Role of faecal occult bloods in the diagnosis of iron deficiency anaemia

A. T. M. Dilshad Chowdhury, G. Longcroft-wheaton, Andrew Davis, David Massey, Patrick Goggin

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Objective: To determine whether faecal occult blood (FOB) testing in patients with iron deficiency anaemia (IDA) can predict the presence of gastrointestinal cancer.  

Design: Cohort study.

Settings: Single secondary care hospital UK.  

Patients: All individuals aged 20 years and older referred for the investigation for IDA.  

Interventions: Data was collected from all the patients regarding haemoglobin (Hb), mean corpuscular volume, age, sex, symptomatology and medication. All patients had FOB tests using laboratory guaiac and haemocell methods, and then underwent gastroscopy and colonoscopy.  

Main outcome measures: Accuracy, sensitivity and specificity of FOBs for identifying cancer in the upper or lower gastrointestinal tract.  

Results: In total, 292 patients completed the study; 37 patients were diagnosed with carcinoma (colon 34, gastro-oesophageal 3). Using an optimal combination of lab guiaic and haemocell test resulted in just one colorectal cancer being missed, a sensitivity of 97%, specificity of 49% and negative predictive value of 99%. The test was less effective for upper gastrointestinal cancer, with 2/3 tumours missed by the tests.  

Conclusions: Patients who have negative FOB tests are very unlikely to have a colorectal cancer, and the benefits to further colonic investigation is limited. This should be carefully considered in patients with significant comorbidities, where the risks of investigation may outweigh the benefits.
Original languageEnglish
Pages (from-to)231-236
JournalFrontline Gastroenterology
Issue number4
Early online date27 Jan 2014
Publication statusPublished - 1 Oct 2014
Externally publishedYes


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