FECALYSI

S
 OBJECTIVES
oUPON COMPLETION OF THIS MODULE, YOU SHOULD BE ABLE TO:

1. DESCRIBE THE NORMAL COMPOSITION OF FECES.

2. DIFFERENTIATE BETWEEN SECRETORY AND OSMOTIC DIARRHEA.
3. LIST THREE CAUSES OF DIARRHEA AND STEATORRHEA.
4. DIFFERENTIATE MALABSORPTION FROM MALDIGESTION SYNDROMES AND
NAME A TEST THAT DISTINGUISHES THE TWO CONDITIONS.
5. INSTRUCT PATIENTS IN THE COLLECTION OF RANDOM AND QUANTITATIVE
STOOL SPECIMENS.
6. STATE A PATHOGENIC AND A NONPATHOGENIC CAUSE FOR STOOLS THAT
ARE RED, BLACK, AND PALE YELLOW.
 LET’S DEFINE
a. FECES- Bodily waste discharge through
the anus: EXCREMENT

b. OCCULT (occult blood)- not revealed:

SECRET
 WHY EXAMINE FECES?
Early detection of gastrointestinal (GI) bleeding
Liver and biliary duct disorder
Maldigestion/Malabsorption syndrome
Inflammations
Causes od diarrhea
Steatorrhea
Identification of pathogenic bacteria and
parasites (Micro)
NORMAL FECAL
COMPOSITION:
o ¾ Water
o ¼ Bacteria, cellulose, and
other undigested
foodstuffs, gastrointestinal
secretions, bile pigments,
cells from the intestinal
walls, electrolytes
FECES
 o Final breakdown of ingested
proteins, carbohydrates and
fats takes place in the small
intestine where they are also
absorbed.
o Bacterial (normal flora)
metabolism produces the
strong odor associated with
feces and intestinal gas
(flatus)
WHAT IS FECES? o The large intestine is
capable of absorbing ~3000
ml of water
DIARRHEA
o Define as an o Can be classified
increased in based on four (4)
daily stool factors
weight above 1.. Duration of
200 g with illness
increased a. ACUTE- <4
liquidity and weeks
frequency of b. CHRONIC-
more than three >4 weeks
 c. Altered Motility
 IRRITABLE BOWEL SYNDROME (IBS)
DIARRHEA  Altered motility in which there is
ENHANCED motility
(HYPERMOTILITY) and SLOW
motility (CONSTIPATION)
2. Mechanism
a. SECRETORY  RAPID (accelerated) gastric
emptying (RGE) dumping syndrome
b. OSMOTIC
 Describes hypermotility of the
c. ALTERED
stomach and the shortened gastric
MOTILITY emptying half-time, which causes
the small intestine to fill too quickly
with undigested food from the
stomach.
 TEST TO o Fecal electrolytes
DIFFERENTIATE THE (fecal Na & K)- used
MECHANISM OF to calculate fecal
DIARRHEA osmotic gap

Osmotic gap = 290 – [ 2 (fecal sodium

+ fecal potassium) ]
 SECRETORY-- <50 mOsm/kg & INCREASED
ELECTROLYTES
 OSMOTIC-- >50 mOsm/kg & NEGLIGIBLE
 o Fecal electrolytes
TEST TO (fecal Na & K)- used to
DIFFERENTIATE THE calculate fecal osmotic
MECHANISM OF gap
DIARRHEA o Fecal Osmolality-
close to the serum
osmolality (290
mOsm/kg)
o Stool pH
o <5.6 = malabsorption
of sugars = OSMOTIC
DIARRHEA
3. Severity
4. Stool
characteristics
 MECHANISM OF
DIARRHEA
SECRETORY OSMOTIC
Caused by ENTEROTOXIN- Caused by INCOMPLETE
PRODUCING bacteria, virus and BREAKDOWN or REABSORPTION
protozoa which induce increased OF FOOD which draws excessive
secretion of water and electrolytes water in the large intestine
into the large intestine overriding its
reabsorptive ability
CAUSES: CAUSES:
Escherichia coli, Clostridium, Vibrio Disaccharidase deficiency (lactose
Cholera, Salmonella, Shigella, intolerance), malabsorption (celiac
Staphylococcus, Campylobacter, sprue), poorly absorbed sugars
Protozoa, and parasites such as (lactose, sorbitol, mannitol),
Cryptosporidium laxatives, magnesium-containing
antacids, amediasis, and antibiotic
 STEATORRHEA

o Increase in stool fat that exceeds 6  Distinguished by D-xylose test

g per day due to absence of bile
salts or due to the decrease in  If urine is low, steatorrhea is
pancreatic enzyme production (as in caused by malabsorption
pancreatic disorders)
 A normal D-xylose indicates
 May also be caused by
PANCREATITIS
malabsorption and maldigestion
 STEATORRHEA
CAUSES OF MALDIGESTION
 Decreased levels of CAUSES OF MALABSORPTION
pancreatic enzymes as in
pancreatitis, pancreatic cancer o Diseases that damage intestinal
mucosa as in tropical sprue, celiac
 Decreased bile-acid formation
disease, bacterial overgrowth,
as in obstructive jaundice
intestinal resection, lymphoma,
o Feces appear pale, greasy, bulky, Whipple disease, Giardia lamblia
infestasion, Crohn’s disease, and
spongy, or pasty in consistency
intestinal ischemia
and have a strong odor.
 SPECIMEN COLLECTION &
HANDLING
1.METHODS
o ROUTINE- collected o For quantitative testing (such
in a clean container as in fecal fats), timed
(plastic or glass) with specimens are required wherein
screw-capped topes the most representative sample
is a 3-day collection
o Specimens are also
collected on a
o CAMMIDGE- scrapping of stool
from diapers
physician’s glove and
samples applied to o JALLIFE- insertion of thick –
filter paper (for FOBT) walled glass in rectum
 PRESERVATION

1. PHYSICAL 2. CHEMICAL
- Refrigeration -Formalin, 95% ethanol,
glycerol in NSS, MIF, PVA
- Containers that can
contain preservatives for
ova and parasites must
not be used to collect
specimens for other test.
 MICROSCOPIC/
PHYSICAL
EXAMINATION
REMEMBER THE VALUES!!
NORMAL VALUES FOR FECAL ANALYSIS
Quantity 100 to 250 g/day
Color Light to Dark Brown
Consistency Soft to well-browned
Odor Foul to Offensive
pH 7.0 to 8.0
 QUANTITY
a. INCREASED CHO- increase output
b. INCREASED MEAT- decrease output
 COLOR
o First indication of GI disturbances can often be provided by
changes in the brown color and formed consistency of the
normal stool
o Differentiation of a non-pathologic cause from a pathologic
cause is needed
o Results from the intestinal oxidation of
STERCOBILINOGEN to UROBILIN; also, from
STERCOBILIN and HYDROBILIN
 VARIATIONS:
 Pale- may signify blockage of
the bile duct or this may result
from use of barium sulfate
 Bloody- more cause for
concern
 Upper GI bleeding
O From esophagus, stomach
or duodenum
O Takes ~3 days to appear in
stool thus degrading the
 VARIATIONS:

 Lower GI bleeding
O From colon, rectum
O Takes lesser time to appear
O BRIGHT RED
 Should be chemically tested
for the presence of blood
 VARIATIONS:
 Other causes of
BLACK/RED STOOLS
O Ingestion of iron, charcoal,
or bismuth- black
O Medications such as
Rifampin & foods including
beets- red
 Green- seen in patients
taking oral antibiotics & this is
due to oxidation of fecal
 VARIATIONS:

 Yellow- milk diet, corn meal, rhubarb

and fats
 APPEARANCE/CONSISTENCY

O WATERY- seen in diarrhea

 “pea-soup”- TYPHOID FEVER
 “rice-water”- CHOLERA
O SMALL, HARD/GOAT
DROPPINGS/SCYBALOUS- seen in
constipation
O SLENDER/FLATTENED, RIBBON-
 APPEARANCE/CONSISTENCY

O BULKY, FROTHY, GREASY & MAY

FLOAT- seen in biliary obstruction &
steatorrhea
O MUCOS-COATED STOOLS- seen in
intestinal inflammation or irritation; may
bbe caused by pathologic colitis or
excessive straining during defecation
O BLOOD-STREAKED MUCUS- seen in
 APPEARANCE/CONSISTENCY

O SMALL CALIBER- cancer, ulcer, tumor

O LARGE CALIBER- Hirschsprung’s disease
(massive enlargement of intestine)
O The presence of mucus should be
reported.
 NORMAL: trace amounts (LI) to
abundant (SI)
O Excessive irritation/inflammation of
 ODOR
o EXTREMELY FOUL-
indicates putrefaction due to
undigested proteins; usually
o Due to SKATOLE,
associated with alkaline reaction
INDOLE, and of feces and bacterial
BUTYRIC ACID contamination
o SOUR/RANCID- gas
o PUTRID- ulcerated and
formation and fermentation of
malignant tumors of the CHOs; due to unabsorbed fatty
lower bowel acids
 pH

o ACIDIC FECES- CHO fermentation

o ALKALINE FECES- CHON
fermentation
 MICROSCOPIC EXAMINATION

1.FECAL LEUKOCYTES
o Leukocytes, primarily NEUTROPHILS , are seen in
feces when the intestinal mucosa is irritated as in
ulcerative colitis and bacterial dysentery
o Presence/Absence of leukocytes aid in the
preliminary investigation of the cause of diarrhea
 MICROSCOPIC EXAMINATION

 PRESENCE OF NEUTROPHILS- if the diarrhea is caused by

INVASIVE BACTERIA such as Salmonella, Shiella, Campylobacter,
Yersinia and enteroinvasive E. coli
 ABSENCE OF NEUTROPHILS- if the diarrhea is caused by
TOXIN-PRODUCING BACTERIA such as S. aureus and Vibrio spp.,
VIRUSES, and PARASITES
 METHODS

 WET PREPARATIONS
 Stained with METHYLENE BLUE
 Faster but may be difficult to interpret
 METHODS

 DRIED PREPARATIONS
 Stained with WRIGHT’S or GRAMS STAIN
 Provide PERMANENT SLIDES for evaluation
 Additional advantage of observation of gram-positive and gram-
negative bacteria which may aid in the choice of initial treatment
 METHODS

 All side preparations must be performed on fresh specimens.

 RESULT:
 As few as 3 NEUTROPHILS/HPF can be indicative of an invasive
condition
 Finding of any neutrophil in OIF has ~70% sensitivity for invasive
condition
o LACTOFERRIN LATEX AGGLUTINATION TEST
 For detection of fecal leukocytes remains sensitive in
refrigerated and frozen specimens
 Lactoferrin is component of granulocyte secondary granules and
its presence is INDICATIVE OF BACTERIAL PATHOGENS
 2. MUSCLE FIBERS

o Can be helpful in diagnosis and monitoring of patients with

PANCREATIC INSUFICIENCY
 Increased amounts of muscle fibers are also seen in biliary
obstruction & gastrocolic fistulas
o Frequently ordered in conjunction with microscopic exam for fecal
fats
 2. MUSCLE FIBERS

o METHODS:
 Slides are prepared by EMULSIFYING a small amount of stool
in 10% ALCOHOLIC EOSIN (enhances muscle fiber striations)
 Entire slides is examined for examined for EXACTLY 5
MINUTES
 2. MUSCLE FIBERS

o METHODS:
 Numbers of RED-STAINED fibers with well-preserved striations is counted
 UNDIGESTED FIBERS- have visible striations running both vertically &
horizontally
 PARTIALLY DIGESTED FIBERS- have striations in only one directions
 DIGESTED FIBERS- have nonvisible striations
 2. MUSCLE FIBERS

o METHODS:
 ONLY UNDIGESTED FIBERS ARE COUNTED
 Presence of >10 is reported as INCREASED
 To produce a representative sample, patients should be instructed to include
red meat in their diet prior to collecting the specimen.
 Specimens should be examined within 24 hours of collection.
 3. QUALITATIVE FECAL FATS

o Used to screen specimens microscopically for the presence

of excess fecal fats from patients suspected of having
steatorrhea
o Also used to monitor patients undergoing treatment for
malabsorption disorders
 3. QUALITATIVE FECAL FATS

o Presence of lipids are observed by straining with any of the following dyes:
 SUDAN III- most routinely used
 SUDAN IV
 OIL RED O
 Staining procedure consists of two parts: NEUTRAL FAT STAIN and SPLIT
FAT STAIN
 3. QUALITATIVE FECAL FATS

o LIPIDS OBSERVED IN FECES

 NEUTRAL FATS (TRIGLYCERIDES)- readily STAINED BY SUDAN III
 Readily stained by Sudan III and appear as LARGE ORANGE-RED
DROPLETS, often located near the edge of the coverslip
 Observation of >60 droplets/HPF = STEATORRHEA
 Split fat stain representing total fat content can provide a better indication
 3. QUALITATIVE FECAL FATS

o LIPIDS OBSERVED IN FECES

 FATTY ACID SALTS (SOAPS) & FATTY ACIDS- DO NOT STAIN
DIRECTLY WITH SUDAN III
 A second slide must be examined after the specimen has been mixed with
acetic acid and heated
 Stained droplets represents the free fatty acids and fatty acids liberated from
the soaps and neutral fats
 3. QUALITATIVE FECAL FATS

o LIPIDS OBSERVED IN FECES

 FATTY ACID SALTS (SOAPS) & FATTY ACIDS- DO NOT STAIN DIRECTLY WITH SUDAN
III

 Both number and size of FAT DROPLETS are noted

- NORMAL: 100 small fat droplets, <4µm in size per HPF
- SLIGHTLY INCREASED: 100 droplets, 1 to 8 µm in size per HPF
- INCREASED: 100 droplets. 6 to 75 µm in size per HPF
 CHEMICAL EXAMINATION

1. OCCULT (HIDDEN) BLOOD or FECAL OCCULT BLOOD

TESTING (FOBT)
- MOST FREQUENTLY performed chemical screening test
- Necessary because any bleeding in excess of 2.5 mL/150 g of stool is
PATHOLOGICALLY SIGNIFICANT and no visible signs of
bleeding may be present with this amount of blood
- Used as a MASS SCREENING FOR THE EARLY DETECTION
OF COLORECTAL CANCER
MELENA
- Large amounts of fecal blood (50 to
100 mL/day) that turned the stool
black & tarry
 CHEMICAL EXAMINATION

1. OCCULT (HIDDEN) BLOOD or FECAL OCCULT BLOOD

TESTING (FOBT
 Has high positive value for detection of colorectal cancer in
the early stages
 Recommended by the American Cancer Society, particularly
for those >50 y/o
 PRINCIPLES

 PSEUDOPEROXIDASE ACTIVITY OF HEMOGLOBIN reacting

with H₂O₂ to oxidize a colorless compound to a colored
compound.
INDICATOR CHROMAGENS vary in their sensitivity (listed
below in DECREASING order)
 BENZIDINE- most sensitive
 ORTHO-TOLUIDINE
 GUM GUAIAC- least sensitive
 PREFERRED for routine testing
 A less sensitive chemical reactant is desirable because a normal
stool can contain up to 2.5 mL of blood
•FALSE-POSITIVE REACTIONS may be due to:
•Hemoglobin & myoglobin in ingested meat & fish
Certain vegetables & fruits
• Some intestinal bacteria
•Prevented by decreasing the sensitivity by varying
the amount and purity of guaiac reagent
used in the test
Procedures to avoid false-positive reactions & other precautions
 Obtain samples from the center of the stool
 Specimens applied to the paper in the laboratory should be
allowed to dry prior to testing
 Specimens should be tested within 6 days of collection
 Specimens mailed to the lab should not be rehydrated prior to
adding H₂O₂
 2 samples from 3 different stools should be tested before a
NEGATIVE results is confirmed
 FOOD AND MEDICATIONS TO BE AVOIDED
 Red meats, horseradish, melons, raw broccoli, cauliflower,
radishes and turnips for 3 DAYS prior to the specimen collection
(this prevents the presence of dietary pseudoperoxidases in stool)
 ASPARIN and NSAIDs other than acetaminophen should NOT
be TAKEN for 7 days prior to specimen collection (this prevents
possible GI irritation)
 Vitamin C and iron supplements containing vitamin C should
be avoided for 3 DAYS prior to specimen collection (ascorbic acid
is a strong reducing agent that interferes with the peroxidase
reaction)
SUMMARY OF INTERFERENCES IN OCCULT BLOOD
TESTING
FALSE-POSITIVE FALSE-NEGATIVE
Aspirin and anti- Vitamin C >250 mg/dL
inflammatory Iron supplements containing vitamin
C
medications
Red meat
Horseradish
Raw broccoli,
cauliflower, radishes,
turnips
Melons
 2. HEMOQUANT

o More sensitive and specific

o Provides a fluorometric test for hemoglobin & porphyrin (cannot be detected by
guaiac)
o As hemoglobin progresses through the intestinal tract, bacterial actions degrade it
to porphyrin that the guaiac test cannot detect
o This can result in some false-negative results from the upper GI bleeding using the
guaiac test
 2. HEMOQUANT

o HEMOCCULT ICT- IMMUNOCHEMICAL OCCULT BLOOD

TEST (iFOBT)
 Specific for the globin portion of human hemoglobin & uses anti-
human hemoglobin antibodies
 Does not require dietary or drug restrictions
 Can be used for patients who are taking aspirin and other
inflammatory medications
 2. HEMOQUANT

o HEMOCCULT ICT- IMMUNOCHEMICAL OCCULT BLOOD TEST

(iFOBT)
 More sensitive to lower GI bleeding (indicator of colon cancer or other GI disease)
 In upper GI bleeding, hemoglobin is IMMUNOCHEMICALLY
NONREACTIVE due to bacterial and enzymatic degradation.
 In lower GI bleeding, there is little hemoglobin degradation, therefore, the blood
is IMMUNOCHEMICALLY ACTIVE
 3. QUANTITATIVE FECAL
TESTING
o Used as a confirmatory test for steatorrhea
o REQUIREMENTS:
 Collection of at least a 3-day specimen (may be collected in paint cans because the
specimen must be homogenized prior to analysis)
 Patient must maintain a regulated intake of FAT (100 g/dL) prior to and during the
collection period
 Care must be taken when opening any fecal specimen to slowly release gas that has
accumulated within the container
 3. QUANTITATIVE FECAL
TESTING
o PRESERVATIONS: Refrigerate the specimen to prevent any bacterial degradation.
o METHODS
 VAN DE KAMER TITRATION
 GOLD STANDARD FOR FECAL FAT
 Routinely used for fecal fat measurement
 Fecal lipids are converted to fatty acids and content is reported as grams of fat or the
coefficient of fat retention per 24 hours
 GRAVIMETRIC METHOD
 3. QUANTITATIVE FECAL
TESTING
o NORMAL VALUES (based on a 100g/dL intake) : 1
to 6 g/dL or at least 95% coefficient of fat retention
 4. OTHER TEST FOR FECAL FAT
TESTING
 ACID STEATOCRIT
 Rapid test to estimate the amount of fat excretion
 Similar to the microhematocrit test
 More convenient than a 72-hour stool collection to exclude day-to-day
variability
 Reliable tool to monitor a patient’s response to therapy and screen for
steatorrhea in pediatric populations
 4. OTHER TEST FOR FECAL FAT
TESTING
 NEAR-INFRARED REFLECTANCE SPECTROSCOPY (NIRA)
 Rapid procedure for fecal fat that requires less stool handling by lab personnel
 Quarantitates water, fat, and nitrogen in grams per 24 hour
 Requires a 48-to-72-hour stool collection to exclude day-to-day variability
 Does not require reagents after homogenization of the sample
 Results is CALCULATED from calibration derived from known samples and is based
on the measurements and computed processing of signal data from reflectance of
fecal surface, which is scanned with infrared light between 1400nM and 2600nM
wavelength
 5. FECAL ENZYMES

o Focuses on the proteolytic enzymes TRYPSIN, CHYMOTRYPSIN & ELASTASE I

 Essential for digestion of DIETARY PROTEINS, CARBOHYDRATES &FATS
 Supplied to the GIT by the pancreas
 CLINICAL SIGNIFICANCE- pancreatic insufficiency (seen decrease in production
of pancreatic enzymes) as in CHRONIC PANCREATITIS and CYSTIC FIBROSIS
 STEATORRHEA OCCURS & PRESENCE OF UNDIGESTED FOOD IN THE
FECES
 5. FECAL ENZYMES

o TRYPSIN (GELATIN TEST)

 Absence is demonstrated by exposing x-ray paper to stool emulsified in
water (historic)
 If trypsin is PRESENT, it will digest the gelatin on the x-ray paper =
CLEAR AREA
 If trypsin is ABSENT, there is inability to digest the gelatin = NO
CHANGE
 5. FECAL ENZYMES

o TRYPSIN (GELATIN TEST)

 INSENSITIVE PROCEDURE; detects only severe cases of pancreatic
insufficiency
 FALSE-POSITIVE:
 Proteolytic activity of bacteria enzymes (in old specimens)
 FALSE-NEGATIVE:
 Intestinal degradation of trypsin
 Possible presence of trypsin inhibitors in the feces
 5. FECAL ENZYMES

o CHYMOTRYPSIN
 MORE SENSITIVE indicator of less severe cases of pancreatic
insufficiency
 MORE RESISTANT to intestinal degradation
 Remains stable in fecal specimens for up to 10 days at a room
temperature
 Capable of gelatin hydrolysis but is more frequently measured by
SPECTROPHOTOMETRIC METHODS
 5. FECAL ENZYMES

o ELASTASE I
 Elastase I isoenzymes of the enzyme elastase and is present in high
concentrations in pancreatic secretions. It is strongly resistant to
degradation and accounts for about 6% of all secreted pancreatic
enzymes.
 Fecal elastase I is pancreas specific and its concentration is about five
times higher than in pancreatic juice. It is not affected by motility
disorders or mucosal defects.
 5. FECAL ENZYMES

 VERY SENSITIVE INDICATOR of exocrine pancreatic insufficiency

 Easy to perform and requires only a single stool sample
 Measured by immunoassay using the ELISA kit
- Uses monoclonal antibodies against human pancreatic elastase-1; therefore, the results
is specific for human enzyme and not affected by pancreatic enzyme replacement
therapy
- The test is SPECIFIC IN DIFFERENTIATING PACREATIC FROM
NONPANCREATIC CAUSES IN PATIENTS WITH STEATORRHEA
 6. CARBOHYDRATES

 Present in feces as a result of an intestinal inability to reabsorb carbohydrates

(as in Celiac disease) or caused by lack of digestive enzymes (such as lactase
resulting to lactose intolerance)
 If increased in amounts in stool, it will produce an OSMOTIC DIARRHEA
(caused by the osmotic pressure of the unabsorbed sugar in the intestine
drawing in fluid and electrolytes)
 6. CARBOHYDRATES

 COPPER REDUCTION TEST (CLINITEST)

 Detects CONGENITAL DSACCHARIDASE DEFICIENCIES
and ENZYME DEFFICIENCIES due to nonspecific mucosal
injury
 MOST VALUABLE in assessing cases of infant diarrhea and
may be accompanied by a pH determination
 NORMAL STOOL pH: 7.0 to 8.0
 6. CARBOHYDRATES

 In CARBOHYDRATES DISORDER = pH of stool is <5.5 (increased use of

carbohydrates by intestinal bacterial fermentation increases the lactic acid
levels as lowers the pH)
 Performed using a CLINITEST tablet and one part stool emulsified in two parts
water
 As a result of 0.5 g/dL is INDICATIVE OF CARBOHYDRATE
INTOLERANCE
 6. CARBOHYDRATES

 Positive CLINITEST in premature infants has a correlation with

INFLAMMATORY NECROTIZING ENTERCOLITIS
 Can distinguish between diarrhea caused by abnormal excretion of
reducing sugars and diarrhea caused by various viruses and
parasites
 Sucrose is NOT detected because it is not a reducing sugar
 6. CARBOHYDRATES

 SERUM CRABOHYDRATE TOLERANCE TESTS

 Used following a positive fecal clinitest
 D-xylose test for malabsorption
 Lactose tolerance test for maldigestion
 6. CARBOHYDRATES

 STOOL CHROMATOGRAPHY
 To identify the malabsorbed carbohydrate but rarely necessary
for the diagnosis of sugar intolerance
 SMALL BOWEL BIOPSY & DISACCHARIDASE
ENZYME ASSAY
 Differentiate primary from secondary disaccharide intolerance
 7. APT TEST FOR FETAL
HEMOGLOBIN
o Distinguishes between the presence of fetal blood or
maternal blood in an infant’s stool or vomitus
o Grossly bloody stools and vomitus are sometimes seen in
neonates as the result of swallowing maternal blood during
delivery.
 7. APT TEST FOR FETAL
HEMOGLOBIN
o PRINCIPLE:
 The material to be tested is emulsified in water (to release hemoglobin) and is
centrifuged
 1% SODIUM HYDROXIDE is added to the pink hemoglobin-containing supernatant
 FETAL HEMOGLOBIN: the solution remains pink (because HbF is alkali
resistant)
 MATERNAL HEMOGLOBIN: produces a yellow-brown supernatant after
standing for 2 minutes
 CONTROLS: cord blood & adult blood
 7. APT TEST FOR FETAL
HEMOGLOBIN
o APT test distinguishes not only between fetal hemoglobin and
hemoglobin A but also between maternal hemoglobins AS, CS, and
SS, and fetal hemoglobin
 SUMMARY
Fecalysis, or a stool exam, is a series of tests conducted on a stool
sample. This procedure detects bacteria and parasites that are causative
agents of diseases. Aside from detecting living organisms, a fecalysis
test can also detect substances such as blood, bile, or sugar, which are
not normally found in the stool. With a fecalysis, results can also
indicate and detect Colon Cancer. Thus, the results of the fecalysis is a
great help to doctors in the diagnosis of the disease of a patient.