Faecal haemoglobin
Trying to determine whether a patient's symptoms reflect significant underlying bowel disease (namely cancer, inflammatory bowel disease or adenomatous polyps) is almost impossible in the absence of other clues.
Why is Faecal Haemoglobin concentration important?
Faecal haemoglobin (FHb) concentrations rise in proportion to the size of any underlying neoplastic lesion. Patients with detectable FHb have a 20% chance of underlying significant bowel disease, rising to almost 60% if levels are >400, and in the context of new bowel symptoms should be referred to the Colorectal Service. On the other hand, we have shown that patients with bowel symptoms and undetectable faecal haemoglobin have an extremely low risk of harbouring significant bowel disease.(1)
Managing my patient's symptoms
- Bowel symptoms are often transient; a clear history may identify the trigger.
- Patients with undetectable faecal haemoglobin may not require immediate invasive investigations; however, those with rectal bleeding, iron deficient anaemia or a palpable mass should be referred.
- Helpful information on how to manage symptoms is available on the NICE Clinical Knowledge Summaries pages.
If you choose to refer
Please include the results of the FIT and blood tests on your referral as this will facilitate speedy Consultant triage.
(1) Faecal haemoglobin and faecal calprotectin as indicators of bowel disease in patients presenting to primary care with bowel symptoms . Mowat C et al. GUT 2015
(1) Faecal haemoglobin and faecal calprotectin as indicators of bowel disease in patients presenting to primary care with bowel symptoms . Mowat C et al. GUT 2015