to 500 ug/g can occur in healthy infants / children
|
|
2 to 4 years
|
Up to 250 ug/g can occur in healthy children
|
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4 to 17 years
|
Up to 100 ug/g can occur in healthy children. Levels up to 250 ug/g can occur in various inflammatory bowel conditions.
Levels greater than 250 ug/g have high specificity for IBD
|
B. For monitoring and management of inflammatory bowel diseases
:
Mucosal healing (MH)
has been proposed as a better marker than clinical indexes to indicate controlled IBD. It is associated with sustained clinical remission, reduced hospitalisation and surgical resection.
Faecal calprotectin level correlates well with mucosal disease activity and is able to detect mucosal inflammation in otherwise clinically quiescent IBD.
In Crohns disease, the correlation is better for colonic than ileal disease. Faecal calprotectin at low level better reflects post-treatment disease response in adults than children.
Faecal calprotectin has the potential as a non-invasive surrogate marker for mucosal healing and may identify those at risk for IBD relapse. However, supportive data is emerging, not yet conclusive. At this stage, it is also unclear if faecal calprotectin guided management protocol will impart any additional advantage in long term disease outcome.
From 7/12/16 the method for testing faecal calprotectin has changed to Liaison XL. Samples which previously had levels above 500ug/g are likely to have lower values when tested by this new method. The magnitude of reduction is variable but can be up to 50% or more in certain samples. For serial monitoring, re-baselining may be required using the new method. Any queries please contact on call Chemical Pathologist at Labplus lablink 09-3074949 ext 22000 or e-mail :
ChemicalPathologist@adhb.govt.nz
.
References:
Burri E, Beglinger C. Faecal calprotectin ? a useful tool in the management of inflammatory bowel disease.
Swiss Medical Weekly 2012; 142:w13557.
Henderson
P, Anderson NH, Wilson DC. The diagnostic accuracy of fecal calprotectin during the investigation of suspected pediatric inflammatory bowel disease: a systematic review and meta-analysis. Am J Gastroenterology 2013
May 14. doi: 10.1038/ajg.2013.131.
Henderson
P, Casey A et al. The diagnostic accuracy of fecal calprotectin during the investigation of suspected pediatric inflammatory bowel disease.
Am J Ga
stroenterology 2012; 107 (6): 941-949
NICE diagnostics guidance (
www.nice.org.uk/dg11
).
Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel (issued October 2013)
Smith LA, Gaya DR. Utility of faecal calprotectin analysis in adult inflammatory bowel disease. World Journal of Gastroenterology 2012; 18(46): 6782-6789
Van Rheenen PF et al. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ 2010; 341:c3369
Emails to
chemicalpathologist@adhb.govt.nz
will receive priority attention from the on-call chemical pathologist.
If the query concerns a specific patient please include the NHI number in your email.
If email is not a suitable option, please contact the on-call chemical pathologist via
Lablink (Auckland City Hospital ext. 22000 or 09-3078995).
Individual chemical pathologists may be contacted but will not be available at all times.
After-hours
: contact
Lablink (Auckland City Hospital ext. 22000 or 09-3078995) or hospital operator for on duty staff after hours.
Dr Samarina Musaad
(Clinical Lead)
:
SamarinaM@adhb.govt.nz
ext. 22402
Dr Cam Kyle:
CampbellK@adhb.govt.nz
ext 22052
Dr Weldon Chiu:
WeldonC@adhb.govt.nz
ext. 23427
Dr Campbell Heron:
CHeron@adhb.govt.nz
ext. 23427
Dr Sakunthala Jayasinghe:
Sakunthala@adhb.govt.nz
ext. 23427