Nurse Practitioner Chronicles

  Fecal Calprotectin & Hyperinflammation Markers: IBD vs. IBS, and When Ferritin >10,000 Is a Diagnosis The stool test that saves your patient a colonoscopy and the serum ferritin level that means macrophage activation, not iron overload. Part 1: Fecal Calprotectin—IBD vs. IBS Fecal calprotectin is a neutrophil-derived protein released into the gut lumen during intestinal inflammation. It's the single best non-invasive test for distinguishing inflammatory bowel disease (IBD) from irritable bowel syndrome (IBS)—a distinction that saves patients from unnecessary colonoscopies and saves the healthcare system significant cost. How to Use It Calprotectin <50 µg/g : IBD very unlikely. Supports IBS or functional GI disorder. Negative predictive value >95%. 50–150 : Borderline. Repeat in 4–6 weeks. If persistently elevated, refer for GI evaluation. >150 : Intestinal inflammation likely. Correlate with clinical picture. Refer for colonoscopy/endoscopy to differentiate Crohn...

  Iron Studies Made Simple: Pattern Recognition for the Busy NP Four numbers, four patterns—and the one pitfall that makes ferritin lie to you every time. Iron studies are ordered constantly in primary care, yet they're consistently misinterpreted. The most common mistake? Checking a ferritin alone and calling it a day. In your autoimmune, inflammatory, and chronically ill patients, a single ferritin can be profoundly misleading. Let's learn the patterns. The Four Tests (and What Each Measures) Serum Ferritin  — Reflects iron  stores . The most sensitive early marker of iron deficiency when inflammation is absent. But it's an acute-phase reactant—levels rise with inflammation, infection, liver disease, obesity, and malignancy, masking true iron deficiency. Serum Iron  — The amount of iron circulating in the blood, mostly bound to transferrin. Highly variable (diurnal fluctuation, affected by recent meals). Low in both iron deficiency AND anemia of chronic disease. No...