Clinical Chemistry 1

LECTURE

MODULE 1 UNIT 1: INTRODUCTION TO CLINICAL CHEMISTRY

To assure that accurate laboratory results are obtained, it is

CLINICAL CHEMISTRY essential that specimens be ordered, collected, processed and
 links the knowledge of: stored correctly.
o general chemistry  This also includes patient preparation, specimen
o organic chemistry considerations and variables.
o biochemistry
o human physiology e. Analytes
 As a service, it produces objective evidence from which Clinical chemistry is a quantitative science that is concerned with
medical decisions may be made. measurement of amounts of biologically important substances
(called analytes) in body fluids.
CLINICAL BLOOD CHEMISTRY ANALYSIS  The methods to measure these substances are carefully
 covers the analysis of blood chemical components, designed to provide accurate assessments of their
including: concentration.
o carbohydrates  The results of clinical chemistry tests are compared to
o lipids reference intervals or a medical decision level to
o non-protein nitrogen provide diagnostic and clinical meaning for the values.
o blood electrolytes
o hormones, proteins NOTE:
o enzymes The primary purpose of a clinical chemistry laboratory is to
o blood gases perform analytic procedures that yield accurate and precise
 It is carried out through the application of the principles of information, aiding in patient diagnosis and treatment.
instrumentation, including the fully automated chemistry
analyser. B. Definition of terms
 Such analysis requires the technique of:
o blood collection through venipuncture Accuracy Agreement between your test result value and
o time of collection the true value
o manner of collection Aliquot The division of a sample into at least two smaller
o the use of the right anticoagulant size vials.
o preparation of patients for blood extraction Analyte The chemical substance being measured in an
o interpretation of results assay, usually contained in blood or other body
o determination of accuracy of results through fluids.
quality control monitoring Assay A diagnostic test to measure the concentration
or level of a particular analyte.
A. Scope Clinical chemistry Buffer A liquid solution containing a combination of
chemicals, which control and maintain the pH of
any other solution it is added to.
a. Instrumentation Calibrator A material, generally serum based with an
The development of instrumentation has determined much of the accurately assigned analytical value, used to
progress of clinical chemistry. Instruments fulfill two functions: calibrate diagnostic assays.
(1) to enable an analysis to be made which is not Control A serum based material with assigned target
otherwise possible, and values and acceptable ranges to evaluate the
(2) to enable it to be made faster, more accurately, on accuracy and reproducibility of a diagnostic
smaller quantities, or more cheaply than by alternative assay.
methods. Linearity It is used to describe the highest concentration,
at which a reaction is still measurable.
b. Quality management Lyophilised The term lyophilised refers to a material that
Total quality management in clinical chemistry consists of efforts has been freeze-dried
to establish and maintain a climate of continued improvements in Metabolite Any biochemical compound which plays a key
the laboratory in order to deliver high-quality services to health role in the metabolism of the body.
care. Plasma The clear amber liquid which is derived from
whole blood that has been collected in the
c. Laboratory safety presence of an anticoagulant
Laboratory safety practices include appropriate facilities and Precision Refers to the reproducibility of test results and
equipment, adequate training, personal protective equipment, is a measure of how disperse the values are
chemical management, standard operating procedures, waste Quality The process of detecting errors in any
handling, signage, proper laboratory practices and safe working Control manufacturing or operational system.
conditions. Reagent A component of a kit used to carry out a
chemical reaction to determine levels of
d. Specimen collection and processing different analytes

CAMACHO, ARRIANE CYREL A. | BSMLS 2

1
Clinical Chemistry 1
LECTURE

MODULE 1 UNIT 1: INTRODUCTION TO CLINICAL CHEMISTRY

Reconstitutio The addition of water to a freeze-dried reagent ammonia

n or control material to return it to its former  refractometer: used for measuring protein
condition. in urine
Serum The clear amber liquid that is derived from  Beckman Instruments: a company that was
clotted blood by centrifuging and removing the to play a large part in laboratory science
red blood cells.  introduced the first pH meter to measure
Standard An aqueous solution containing a known level or the acidity and alkalinity of fluids
concentration of analyte that will not change
and can be used to calculate diagnostic results. 1940  photoelectric colorimeters: to read color
reactions of chemistry analyses
C. History of Clinical chemistry  vacuum collection tubes
 College of American Pathologists (CAP) and
Hippocrates  attributing disease to abnormalities in the the American Association of Clinical
ancient body fluids Chemistry (AACC
Greece(300  tasting the patient’s urine, listening to the 1950  *Shewhart QC chart: made tracking quality
B.C) lungs, and observing the patient’s (Levey and control easier
appearance Jennings)  Methods to measure several enzymes were
 made the connection between the developed: useful for indicating the site of
appearance of blood and pus in the urine organ or tissue damage
to the presence of disease Technicon  a method was developed to directly
Physician in  hematuria: blood in the urine Corporation measure blood triglycerides
Ephesus  Urine testing continued to be important in (late 1950s)  *AutoAnalyzer: a landmark invention
(A.D. 50 medicine through the Middle Ages  flame photometry was applied to
1600s)  microscope: to study structures such as automated methods of clinical analysis
plant cells Perkin-Elmer  rapid development in technology and stage
 circulation of blood throughout the body (1960) for the rapid progression
 a method of precipitating urine protein by  *atomic absorption spectrophotometer:
heat and acid for determination of calcium and
late 1700s  diabetes: sugar was responsible for the magnesium
sweetness of urine of some patients  laser
 first tests for sugar in the urine, using  Auto Dilutor: first mechanical pipetter
yeasts Becton  disposable needle and syringe
1850 to 1809  laboratory medicine became more Dickinson
accepted IBM  disk storage for computers
 most laboratory tests were performed by DuPont  first random-access analyzer
physicians using a microscope in their
homes or offices 1960s  rapid progression of clinical chemistry
instrumentation that continues today
1918  the inspection criteria of the American
 Analyzers have evolved from being large
College of Surgeons required hospitals to
and complex to smaller counter-top
have an adequately equipped and staffed
analyzers and handheld instruments, some
laboratory
simple enough to be used at home by the
Otto Folin  almost half of US hospitals had
patient.
(1920s) laboratories
 *several methods for determining urine
D. Importance of Clinical Chemistry Analysis
analytes had been developed
 A central function of the clinical chemistry laboratory is to
 epinephrine, uric acid, ammonia,
provide biochemical information for the management of
nonprotein nitrogen (NPN) and protein in patients.
blood o Such information will be of value only if it is accurate
 established the relationship of uric acid, and relevant, and if its significance is appreciated by
NPN, and blood urea nitrogen (BUN) to the clinician so that it can be used appropriately to
renal function guide clinical decision-making.
 FolinCiocalteau reagent  The clinical chemistry laboratory provides accurate, precise
measurements of selected biochemical markers, accompanied
 still used today for protein determination
by reference, or comparison, ranges of the concentration of
 clinical methods for measuring phosphorus these biochemical markers in healthy individuals.
and magnesium in serum were introduced o Biochemical marker analysis is one factor in the
1930s  clinical determinations of alkaline assessment of the patient.
phosphatase, acid phosphatase, serum  Biochemical investigations are used extensively in medicine,
lipase, serum and urine amylase, and blood both in relation to diseases that have an obvious metabolic

CAMACHO, ARRIANE CYREL A. | BSMLS 2

2
Clinical Chemistry 1
LECTURE

MODULE 1 UNIT 1: INTRODUCTION TO CLINICAL CHEMISTRY

basis (e.g. diabetes mellitus, hypothyroidism) and those in 5. Adapt policies and procedures in the conduct of clinical
which biochemical changes are a consequence of the disease chemistry analysis. Perform correctly laboratory assays used to
(e.g. kidney failure, malabsorption). measure concentration of analytes
o The principal uses of biochemical investigations are 6. Recognize common problems encountered in the clinical
for diagnosis, prognosis, monitoring and screening. laboratory and come up with appropriate solutions
 Clinical chemistry includes the quantitative analysis of the 7. Demonstrate punctuality in accomplishing expected tasks and
various analytes (substances being analyzed; in this case, functions as a clinical chemistry scientist and student
chemicals) dissolved in the fluids of our bodies. 8. Show professional behavior and attitude
o Quantitative tests provide an actual number that 9. convey knowledge regarding the interactions among different
represents the amount of a substance present in the biochemical substances
body. 10. Recognize and be responsive to new and diverse perspectives
o Qualitative testing, which indicates the presence or and feedback into the work
absence of specific chemicals, may also be performed
in the clinical chemistry department in the laboratory.
o Chemical elements are present in our bodies at all
times, but increases or decreases in the levels of
certain analytes may be indicative of a disease
process.
o Clinical chemistry testing allows the health-care
provider to evaluate these changes and use them to
diagnose and prescribe treatment.
 Blood chemistry tests can be organized into the categories of
routine and special.
o The routine tests are those that are frequently
ordered, such as a single test for glucose or a
chemistry profile.
o A routine chemistry profile, also called a complete
metabolic profile, is a group of tests performed
simultaneously on a patient specimen to provide an
assessment of the patient’s general condition.
o Tests included in a routine chemistry profile reflect
the state of carbohydrate and lipid metabolism, as
well as kidney, thyroid, liver, and cardiac function.
o Profiles or panels that assess one particular biological
system, such as renal or liver function, are also
performed.
 Many chemistry analyzers are capable of performing chemistry
profiles on hundreds of patient samples per hour.
o Tests that are ordered less frequently, such as
hormones or certain drug levels, might be performed
only on certain days even in the larger laboratories
and are sometimes referred to as special tests.
o Many laboratories send these specimens to a regional
or reference laboratory.
o These tests are usually requested when a particular
diagnosis is suspected or treatment must be
monitored.

E. Roles of Medical laboratory scientist in the clinical chemistry

section

Roles of medical laboratory scientist in the clinical chemistry

section
1. Calculate basic laboratory mathematical problems
2. Practice quality assurance and laboratory safety in doing
chemistry analysis
3. Perform correct specimen collection and processing according
to standard guidelines
4. Apply concepts and principles of instrumentation in the
laboratory

CAMACHO, ARRIANE CYREL A. | BSMLS 2

3