Calprotectin

Biochemistry Blood Sciences Test

Specimen

Faeces collected using Green Picker only

Special Instructions Faecal Calprotectin collection instructions

Calprotectin questions on ICE/EPIC must be completed

The Blood Sciences Department at the RDUH will be changing the laboratory equipment used to analyse Faecal Calprotectin to the Mast OC Sensor Pledia from the 26th of February 2024.

The new methodology uses a sample collection picker (similar to FIT testing) that significantly increases sample stability, patient convenience and test accuracy. The Calprotectin picker has a flat green lid. PLEASE NOTE: this is different from the FIT picker which has a blue lid with a grip handle. All surgeries will receive a supply (approximately 6 months worth). If you require further pickers, please contact us at rduh.bloodsciencesadmin@nhs.net and we can arrange to send you more.

Units

ug/g stool

Reference Range

It is important to note the results from the new method generate significantly higher results than the existing method. The old cut-off of 100 ug/g will increase to 500 ug/g. The interpretive comment and normal range in the report will be updated to reflect this.

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	< 3800
6 months > 12 months	< 2900
12 months > 2 years	< 1900
2 years > 4 years	< 900

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 Calprotectin. 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