Thanks to all of those who replied to my recent question to the mailbase:  “Now that faecal calprotectin has been in use for a while it would be interesting to know whether everyone is using 50 mg/kg as the cutoff and whether an “intermediate range” is being applied which does not necessarily result in referral to secondary care (maybe being repeated first) – and also whether this is method dependent”.

Summary of information obtained:

Phadia user: My grey zone for suggesting repeats, and excluding NSAID and infections is 50-150. But this is not locally derived.

We use the Buhlmann Quantum Blue kit and the 50ug/g cut off.

For results between 40-60ug/g we do add a comment to suggest repeat as near the border etc. This as per the kit insert info. 

Just to note- We only do samples for the Gastro and Paediatric teams as we bill them directly for Calprotectins.  GPs can send in samples but someone from either of these teams must be copied into the report.

We are in the process of changing assay to ELISA- all the different companies have various bias, as seen on the EQA.  Changing bias will mean more or less patients have a positive result vs current assay.  Problem is which assay is 'correct'?

We used the Quantum Blue assay

We have an ‘indeterminate range’ of 40-80 mg/kg.

If the first result is in this range a repeat sample is suggested.

.

We use a cut-off of 50 and suggest a repeat sample if the result is between 50-150

There is currently a pilot study going on with the CCG based upon the following cut-offs.

<100  - treat locally

100-250 stop any NSAID and repeat

>250 - suggest immediate referral to gastro

(No method stated).

Buhlman method.

<100 ug/g: Unlikely IBD. Treat as IBS

100-300 ug/g: Intermediate. Repeat after 4 weeks. Stop NSAID for 2 weeks before test.

>300 ug/g: Consider consultant referral

Regards

Marieke

Dr Marieke Jordaan

Consultant Chemical Pathologist / Head of Clinical Service, Pathology

Mid-Yorkshire Trust

Email: [log in to unmask]

Tel: (01924) 317060 or ext 57060

PA, Diane Blakeston: (01924) 317056 or ext 57056

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