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(CLINICAL CHEMISTRY) (ANALYTES) (CORRECT PERFORMANCE) (ACCURATE AND PRECISE INFORMATION,

AIDING PATIENT DIAGNOSIS AND TREATMENT)

(__________________)

A QUANTITATIVE SCIENCE THAT IS CONCERNED WITH MEASUREMENT OF AMOUNTS OF BIOLOGICALLY IMPORTANT SUBSTANCES

(CALLED (________) IN BODY FLUIDS.

PRIMARY PURPOSE: TO FACILITATE THE (_____________). OF ANALYTIC PROCEDURES THAT YIELD (________, __________, __________, _________)

(RAPIDLY ADVANCING)

CLINICAL CHEMISTRY

.

CONTINUES TO BE

ONE OF THE MOST

(__________________) AREAS OF LABORATORY MEDICINE.

Improving quality of patient care

(___________________________)

- by releasing the accurate and precise results for diagnosis and treatment of diseases

Individual patient outcomes

Financial responsibility

Total quality management

REAGENTS

SUBSTANCES THAT ARE EMPLOYED TO PRODUCE A CHEMICAL REACTION WHEN COUPLED WITH OTHER

SUBSTANCES

(LIQUID, DRY, CARTRIDGE.) (DATE/TIME)

(PREPARATION, CONCENTRATION)

REAGENTS

" DEPENDING ON THE INSTRUMENTATION, REAGENTS COME IN SEVERAL FORMS: (_______, ______, _______) STRIP

ANY REAGENT THAT IS PREPARED MUST

BE LABELED

WITH (__________) OF

(_________, ____________).

(MANUAL)

• (______) MEANS MAKING THE TEST REAGENTS AND PERFORMING THE BY HAND.

(SLOW/ TIME-CONSUMING) (LABOR INTENSIVE) (OFTEN NOT PRECISE) (TECHNOLOGISTS)

TESTING BY MANUAL METHODS

• (_______________).

• (________________)

• (_________________)

EVEN AS LATE AS 1960 MOST TESTS PERFORMED IN THE LAB WERE DONE MANUALLY.

REAGENTS WERE MADE BY THE (____________): TESTS WERE PERFORMED USUALLY SINGLY WHEN NEEDED.

AUTOMATED ANALYZERS

(_______________________) MERELY INCORPORATE THE METHODS PREVIOUSLY MANUAL METHODS FOR CHEMICALS USED IN ANALYSIS

(TESTS PERFORMED) (LABOR COSTS DECREASE) (VARIATION IN RESULTS) (VARIETY OF TECHNIQUES/TESTS)

TESTING BY AUTOMATED METHODS

• COMMON BENEFITS OF AUTOMATION:

INCREASED NUMBER OF (____________) BY TECHNOLOGIST IN A GIVEN TIME PERIOD ONE

• (______________)

• MINIMIZED (___________) BETWEEN TECHNOLOGISTS DUE TO SLIGHT VARIATIONS IN TECHNIQUE.

OFFERED;

• INCREASED (______________) BEING IMPROVED PATIENT CARE AS A RESULT

(Analytical chemistry) (Qualitative analysis) (Quantitative analysis)

AREAS OF INTEREST OF CLINICAL CHEMISTRY

	• Studies and uses instruments and methods to separate, identify, and quantify matter • In our practice, the separation, identification, and quantification may constitute the entire analysis or become combined with another method. • In the separation, it isolates the analytes.
	• (_________) means that The analyte must be identified.
	• (__________) determines the numerical amount or concentration of that certain analyte.

(Biologic Chemistry) (Chemistry) (Biology) (Structural biology) (Enzymology) (Metabolism)

AREAS OF INTEREST OF CLINICAL CHEMISTRY

(________)	• Otherwise known as (_______) • Study of chemical processes within and relating to living organisms
	• A subdiscipline of Biochemistry includes (______) and (_______).
	• May be divided into 3 different fields: o (_________) o (________) o (___________)

(Endocrinology) (hormones)

AREAS OF INTEREST OF CLINICAL CHEMISTRY

(_______)	• Branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions known as “(______)”
	• Also concerned with the integration of developmental events, such as: o proliferation, o growth, o differentiation, o psychological or behavioral activities of metabolism, o growth and development, o tissue function, o sleep, o digestion, o respiration, o excretion, o mood, o stress, o lactation, o movement, o reproduction, o and sensory perception cause by our hormones

(Instrumentation) (laboratories, factories, vehicles) (household)

AREAS OF INTEREST OF CLINICAL CHEMISTRY

	• A collective term for measuring instruments and is used for indicating, measuring, and recording physical quantities • A field of study about the art and science of making measurements instruments involving the related areas of automation
	• 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
	• Instruments can be found in (______, _____, _____), and everyday (________) use.

(Toxicology) (dose) (effect) (cancer research)

AREAS OF INTEREST OF CLINICAL CHEMISTRY

(________)	• scientific discipline which overlaps with Biology, Chemistry, Pharmacology, and Medicine that involves the study of adverse effects of chemical substances on living organisms • It is also the practice of diagnosing and treating exposure to toxins and toxicants.
	• The relationship between (____) and its (____) on the exposed organism is of high significance in Toxicology. • It is currently contributing to the field of (_________) because some toxins can be used as drugs for killing tumor cells.

(carbonate,

• acetate,

• ammonium,

• nitrate,

• nitrite)

(• sodium chloride

• potassium dichromate)

(• calcium

• iodine

• magnesium

• phosphorus

• sodium

• zinc)

(• glucose (for sugar/carbohydrates)

• cholesterol (for lipids)

• stearic acid (for fatty acid)

• lysine (amino acid))

(• 4 main types of biologic

macromolecules for the mammalian

system

• Carbohydrates

• Nucleic acid

• Proteins

• Lipids)

COMMON ANALYTES MEASURED IN THE CLINICAL

CHEMISTRY LABORATORY:

	EXAMPLES
Ions
Salts

Minerals	- - - - - -
Small organic molecules	- - - -
Large macro- molecules	- - - -

Ions, salts, and minerals	Small organic molecules	Large macromolecules
- - - - - - - - -	Metabolites - - - - - - - - -	Transport Proteins - - - - -
	Therapeutic Drugs - - - - - Toxicology - - -	Enzymes

	Small organic molecules	Large macromolecules
	Drug of Abuse - - - - -	Specific Proteins - - - - Lipoprotein - - -
		Diabetes Marker -

panel or profile

When an individual test alone is not sufficient to assess a

medical condition, a combination of several tests may be

used on the same sample, often ordered as a group called

(_____/____).

(• Sodium (Na)

• Potassium (K)

• Chloride (Cl)

• Carbon dioxide (CO2) (• Albumin

• Total Protein

• Alkaline phosphatase

• Alanine aminotransferase (ALT)

• Aspartate Aminotransferase (AST)

• Total bilirubin

• Direct bilirubin) (• 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 TYPICAL PANELS

Electrolyte panel	- - - -
Hepatic panel (liver profile)	- - - - - - -
Comprehensive Metabolic profile	- - - - - - - - - - - - -

Basic metabolic panel	- - - - - - - -
Lipid profile	- - - -

Blood

Urine

Cerebrospinal fluid (CSF)

Amniotic fluid

Synovial fluid

Pleural fluid (CSF)

Peritoneal fluid

Pericardial fluid

Others

COMMON BIOLOGICAL SPECIMENS ACCEPTABLE IN

THE CLINICAL CHEMISTRY DEPARTMENT

BLOOD

• The most common biologic fluid collected for clinical

laboratory testing.

(Fluid portion) (plasma) (cellular portion)

Blood consists of 2 main parts:

(_______)	• (_____) (anticoagulated blood) containing dissolved ions and molecules
(________)	• Made up of the red blood cells, white blood cells, and platelets

(anticoagulants) (anticoagulants) (Clotting factors) (CF) (Plasma - CF) (blood cells) (diagnosis)

PLASMA	SERUM
• Centrifugation done directly with (____________)	Centrifugation done after coagulation without (________)
(_________) present	• (__) absent • Serum= (____-___)

Given to patients lacking (_________)	• Used for (______)

(Plasma) (WBC and platelets)

• (_______) is the main component of blood

• It consists mostly of water with proteins, ions, nutrients,

and wastes mixed in.

• (______&_____) are found in the buffy coat area

SERUM

(_______)

• Centrifugation is done after coagulation without

anticoagulants.

• Usually used for diagnosis

• Majority of immunology and serology & chemistry test

makes use of serum

(plasma) (serum)

• If a blood sample is collected in a tube containing

additive which prevents blood from clotting, the fluid

portion of the blood is known to be as “(______)”

• If blood collected in a tube with no anti-coagulant which

  the blood allow to clot is known to be “(______)”

• Upon centrifugation, the blood descent to the bottom of

  the tube along with the cells. The resulting above the cell

  and clot is called “(2) (________)”.

(URINE) (drug of abuse (DOA)) (creatinine clearance measurements) (24) (proteins and/or glucose)

• 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 urine, such as (___________).

• Other tests:

o (____________) (makes use of (___)-

hour urine)

o (___________) (to know if there is already a

certain amount of damage in the kidneys)

(1st morning sample) (Random) (24-hour)

(_______)	• Useful for detection of proteins or unusual analytes
(_______)	• Convenient sample that can be collected at any time
(________)	• 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

(specific time) (common) (time) (Routine screening) (Chemical) (FEME)

(First urine) (concentrated) (Pregnancy test) (Microscopic test)

(Discard first few mL) (Culture) (day and night) (next day

1st sample) (Quantitative and

qualitative) (diabetic) (• Needle aspiration) (sterile urine) () () () ()

TYPES OF URINE SAMPLE

Sample Type	Sampling	Purpose
Random specimen	• No (______) • Most (_____) • Taken any (____) of day	• (_________) • (________) • (_______)
Morning sample	• (_____) in the morning • Most (_________)	• (__________) • (__________)

Clean catch midstream	• (_____), collect the rest	(______)
24 hours	• All the urine passed during the (______) and (__________) is collected	• (_____&_____) analysis of substances
Postprandial	• 2 hours after meal	• Determine glucose in (_______) monitoring

Supra-pubic aspired	(________)	• Obtaining (________)

(Amniotic fluid) (Pericardial fluid) (Peritoneal fluid) (Pleural fluid)

OTHER FLUIDS ACCEPTED FOR CLINICAL CHEMITRY

ANALYSIS:

(_______)	(_______)
(________)	(_________)

AMNIOTIC FLUID

• A clear to slightly yellow liquid that cushions the fetus

within the amniotic sac

• The developing fetus floats in the amniotic fluid for the

entire duration of the pregnancy

(AMNIOCENTESIS) (35) (Trisomy 21) (Down syndrome) (Parent) () () () ()

• Indications:

o The mother’s age is (___) or more

o There can be an indication for chromosomal defects

o Family history of chromosome abnormality, such as

(________) or (________)

o Parents carry an abnormal chromosome

rearrangement

o (_______) is a carrier of a metabolic disorder

o To assess if the fetus’ lungs have already matured à

fetal lung maturity

(PERITONEAL FLUID) (Abdominal Paracentesis) (serous fluid)

(___________)

• Collection is called (______________)

• Is collected in the peritoneum of the abdominal cavity

which lubricates the surface of tissue that lines the

abdominal wall and pelvic cavity

• A (________) that covers most of the organs in the

abdomen

ASCITES

• Increased volume of peritoneal fluid

PERICARDIAL FLUID

• Serous fluid secreted by the serous layer of the

pericardium into the pericardial cavity

• Its purpose is to reduce the friction within the pericardium

by lubricating the epicardial surface, allowing the

membranes to glide over each other with each beating of

the heart

(PLEURAL FLUID) (Pleura) (lymphatic

system)

(________________)

• Serous fluid produced by the serous membrane covering

the normal pleura

• (_______) refers to the lining of the lungs

• Most fluid is produced by the exudation and parietal

circulation via bulk flow and reabsorbed by the (_____________)

(cytopathologic evaluation) (clinical microscopy) (microbiology) (chemical studies) (tumor markers) (fluid)

• When the accumulation of the pleural fluid is noted, we can

do:

o (____________) of the fluid,

o (_____________)

o (__________)

o (__________)

o (____________)

o and all of the other tests that serve as diagnostic tools

for determining the causes of this abnormal

accumulation

• The fluid is normally there but there shouldn’t be any

accumulation.

• Abnormal accumulation indicates the removal of the (____)

for testing.

(color change) (reagent strip) (chemical examination) (quick screening

test) (spectrophotometer) (results) (more accurate)

TWO CHEMISTRY SYSTEMS IN THE

CLINICAL CHEMISTRY DEPARTMENT:

Dry reagent strips	Wet and dry chemistry systems
• require the comparison of a (________) on the (_________) color chart • commonly done in the (_____________) for urine in the clinical microscopy section • most commonly used as a (___________) accuracy is only low to moderate	• utilizes a (______________) to mechanically measure color change

MAIN DIFFERENCE

subjectivity to the reading of the (_____)	• (_________)

(descriptive, non-numeric form) (definitive form) (numbers) (dry reagent strip)

TYPES OF MEASUREMENTS IN

CLINICAL CHEMISTRY DEPARTMENT:

Qualitative	Quantitative
• gives result in (________, ________, ______)	• gives results in a (______), usually in (____) with units
• when a (_______) is used, the color chart is utilized to compare the readings