LECTURE 1: Introduction to Clinical Chemistry

CLINICAL CHEMISTRY

Is a quantitative science that is concerned with the measurement of amounts of biologically important substances (called ANALYTES) in body fluids.

CLINICAL CHEMISTRY

A biochemical analysis of our body fluids to detect any analytes that you wish to study or measure in support of the diagnosis and treatment of certain diseases

ANALYTES

Biologically important substances in body fluids are called?

CLINICAL CHEMISTRY

The branch of laboratory medicine that focuses primarily on molecules

JOHAN HELLER

An Austrian Chemist who is known as the Father of Clinical Chemistry.

Analyzing the chemical composition of the human body.

SCOPE OF CLINICAL CHEMISTRY RESEARCH:

To facilitate the correct performance of analytic procedures that yield accurate and precise information thereby aiding patient diagnosis and treatment.

PRIMARY PURPOSE OF A CLINICAL CHEMISTRY LABORATORY:

CLINICAL CHEMISTRY

Continues to be one of the most rapidly advancing areas of laboratory medicine.

1. Improving quality of patient care

2. Individual patient outcomes

3. Financial responsibility

4. Total quality management

4 Purpose of a Clinical Chemistry Laboratory:

1. Package inserts

2. Instrument manuals

3. Kit package inserts

COMMERCIAL KITS COMMONLY USED IN TODAY’S CLINICAL LABORATORIES:

REAGENTS

Substances that are employed to produce a chemical reaction when coupled with other substances

REAGENTS

They are an integral part of any chemical reaction.

• Liquid

• Dry

• Cartridge

• Strip

Depending on the instrumentation, reagents come in several forms:

• Date

• Time of preparation

• Concentration

Any reagent that is prepared must be labeled with:

TESTING BY MANUAL METHODS

Making the reagents and performing the test by hand.

• Slow or time-consuming

• Labor intensive

• Often not precise

Disadvantages of Testing by Manual Methods:

AUTOMATED ANALYZERS

These merely incorporate the methods previously used in manual methods for chemical analysis.

• Increased numbers of tests performed by one technologist in a given time period

• Labor cost decrease

• Minimized variation in results between technologists due to slight variations in technique

• Increased variety of techniques or tests being offered; improved patient care as a result

COMMON BENEFITS OF AUTOMATION:

1. Analytical Chemistry

2. Biochemistry

3. Endocrinology

4. Instrumentation

5. Toxicology

AREAS OF INTEREST OF CLINICAL CHEMISTRY:

ANALYTICAL CHEMISTRY

Studies and uses instruments and methods to separate, identify, and quantify matter

separation; identification; quantification

In our practice, the ____, _____, and _____ may constitute the entire analysis or become combined with another method.

Separation

It isolates the analytes.

QUALITATIVE ANALYSIS

Means that the analyte must be identified

QUANTITATIVE ANALYSIS

Determines the numerical amount or concentration of that certain analyte.

BIOCHEMISTRY

Otherwise known as Biologic Chemistry

Biologic Chemistry

Biochemistry is also known as?

BIOCHEMISTRY

Study of chemical processes within and relating to living organisms

BIOCHEMISTRY

A subdiscipline of this includes Chemistry and Biology.

Chemistry and Biology

Subdiscipline of Biochemistry includes?

BIOCHEMISTRY

This may be divided into 3 different fields:

• Structural biology

• Ezymology

• Metabolism

1. Structural biology

2. Ezymology

3. Metabolism

3 Different fields of Biochemistry:

ENDOCRINOLOGY

Branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions known as “hormones”

hormones

Specific secretions in Endocrinology is known as?

ENDOCRINOLOGY

Also concerned with the integration of developmental events, such as:

• proliferation

• growth

• differentiation

• psychological or behavioral activities of metabolism

• growth and development

• tissue function

• sleep

• digestion

• respiration

• excretion

• mood

• stress

• lactation

• movement

• reproduction

• and sensory perception cause by our hormones

INSTRUMENTATION

A collective term for measuring instruments and is used for indicating, measuring, and recording physical quantities

INSTRUMENTATION

A field of study about the art and science of making measurement instruments, involving the related areas of automation

INSTRUMENTATION

The term has its origins in the art and science of scientific instrument making

INSTRUMENTATION

Can refer to devices as simple as direct reading thermometers at home, or as complex as multisensory components for clinical chemistry analyte-measuring devices

simple; complex

Instrumentation can refer to devices as ____ as direct reading thermometers at home, or as _____ as multisensory components for clinical chemistry analyte-measuring devices

INSTRUMENTATION

Can be found in laboratories, factories, vehicles, and everyday household use.

TOXICOLOGY

A scientific discipline which overlaps with Biology, Chemistry, Pharmacology, and Medicine that involves the study of adverse effects of chemical substances on living organisms

• Biology

• Chemistry

• Pharmacology

• Medicine

Toxicology is a scientific discipline which overlaps with:

TOXICOLOGY

It is also the practice of diagnosing and treating exposure to toxins and toxicants.

TOXICOLOGY

The relationship between dose and its effect on the exposed organism is of high significance in this area.

TOXICOLOGY

It is currently contributing to the field of cancer research because some toxins can be used as drugs for killing tumor cells.

1. Ions

2. Salts

3. Minerals

4. Small organic molecules

5. Large macromolecules

COMMON ANALYTES MEASURED IN THE CLINICAL CHEMISTRY LABORATORY:

• carbonate

• acetate

• ammonium

• nitrate

• nitrite

Examples of Ions:

• sodium chloride

• potassium dichromate

Examples of Salts:

• calcium

• iodine

• magnesium

• phosphorus

• sodium

• zinc

Examples of Minerals:

• glucose

• cholesterol

• stearic acid

• lysine

Examples of Small organic molecules:

Glucose

Small organic molecules for sugar/carbohydrates

Cholesterol

Small organic molecules for lipids

Stearic acid

Small organic molecules for fatty acid

Lysine

Small organic molecules for amino acid

• Carbohydrates

• Nucleic acid

• Proteins

• Lipids

4 MAIN TYPES OF BIOLOGIC MACROMOLECULES FOR THE MAMMALIAN SYSTEM:

1. Electrolyte panel

2. Hepatic panel (liver profile)

3. Comprehensive Metabolic Profile

4. Basic metabolic panel

5. Lipid profile

EXAMPLES OF TYPICAL PANELS:

• Sodium (Na)

• Potassium (K)

• Chloride (Cl)

• Carbon dioxide (CO2)

Examples of Electrolyte panel:

• Albumin

• Total Protein

• Alkaline phosphatase

• Alanine aminotransferase (ALT)

• Aspartate Aminotransferase (AST)

• Total bilirubin

• Direct bilirubin

Examples of Hepatic panel (liver profile):

• Sodium (Na)

• Potassium (K)

• Chloride (Cl)

• Carbon dioxide (CO2)

• Glucose

• Creatinine

• Urea

• Calcium

• Total Protein

• Albumin

• Alanine aminotransferase (ALT)

• Aspartate Aminotransferase (AST)

• Alkaline phosphatase

• Total bilirubin

Examples of Comprehensive Metabolic profile:

• Sodium (Na)

• Potassium (K)

• Chloride (Cl)

• Carbon dioxide (CO2)

• Glucose

• Creatinine

• Chloride (Cl)

• Urea (Blood Urea Nitrogen; BUN)

Examples of Basic metabolic panel:

• Total cholesterol

• LDL cholesterol

• HDL cholesterol

• Triglycerides

Examples of Lipid profile:

1. Blood

2. Urine

3. Cerebrospinal fluid (CSF)

4. Amniotic fluid

5. Synovial fluid

6. Pleural fluid (CSF)

7. Peritoneal fluid

8. Pericardial fluid

9. Others

COMMON BIOLOGICAL SPECIMENS ACCEPTABLE IN THE CLINICAL CHEMISTRY DEPARTMENT

BLOOD

The most common biologic fluid collected for clinical laboratory testing.

1. Fluid portion

2. Cellular portion

2 MAIN PARTS OF BLOOD:

Plasma

Fluid portion of the blood (anticoagulated)

Serum

Fluid portion of the blood (coagulated)

Fluid portion

What portion of the blood contains dissolved ions and molecules?

Cellular portion

What portion of the bloontains red blood cells, white blood cells, and platelets.

PLASMA

Centrifugation done directly with anticoagulants

PLASMA

Clotting factors (CF) present

• e.g. Fibrinogen

PLASMA

Given to patients lacking blood cells

PLASMA

Is the main component of blood

PLASMA

It consists mostly of water with proteins, ions, nutrients, and wastes mixed in

White blood cells and platelets

What are found in the buffy coat are?

buffy coat

WBC and platelets are found in this area

SERUM

Centrifugation done after coagulation without anticoagulants

SERUM

• Clotting factors (CF) absent

• ______ = Plasma - CF

SERUM

Used for diagnosis

SERUM

Majority of immunology and serology & chemistry test makes use of this portion of the blood.

URINE

Is especially suitable for tests that evaluate kidney functions, tests that look at waste products that are excreted by the kidneys, and for metabolites that are cleared quickly from the bloodstream and accumulate in the here, such as drug of abuse (DOA).

• Creatinine Clearance measurements

• Proteins and/or Glucose

Other tests that makes use of urine:

Creatinine Clearance measurements

This test makes use of 24-hour urine

Proteins and/or Glucose

This test is used to know if there is already a certain amount of damage in the kidneys.

1st morning sample

Useful for detection of proteins or unusual analytes

Random specimen

Convenient sample that can be collected at any time

24-hour

Like a timed urine, but used for metabolites whose excretion rates may vary with time of day and full 24 hour collection is needed to be representative

1. Random specimen

2. Morning sample

3. Clean catch midstream

4. 24 hours

5. Postprandial

6. Supra-pubic aspired

TYPES OF URINE SAMPLE:

Random specimen

Sampling: No specific time

Random specimen

Sampling: Most common

Random specimen

Sampling: Taken any time of day

Random specimen

Purpose: Routine screening

Random specimen

Purpose: Chemical

Random specimen

Purpose: FEME

Morning sample

Sampling: First urine in the morning

Morning sample

Sampling: Most concentrated

Morning sample

Purpose: Pregnancy test

Morning sample

Purpose: Microscopic test

Clean catch midstream

Sampling: Discard first few mL, collect the rest

Clean catch midstream

Purpose: Culture

24 hours

Sampling: All the urine passed during the day and night and next day 1st sample is collected