Digestive Diseases and Sciences

, Volume 64, Issue 2, pp 503–517 | Cite as

Detectable Laboratory Abnormality Is Present up to 12 Months Prior to Diagnosis in Patients with Crohn’s Disease

  • James R. IrwinEmail author
  • Emma Ferguson
  • Lisa A. Simms
  • Katherine Hanigan
  • James D. Doecke
  • Daman Langguth
  • Ashley Arnott
  • Graham Radford-Smith
Original Article


Background and Aims

Patients with inflammatory bowel disease (IBD) often have subjective symptoms for months or years prior to their diagnosis. Blood tests taken prior to diagnosis may provide objective evidence of duration of pre-diagnosis disease. We aim to describe the pre-diagnosis laboratory pattern of patients with IBD.


A total of 838 patients diagnosed with IBD between 01/01/1996 and 01/03/2014, with pre-diagnosis laboratory testing available, contributed data for analysis. C-reactive protein, erythrocyte sedimentation rate, hemoglobin level, mean cell volume (MCV) platelet count, white blood cell count, neutrophil count, albumin level, ferritin level, serum iron level, alanine transaminase level, and fecal calprotectin were examined in the 24 months leading up to diagnosis and compared to baseline data taken between 24 and 36 months prior to diagnosis.


For patients with Crohn’s disease, a significant drop in serum albumin and MCV levels and a significant rise in platelet count were observed between 115 and 385 days prior to diagnosis (p < 0.01, two-tailed t test). For patients with ulcerative colitis, a significant change in albumin level, MCV, hemoglobin level, platelet count, and serum iron level was observed at diagnosis (p < 0.01, two-tailed t test) but was not detectable before.


These data provide objective evidence of duration of delay between disease onset and diagnosis in a cohort of patients with IBD. Expediting diagnostic testing in patients presenting with symptoms consistent with IBD, who also have abnormal laboratory results, may reduce diagnostic delay, speed access to therapy, and improve clinical outcomes.


Crohn’s disease Biomarker Pre-diagnosis 



Alanine transaminase


C-reactive protein


Erythrocyte sedimentation rate


Inflammatory bowel diseases


Mean cell volume


White blood cell count


Author’s contribution

JRI performed data collection, performed statistical analysis, drafted the manuscript, and was involved in the final review of the manuscript. GRS performed data collection and was involved in the final review of the manuscript. JDD performed statistical analysis and was involved in the final review of the manuscript. EF, KH, LAS, AA, and DL performed data collection and were involved in review of the manuscript.


This work was supported by peer-reviewed grants from the National Health and Medical Research Council (Australia) and the Royal Brisbane and Women’s Hospital Foundation.

Compliance with ethical standards

Conflict of interest

GRS has worked on advisory boards for and received consulting fees from Abbvie, Janssen, Ferring, Takeda, and Amgen. JRI, EF, KH, LAS, JD, DL, and AA have no conflict of interest to declare.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Inflammatory Bowel Diseases Research GroupQIMR Berghofer Medical Research InstituteBrisbaneAustralia
  2. 2.Department of Gastroenterology and HepatologyRoyal Brisbane and Women’s HospitalBrisbaneAustralia
  3. 3.School of MedicineThe University of QueenslandBrisbaneAustralia
  4. 4.CSIRO Health and Biosecurity/Australian E-Health Research CentreBrisbaneAustralia
  5. 5.Department of ImmunologySullivan and Nicolaides PathologyBrisbaneAustralia
  6. 6.Palmerston North HospitalPalmerston NorthNew Zealand

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