Occult Blood, Immunochem

Stool
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Stool Occult Blood, Immunochemical (FIT test)

The fecal immunochemical test (FIT) checks for tiny, invisible amounts of human blood in stool. It uses antibodies that detect human hemoglobin, making it more specific for bleeding in the lower gastrointestinal (GI) tract (colon and rectum) than older guaiac-based stool tests.

Why it matters

Blood in stool can come from colon polyps, colorectal cancer, hemorrhoids, or other lower GI conditions. Detecting it early allows doctors to identify and remove precancerous growths or start treatment when it is most effective. FIT is widely used as a noninvasive colorectal cancer screening tool and is typically recommended once a year starting at age 45 for people at average risk.

How FIT differs from older stool tests

  • Human-specific: Detects human, not animal, blood proteins.

  • No diet restrictions: Foods like red meat and supplements (e.g., vitamin C) don’t affect results.

  • Lower-GI focused: More reliable for the colon and rectum than for bleeding in the stomach or small intestine.

When it’s used

  • Routine colorectal cancer screening for average-risk adults (often yearly from age 45).

  • Follow-up monitoring after colon polyps are removed or when colonoscopy is deferred.

  • Not diagnostic: A positive FIT shows blood is present but does not identify the cause. Colonoscopy is the usual follow-up.

How to collect the sample

  • Follow the kit instructions exactly. Typically, you use a brush or applicator to collect a small stool sample and place it in the provided tube.

  • Avoid collection during menstrual periods or when you have active bleeding from hemorrhoids if possible.

  • Return the sample promptly, as FIT accuracy decreases if it is stored too long or exposed to heat.

  • Use clean techniques and label correctly to avoid invalid results.

Understanding your result

  • Negative: No blood detected. This is reassuring, but regular testing is still important since some growths bleed intermittently.

  • Positive: Blood was detected. This does not mean cancer but indicates the need for colonoscopy to find the source (such as a polyp, inflammation, hemorrhoids, or another cause).

  • Invalid: The sample could not be processed (e.g., insufficient material, expired kit, mishandling). A repeat test is required.

Common reasons for a positive FIT (besides cancer)

  • Adenomatous (precancerous) polyps

  • Hemorrhoids or small fissures

  • Colitis or other inflammatory gut conditions

  • Recent lower-GI procedures or straining with constipation

What a negative result means

A negative FIT lowers the chance you are bleeding from the colon or rectum at the time of testing, but it does not rule out all problems. Because bleeding can be intermittent, repeated annual testing is essential for effective screening.

Follow-up steps

  • Positive result: Colonoscopy is usually recommended to locate and treat the source of bleeding.

  • Negative result: Stay on schedule with annual or clinician-directed screenings. Report any symptoms such as rectal bleeding, unexplained weight loss, changes in bowel habits, or persistent abdominal pain.

  • Invalid result: Repeat with a new kit and follow all instructions carefully.

Notes on diet and medications

  • No dietary restrictions—red meat, vitamin C, and most supplements don’t interfere.

  • Blood-thinning medicines (such as aspirin, anticoagulants) do not cause false positives but may increase bleeding from existing lesions. Discuss with your clinician if you have questions.

Who should skip FIT and consider colonoscopy directly?

  • People with a history of advanced colon polyps or colorectal cancer

  • Individuals with hereditary colorectal cancer syndromes, inflammatory bowel disease, or strong family history

  • Anyone with visible rectal bleeding, iron-deficiency anemia, or unexplained weight loss

Test limitations

  • FIT is best for bleeding in the colon and rectum; it may not detect bleeding from higher in the GI tract.

  • Intermittent bleeding can lead to false negatives.

  • Proper collection, handling, and prompt return of the sample are critical for accuracy.

Related tests

  • Colonoscopy – diagnostic and therapeutic after a positive FIT.

  • CT colonography or flexible sigmoidoscopy – alternative colon exams in select cases.

  • Guaiac FOBT (gFOBT) – an older stool test with more dietary interferences.

  • Multitarget stool DNA testing – another noninvasive screening tool, done less frequently.

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