Clinical Biochemistry

Introduction
Dr. Abeer Shnoudeh
Philadelphia University
Faculty of Pharmacy
Objectives
• To understand what is clinical biochemistry and what is its role and
uses in medical field.
• To know the types of test and samples
• To understand what is sampling, and sampling errors.
• To know what is reference range (normal range).
What is clinical Biochemistry/clinical
chemistry?
• It is a branch of laboratory medicine in which chemical and biochemical methods
are applied to study a disease.
• (laboratory medicine: microbiology lab, hematology lab, histopathology,
immunology, clinical biochemistry)
• It is used to provide information to mange patients.

• Analysis are made on:

• Blood
• Urine
• Body fluids
• Gastric aspirates
• Cerebrospinal fluid
What are the Uses of Clinical Biochemistry?
Biochemical test are used in medicine:
In relation to diseases that have clear metabolic basis such as DM, hypothyroidism
In relation to diseases in which biochemical changes are a consequence of the
disease such as renal failure, and malabsorption

Screening
Detection of subclinical disease
(eg Measuring G6PD, bilirubin, TSH , PKU in newborn)
Monitoring
Monitoring progression or monitor response to
treatment
Eg. Hyperthyroidism, glycosylated Hb in DM ..etc)
Diagnosis
Confirmation or rejection of clinical diagnosis
Eg Diagnosis of DM, hypothyroidism)
Prognosis
Information regarding the likely outcome of disease
Eg: serial measurements of plasma creatinine
concentration in progressive renal disease are used to
indicate when the patient need dialysis.
Cholesterol concentration…may predict ? Coronary
artery disease.
Where is the place of clinical biochemistry in
medicine?
• History

• Clinical examination

• Diagnosis services (imaging, physiological tests, ECG, EEG)

• Laboratory Services (Haematology, histopathology, immunology,

microbiology.

• Clinical Biochemistry (emergency services, core biochemistry, specialized

tests)
Core test and specialized tests:
• Core tests are:
Urea and electrolytes
Liver function tests
Blood gases

• Specialized tests includes tests for:

Hormones
Specific proteins
Traces elements
Vitamins
Drugs
Lipids and lipoproteins
DNA analysis
Specimen Types:
• Venous blood (serum or plasma)
• Arterial blood
• Capillary blood
• Urine
• Feces (stool)
• CSF (cerebrospinal fluid)
• Sputum and saliva
• Tissues and cells
• Aspirates like pleural fluid, and joint fluid
• Calculi (kidney stones)
What is the difference between serum and
Plasma?

Serum=plasma-clotting factors
Laboratory tubes cap color indication
Sampling
The collected sample should include:
• Patient’s name, sex, and date of birth
• Hospital number
• Ward/clinic/address
• Name of requesting doctor
• Clinical diagnosis/problem
• Test(s) requested
• Type of specimen
• Date and time of sampling
• Relevant treatment e.g. drugs
Important factors which influence
biochemical variables

Fig 1.2
sample
• Should use right tube(container) and avoid hemolysis of samples.
why?

• Hemolysis causes:
1. increases in plasma potassium and phosphate concentrations and
aspartate aminotransferase activity, owing to leakage from red cells.
2. If haemolysis is a consequence of a delay in centrifugation to
separate blood cells from plasma, glucose concentration can fall
 example
• Case study 1.1
The laboratory staff were concerned when a serum specimen from an outpatient due to attend the
diabetic clinic was analysed and the following results were found:

Investigations
Serum:
potassium 12.2 mmol/L (3.6-5 mmol/L)
sodium 140 mmol/L (135-145 mmol/L)
creatinine 84 µmol/L (60-120 umol/L)
calcium 0.34 mmol/L (2.2-2.6 mmol/L)
phosphate 1.22 mmol/L (0.8-1.4 mmo/L)

Comment
The potassium and calcium concentrations are not compatible with life. Investigation disclosed
that a locum phlebotomist who had taken the blood had collected the original specimen into a
tube containing (potassium) fluoride and oxalate, the correct container for an accurate blood
glucose measurement, but had then concealed his error by transferring the sample to a plain
tube. Oxalate acts as an anticoagulant by binding to calcium ions (cofactors in several of the
reactions in the clotting cascade) to form insoluble calcium oxalate.
Sample Analysis and reporting of results (1)
• The ideal analytical method is accurate, precise, sensitive and specific.
• Precision: is the reproducibility of an analytical method.
• Accuracy: defines how close the measured value is to the actual
value.
• EXAMPLES
• Precision
• 1st time= 2.4, 2nd= 2.38, 3rd time 2.41 this method is precise
• Not precise if 1st time= 2.4, 2nd time = 5, 3rd time =3.5

• Accuracy:
• How close the value is to the true value x=1
• Method A- 1.1
• Method B-2
Sample Analysis and reporting of results (2)
• Sensitivity: is a measure of how little of analyte the method can
detect
• Specificity: how good the assay is at discriminating between the
requested analyte and potentially interfering substances.
sensitivity
method 1 can test lowest conc of x= 0.01
Method 2 the lowest conc of x can be measured= 1
Which method is sensitive?

Specificity:
Method A can measure X without interference from X*

Method B measure x with measuring small amount of X*

Which method is specific?

 • False positive (FP): an abnormal result in a patient who is
subsequently found not to have the disease.
• False Negative (FN): A normal result in a patient who has the
disease
• True positive (TP)
• True negative (TN)

• Sensitivity= {TP/all with disease(TP+FN)} x 100

• Specificity= {TN/all without disease (FP+TN)} x 100

Sources of error
• pre-analytical, occurring outside the laboratory (e.g. the wrong
specimen being collected,mislabelling, incorrect preservation, etc.)
• analytical, occurring within the laboratory (e.g. human or
instrumental error)
• post-analytical, whereby a correct result is generated but is
incorrectly recorded in the patient’s record (e.g. because of a
transcription error).
Reference Intervals:
• Biochemical test results are usually compared to reference interval
chosen arbitrarily to include 95% of the values found in healthy
volunteers this means that 5% of any population will have a result
outside the reference interval
References
• Clinical Biochemistry : Lecture notes, by Geoffery Beckett, Simon Walker,
Peter Rae, Peter Ashby, Blackwell publishing, 7th edition, 2005, ISBN, 978-1-
4051-2959-6

• Clinical Biochemistry: an Illustrated color text, by Allan Gaw, Robert Cowan,

Denis O'Reilly, and Michael Stewart Edinburgh: Churchill Livingstone, 3rd
Edition, 2004,. ISBN 0-443-07269-8
•
• Clinical Chemistry: Principles, Procedures, Correlations by Michael L.
Bishop, Edward P. Fody, Larry E. Schoeff Publisher: Lippincott Williams &
Wilkins; 5th edition (July 6, 2004) ISBN: 0781746116