Ehi Ediale

Week 2
August 17, 2018
Test 7: Occult Blood Test

What is tested: How is test done:

Fecal occult blood test (FOBT) is
used to detect blood loss in stool
that is not clinically apparent
Guaiac fecal occult blood test- gFOBT
o Before collection of fecal sample, patient must fast from NSAIDS, red meat,
peroxidase-rich vegetables and fruits, and vitamin C
o 2 samples from each of 3 consecutive bowel movements should be collected
o Samples are smeared on white testing cards impregnated with guaiac resin
o 1-2 drops of hydrogen peroxide developer are added to the back of the testing
card (directed over each smear)

Fecal immunochemical test- FIT

o Patient does not have dietary restrictions
o 2 samples from each of 3 consecutive bowel movements should be collected
o Samples are smeared on collection card
o Collection card brought into contact with a test strip impregnated with antihuman
hemoglobin antibodies

How interpreted:
Guaiac fecal occult blood test- gFOBT
o Positive result: testing card turns blue after the addition of H2O2
 Blue color indicates that guaiac has been oxidized by H2O2 in the presence of
heme
 FYI: Heme has peroxidase activity
 This means that there is occult blood in the fecal sample
o Negative result: testing card remains white after the addition of H2O2
 White color indicates that guaiac has NOT been oxidized by H2O2 in the
presence of heme
 This means that there is NOT occult blood in the fecal sample

Fecal immunochemical test- FIT

o Positive result: test strip turns pink after contact with sample
 Pink color indicates the presence of hemoglobin in sample
 This means that there is occult blood in the fecal sample
o Negative result: test strip remains white after contact with sample
 White color indicates hemoglobin is not present in sample
 This means that there is NOT occult blood in the fecal sample

How accurate:

Sensitivity for detecting colorectal cancer

o gFOBT- 65%
o FIT- 80%

Specificity for detecting colorectal cancer

o gFOBT- 78%
o FIT- 90.12%

FITs are more specific than guaiac tests because FIT detects only globin and therefore does not detect upper GI bleeding
(since the globin is digested in transit)
 How safe:
o The fecal occult blood test is safe and painless.
o This test is not invasive and does not have complications.

When: In Whom:
o For patients without a history/family history of colorectal o Suspected GI bleeding in Henoch- Schonlein
cancer, FOBT should be done once a year starting at the purpura
age of 50 o Suspected GI bleeding
o For patients with a history/family history of colorectal o Screening for colorectal caner in average-risk
cancer, FOBT should be done once a year starting at the men and women (50 years of age and older)
age of 40 or 10 years younger than the earliest diagnosis o Suspected infectious diarrhea
in their family, whichever comes first
o FOBT should done as soon as possible, in patients with
chronic diarrhea (diarrhea last longer than 4 weeks),
black stool, or anemia with or without iron deficiency.

In summary:
1. There are 2 tests used for fecal occult blood testing: guaiac fecal occult blood test and fecal immunochemical test
2. The fecal immunochemical test is becoming more popular since it has a higher sensitivity and specificity for the
detection of colorectal cancer.

Sources:

1. Aboulian, A. & Kumar, R. R. Diagnostic Evaluations. in Colorectal Surgery 17–40 (Elsevier/Saunders, 2013).
2. Bresalier, R. S. Colorectal Cancer. in Sleisenger and Fordtran’s Gastrointestinal and Liver Disease 2248-2296.e5
(Elsevier/Saunders, 2016).
3. Swartz, M. H. The Abdomen. in Textbook of Physical Diagnosis 429-467.e2 (Elsevier/Saunders, 2014).
4. Warner, E. A. & Herold, A. H. Interpreting Laboratory Tests. in Textbook of Family Medicine 157-180.e1 (Elsevier.,
2016).
5. Macaron, C. & Burke, C. A. Colorectal Cancer Screening and Surveillance. in Current Therapy in Colon and Rectal
Surgery 267–272 (Elsevier, 2017).
6. Flexible sigmoidoscopy versus faecal occult blood testing for colorectal cancer screening in asymptomatic individuals.
- PubMed - NCBI. Available at: https://www-ncbi-nlm-nih-gov.ezproxy.augusta.edu/pubmed?term=24085634.
(Accessed: 17th August 2018)
7. Screening for Colorectal Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services
Task Force. - PubMed - NCBI. Available at: https://www-ncbi-nlm-nih-
gov.ezproxy.augusta.edu/pubmed?term=27305422. (Accessed: 17th August 2018)
8. Screening for colorectal cancer: randomised trial comparing guaiac-based and immunochemical faecal occult blood
testing and flexible sigmoidoscopy. - PubMed - NCBI. Available at: https://www-ncbi-nlm-nih-
gov.ezproxy.augusta.edu/pubmed?term=19671542. (Accessed: 17th August 2018)