Module 1 - Introduction to Clinical Chemistry

Clinical chemistry

is a branch of science which deals with the quantitative science that is concerned with measurements of amounts of biologically important substances or otherwise called the analytes found in the body fluids.

Mr. Johann Heller

Who is the father of Clinical Chemistry?

to facilitate the correct performance of analytic procedures that yield accurate and precise information, aiding in patient diagnosis, and treatment.

What is the primary purpose of a Clinical Chemistry laboratory?

Reagents

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

• integral part of any chemical reaction.

• liquid

• dry

• cartridge

• strip

What are the different forms of reagents?

• Analytical chemistry

• Biochemistry

• Endocrinology

• Instrumentation

• Toxicology

What are the areas of interest of Clinical Chemistry?

Analytical chemistry

• These studies use instruments and methods to separate, identify, and quantify matter.

• The separation, identification, or quantification may constitute the entire analysis or be combined with another method.

Qualitative analysis

means that a person needs to identify the analytes

Quantitative analysis

determines the numerical amount or concentration of a certain analyte.

Biochemistry

• It is otherwise known as biologic or biological chemistry.

• It's the study of chemical processes within and relating to living organisms.

• Structural biology

• Enzymology

• Metabolism

Three different fields of biochemistry:

Endocrinology

is a branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions, which is commonly known as hormones.

Instrumentation or automation

is a collective term for measuring instruments and it's used for indicating, measuring, and recording physical quantities.

Toxicology

is a scientific discipline which overlaps with biology, chemistry, pharmacology, and even medicine that involves the study of the adverse effects of chemical substances on living organisms.

1. Ions, salts, and minerals

2. Small organic molecules

3. Large macromolecules

What are the common analytes measured in the Clinical chemistry laboratory?

• carbonate

• acetate

• ammonium

• nitrate

• nitrite

Ions can be either?

• sodium chloride

• potassium dichromate

Example of salts

• iodine

• magnesium

• calcium

• phosphorus

• sodium

• zinc

What are the important minerals of the body?

• glucose

• cholesterol

• seric acid

• lysine

What are examples of small organic molecules?

• carbohydrates

• nucleic acid

• proteins

• lipids

four main types of biologic macromolecules for the mammalian system:

• glucose

• cholesterol

• urea

• lactic acid

• bilirubin

• creatinine

• triglycerides

• ammonia

• cystatin C

What are the common metabolites?

• Vancomycin

• Theophylline

• Digoxin

• Phenytoin

• Valproic acid

What are the common therapeutic drugs?

• Alcohol (ethanol)

• Salicylate (Aspirin)

• acetaminophen

Example of small organic molecules in toxicology

• Cocaine

• Barbiturates

• Amphetamines

• Opiates

• Cannabinoids

Common drugs of abuse

• Albumin

• Transferrin

• Haptoglobin

• Ferritin

• total protein

Examples of transport proteins

• Lipase

• Amylase

• Alanine Aminotransferase (ALT)

• Aspartate Aminotransferase (AST)

• Alkaline phosphatase (AlkP)

• Lactate dehydrogenase (LD)

• Creatinine kinase (CK)

Example of common enzymes

• Immunoglobulins (IgA, IgG, IgM)

• Complement C3

• Complement C4

• C-Reactive Protein (CRP)

Example of specific proteins

• High Density Lipoprotein (HDL)

• Low Density Lipoprotein (LDL)

• Lipoprotein (a)

Example of Lipoproteins

Hemoglobin Alc (HbA 1c)

Example of Diabetes marker

• Electrolyte panel

• Hepatic panel (Liver profile)

• Comprehensive metabolic profile

• Basic metabolic profile

• Lipid profile

What are the typical panels of tests?

• Sodium

• Chloride

• Potassium

• Carbon Dioxide

What are the components of an Electrolyte panel?

• Albumin

• Alkaline phosphatase

• Aspartate Aminotransferase (AST)

• Direct Bilirubin

• Total protein

• Alanine Aminotransferase (ALT)

• Total Bilirubin

What are the components of a Hepatic panel (Liver profile)?

• Sodium

• Chloride

• Glucose

• Potassium

• Carbon Dioxide

• Creatinine

• Urea (blood urea nitrogen:BUN)

What are the components of a Basic metabolic panel?

• Sodium

• Chloride

• Glucose

• Urea

• Total protein

• Alanine Aminotransferase (ALT)

• Alkaline Phosphatase (AlkP)

• Potassium

• Carbon Dioxide

• Creatinine

• Calcium

• Albumin

• Aspartate Aminotransferase (AST)

• Total Bilirubin

What are the components of a Comprehensive metabolic profile?

• Total cholesterol

• HDL cholesterol

• LDL Cholesterol

• Triglycerides

What are the components of a Lipid profile?

Blood

What is the most common biologic fluid collected for Clinical laboratory testing?

1. Fluid portion

2. Cellular portion

What are the two main parts of the blood?

Plasma (anticoagulated) / Serum (coagulated)

What is in the fluid portion of the blood?

• Red Blood Cells

• White Blood Cells

• Platelets

What is in the cellular portion of the blood?

Plasma

• the fluid portion of the blood that has clotting factors

• it is the main component of the blood

• water with proteins

• ions

• nutrients

• wastes

The plasma consist mostly of?

buffy coat

In what area of the centrifuged blood is RBC and WBC seen?

Serum

• Is usually used for diagnosis

• Majority of immunology and serology tests and even chemistry makes use of this

Urine

• Is suitable for tests that evaluate and check for kidney function

• It can also be used to test for proteins and/or glucose to know if there is already certain amount of damage in the kidneys

1. Random urine specimen

2. First morning urine specimen

3. Clean catch midstream urine specimen

4. 24 hours urine specimen

5. Postprandial urine specimen

6. Supra-pubic aspired urine specimen

What are the 5 types of urine samples?

Random urine specimen

• A type of urine sample that has no specific time

• It is the most common and is taken any time of the day

• Routine screening

• Chemical and FEME (Full Examination and Microscopic Examination)

What is the purpose of random urine specimen?

First morning urine specimen

• A type of urine specimen that is the most concentrated

• It is the first urine in the morning

• Pregnancy test

• Microscopic test

What is the purpose of First morning urine specimen?

Clean catch midstream urine specimen

• A type of urine specimen wherein the first flow of the urine is discarded and then the rest is collected

Culture

What is the purpose of Clean catch midstream urine specimen?

24 hours urine specimen

• A type of urine specimen wherein all the urine passed during the day and night, and the next day, 1st sample is collected

• Qualitative and Quantitative analysis of substances

What is the purpose of 24 hours urine specimen?

Postprandial urine specimen

• A type of urine specimen that is collected 2 hours after a meal

Determine the glucose in diabetic monitoring

What is the purpose of postprandial urine specimen?

Supra-pubic aspired urine specimen

• A type of urine specimen wherein it uses a needle to aspirate the urine

To obtain sterile urine

What is the purpose of supra-pubic aspired urine specimen?

Amniotic fluid

• is a clear to slightly yellow fluid that cushions the fetus within the amniotic sac

Amniocentesis

is a medical procedure used primarily in the prenatal diagnosis of genetic conditions.

• Mother’s age is 35 or more

• Chromosomal defects

• Family history of chromosomal abnormalities

• The parents carry an abnormal chromosome rearrangement or if the parent is a carrier of a metabolic disorder

• Assess if the fetus lungs have already matured for fetal lung maturity

What are the indications for Amniocentesis?

Peritoneal fluid

• Is collected in the pericardium of the abdominal cavity which lubricates the surface of tissue that lines the abdominal wall and the pelvic cavity

Paracentesis

What is the collection of peritoneal fluid called?

Ascites

An increased volume of peritoneal fluid is called?

Pericardial fluid

• Is secreted by the serous layer of the pericardium into the pericardial cavity

Reduces friction within the pericardium by lubricating the epicardial surface allowing the membranes to glide over each other with each of the beating of the heart

What is the purpose of the pericardial fluid?

Pleural fluid

• Is produced by the serous membrane covering the normal pleura

• Clinical microscopy

• Microbiology

• Chemical studies

• Tumor markers

If there is accumulation of pleural fluid, what are the cytopathologic evaluation done?

Dry reagent strip

• requires the comparison of a color change on the reagent strip color chart

• Subject to inaccuracy but there is subjectivity

• Commonly done in the chemical examination for urine

Wet and dry chemistry systems

• Makes use or utilizes a spectrophotometer to mechanically measure any color change

• standardized

1. dry reagent strip

2. wet and det chemistry system

2 types of chemistry system

1. Qualitative measurement/Analysis

2. Quantitative measurement/Analysis

2 types of measurement

Qualitative measurement/analysis

• Gives results in descriptive, non-numeric form

Quantitative measurement/analysis

• Give results in definitive numeric for

• It has numbers with the units provided