Calprotectin (Now available to GPs)

Blood Sciences Test

Specimen

Faeces

Please ensure that stool samples are not over-filled, nor under-filled. We require a minimum volume of 2 heaped scoops (i.e. the scoop that is connected to the stool container) and a maximum volume that is half full.

Special Instructions

Calprotectin questions on ICE must be completed or please complete special form required from Primary Care (Calpr – loads PDF)

Units

ug/g stool

Reference Range

If Inflammatory Bowel disease is suspected in Primary Care for patients aged 4 Y – 49 Y, perform Faecal Calprotectin (FC).

Result interpretation

Please be aware of changes to the Calprotectin cut off values will come into effect from 18/11/20 to align with the Devon Formulary.

Values <100 ug/g fall within the reference range and are not suggestive of gastro-intestinal inflammation (currently <50 ug/g). If previously diagnosed with IBD, the level would indicate a period of remission.

Values >/= 100ug/g are suggestive of gastro-intestinal inflammation: possible causes include IBD, infection, polyps, neoplasia and NSAID’s. If previously diagnosed with IBD, consistent with active disease.

Further information can be found at: https://northeast.devonformularyguidance.nhs.uk/referral-guidance/eastern-locality/gi-liver/irritable-bowel-syndrome-ibs-diagnosis-and-management-for-adults-under-the-age-of-50

Please note, the age related reference ranges for patients less than 4 years old is as follows:

Age	Reference range Faecal Calprotectin (ug/g faeces)
up to 6 months	< 800
6 months > 12 months	< 600
12 months > 2 years	< 400
2 years > 4 years	< 200

Consider referral to paediatric gastroenterology if FC result exceeds the top of the age-related reference range.

Test Usage

Calprotectin is a 36 kDa calcium and zinc binding protein. It accounts for 60% of neutrophils cytosol. In vitro studies show it has bacteriostatic and fungistatic properties. It is resistant to enzymatic degradation, and can be easily measured in faeces[1].

Inflammatory bowel diseases (IBD) are a group of conditions that cause a pathological inflammation of the bowel wall. Neutrophils influx into the bowel lumen as a result of the inflammatory process. Measurement of faecal calprotectin has been shown to be strongly correlated with 111-indium-labelled leucocytes – considered the gold standard measurement of intestinal inflammation[2].

Diseases causing increased excretion of faecal calprotectin include Crohn’s Disease, Ulcerative colitis and neoplasms (cancer) have all been shown to raise faecal calprotectin levels. Levels of faecal calprotectin are normal in patients with irritable bowel syndrome (IBS)[3].

Calprotectin may be used to[4]

Identify organic bowel disease against functional bowel disease (IBS), and thus avoid the need for invasive tests such as colonoscopy.
Assessing efficacy of IBD treatments.
Predicting relapses or flares of IBD.
Offer an alternate diagnostic test for patients phobic of needles or endoscopy.

References

A simple method for assessing intestinal inflammation in Crohn’s disease. Tibble et al. Gut.2000; 47: 506-513
Role of fecal calprotectin as non-invasive marker of intestinal inflammation. Costa F et al. Dig Liver Dis. 2003 Sep;35(9):642-7
Calprotectin is a stronger predictive marker of relapse in ulcerative colitis than in Crohn’s disease. Costa F et al. Gut. 2005 Mar;54(3):364-8.
A simple method for assessing intestinal inflammation in Crohn’s disease Tibble et al. Gut.2000; 47: 506-513

Availability

Local test

Turnaround Time

7 days

Cannot be added on to an existing request

REFERRALS

We welcome referrals for Anti TNF monitoring. If you are a new requestor please complete the following form: New requestor form.

We now also have the option to use NPEx for referral requesting.

Further information about sample requirements for this test can be found here: Faecal Calprotectin – further information

Specimen Labelling Procedure