Explanation

Hemoglobin in stool: what is measured?

Hemoglobin is the red pigment in red blood cells. The test looks for a trace of blood in the stool that you cannot see with the naked eye. In this gut panel, the laboratory uses the result together with calprotectin and lactoferrin as a sign of inflammation or damage to the intestinal lining.

What can it detect?

Inflammation or damage of the intestinal lining, for example with a gut infection or chronic inflammatory bowel disease
Blood loss from hemorrhoids or a small tear at the anus

Result

What does the result mean?

Positive result

A positive result means that a trace of blood has been found in the stool. The cause is often harmless, such as hemorrhoids or a small tear at the anus, but inflammation of the gut can also cause blood. Because the test does not show where the blood comes from, a positive result should always be taken to your GP.

Negative result

A negative result means that no blood was found in this stool sample. This does not rule out inflammation or bleeding, because blood loss comes and goes.

After an abnormal result

With a positive result, especially together with abdominal symptoms, a change in bowel habits or visible blood, the GP assesses what is needed. This may be a physical examination, calprotectin in the stool or a referral to a gastroenterologist.

Reliability

How reliable is the test?

The laboratory determines this value qualitatively, as an inflammation marker in a panel with calprotectin and lactoferrin. A positive result means that a trace of blood has been found in the stool; the test does not say where the blood comes from. A negative result does not rule out bleeding or inflammation, because blood loss comes and goes.

What can affect the result?

Blood from the gums, nose or hemorrhoids, menstrual blood and a small wound at the anus can make the result positive.
Iron tablets and red meat have little effect with this method, but a small blood loss can vary between two stool samples.
The test is not intended and not suitable as bowel cancer screening; for that there is the national screening program for people aged 55 up to and including 75.

Who it is for

Who is the test useful for?

Useful for

Only useful as part of a gut examination when you have symptoms. For people without symptoms aged 55 up to and including 75, there is the national bowel cancer screening program; this test does not replace it.

How common is it?

Bowel symptoms are common: according to the guideline, irritable bowel syndrome affects about 4 in 100 adults in the Netherlands. Chronic inflammatory bowel diseases such as Crohn's disease and ulcerative colitis are much rarer; the guideline gives no Dutch figure for them. How often an abnormal result for these markers occurs in people without symptoms is not known.

Dutch medical specialists' guideline (FMS) on irritable bowel syndrome (NHG and NVMDL)

Drawbacks and risks

A positive result from a harmless cause can lead to unnecessary worry and further testing.
A negative result can give false reassurance.

Get tested