LABORATORY

SAFETY AND EQUIPMENT

CHAPTER

LEARNING OUTCOMES

At the end of this chapter, the students should be able to:

1. describe the classes of fire and hazardous materials;

2. discuss the hazards related to handling of biological samples and chemicals;
3. relate laboratory-acquired infection with the workstation procedures;
4. cite the biosafety practices;

5. distinguish the types of biological safety cabinets; and

6. outline the instruments which require quality control monitoring.

be provided with
Safety in the clinical laboratory is fundamental in quality management. The personnel should
a secure working environment with provisions for containment of hazards, as well as infographics on ergonomics,
safety protocols, and proper disposal.

TABLE 2. Types of Hazards and Fire Extinguishers

Class of Fire Hazard Extinguisher

Ordinary combustibles Water, dry chemical, and loaded steam

Type A
cloth, paper, plastics, and wood
Flammable liquids Dry chemical, carbon dioxide, and halon foam
2. Type B
grease, gasoline, paints, and oil
Electrical equipment Carbon dioxide, dry chemical and halon
3. Type C
motor switches
Metal X
4. Type D Flammable metals
mercury, magnesium, sodium, and lithium This type of fire should be extinguished by fire
fighters only.

Detonation (arsenal fire) Usually allowed to burn out and nearby materials
5. Type E
are protected

Source: National Fire Protection Association(NFPA)

Hazardous Wastes

These are substances which, singly or in combination, pose significant threat or hazard to human health or to
the environment and require special handling, processing, or disposal.
They could be flammable, explosive, reactive, corrosive, toxic, infectious, carcinogenic, bioconcentrative-
persistent in nature, potentially lethal, an irritant, an oxidizer, or a strong sensitizer.
Source: Review Handbook in Diagnostic Bacteriology (3rd ed.) by Rodriguez, 2022.
 LABORATORY SAFETY AND EQUIPMENT
10

ASSESSMENT QUIZ
another room or place?
1. At what volume of acids should a safety carrier be provided during transport to
a. 100 mL c. 300 ml
b. 200 mL d. 500 mL

_ 2. Petrolatum, oil, and greases are hazards which may cause which class of fire?
type A C. type (
b. type B d. type E
be in contact with the surface
To inactivate hepatitis B virus, how long should the household bleach
or area?
3.

a. 10 minutes c. 40 minutes
b. 20 minutes d. 60 minutes
to their incompatibility.
4. Chlorine should not be stored together with this chemical due
a. bromine c. halogen
b. ammonia d. potassium
5. Which type of biological safety binet must be used when processing radioisotopes and possible
carcinogenic chemicals?
a. class II, type A1 C. class II, type B1
b. class II, type A2 d. class II, type B2
In quality control monitoring, which component of the fume hood should be checked and at what interval?
a air flow, biannual
b. air duct, annual
C. face velocity and operation, annual
d. exhaust duct, biannual

7. What is the maximum volume of flammable solvent that could be stored outside the designated cabinet?
a. 1 gallon/room C. 5 gallons/room
b. 3 gallons/room d. gallons/room
8. Which of the following is considered as the standard health hazard sign?
a. white quadrant C. yellow quadrant

b. blue quadrant d. red quadrant

9. Heat is an effective surface decontaminating agent when it is maintained at least at this temperature and
contact time.

a. 250° C for 15 minutes C. 400° C for 20 minutes

b. 350° C for 30 minutes d. 500° C for 10 minutes
10. What is the recommended interval for recalibration of automatic pipettes?
a. every 2 months C. every 6 months
b. every 3 months d. every 12 months
 3 REAGENT PREPARATION
CHAPTER

LEARNING OUTCOMES
At the end of this chapter, the students should be able to:
1. discuss the types of reagent water;
2. elucidate the process of documenting the water purification; woealy antlduawrgel bosesi it
3. distinguish the chemical grades utilized in reagent preparation; and
4. explain the various solutions used in the clinical chemistry laboratory.

In preparing reference materials, reagents, and solutions, appropriate water should be utilized to ensure the
reliability of results. Water purity should be confirmed with proper documentation.

Chemicals Used for Reagent Preparation

1. Analytical Reagent Grade (AR)
It is important for qualitative and quantitative analyses, and essential for accuracy.
Specifications were established by the American Chemical Society (ACS).
Labels on these reagents either state the actual impurities for each chemical lot or list the maximum

allowable impurities ( percentage of impurities).

Uses: Trace metal analysis and preparation of standard solutions

2. Ultrapure Reagents
These types of reagents have been put through additional purification steps.
Examples: Spectrograde, nanograde, and HPLC pure
Uses: Chromatography, atomic absorption, and immunoassays

3. United States Pharmacopeia (USP) and National Formulary (NF)

It is approved for human consumption (not injurious to individuals) but may not be applicable for
laboratory analysis.
Use: For drug manufacturing
4. Technical or Commercial Grade
It is used primarily in manufacturing.
It should never be used in clinical laboratory testing.

5. Chemically Pure (CP) or Pure Grade

The impurity limitations of this type of chemicals are usually
not stated.

It also fails to reveal the tolerance limits of impurities.

Preparation of these chemicals is not uniform.

Purity is usually delivered by measurement of melting point or boiling point.
It is not recommended for research and analytical chemistry unless further purification or a reagent blank
is included.
 14 PREPADT
REAGENT REPARATI

ASSESSMENT QUIZ
following grades of water is required>
1.
For analytical testing which requires maximum purity, which of the
a. Type II
b. Type I
C. Type IV
d. Type IlI
2. Which type of chemical is utilized for qualitative and quantitative analyses of trace metals?
a. Ultra-pure
b. Analytical reagent grade
c. USP Grade

d. Chemically Pure
Which of the following may not be included when documenting the properties of reagent grade water?
a. water resistance

b. pH
c. culture growth

d. purification procedure
4. It is the most commonly isolated bacteri: in water after completing the purification step:
a. Atypical bacteria
b. Gram-positive cocci
C.Gram-positive bacilli
d. Gram-negative bacilli
5. The following are correct regarding water purification, EXCEPT:
a. Water may be distilled more than once.
b. Water can be purified by ozone treatment.

C. Detergent contaminated water has an acidic pH.

d. Chemical oxygen demand is included in the tests for watery purity.
 LABORATORY
MATHEMATICS
CHAPTER

LEARNING OUTCOMES
At the end of this chapter, the students should be able to:
1. calculate basic laboratory mathematics;
2. explain the outcome of each laboratory computation; and
3. convert the units of measurement from conventional method to SI.

Basic calculations are utilized in chemistry to determine percent solutions, concentration, and
moles and solute
dilution. Precautions should be in placed especially when preparing concentrated acid solutions; always add acid to
water.

TABLE 8. Percent Solution

Weight/Volume Number of grams of solute per

% solution desired x total volume desired
(w/v) % solution 100 ml of solution
Grams of solute
100
Most common type of solution
prepared in clinical laboratory
Volume/Volume Amount of solute in milliliter (mL)
% solution desired x total volume desired
(v/v) % solution per 100 mL of solvent
mL of solute =
Used when both solute and solvent 100

are liquid

Weight/weight Number of grams of solute per 100 % solution desired X grams of the total solution
grams (gms) of solution Grams of solute =
(w/w) % solution 100

TABLE 9. Laboratory Mathematics

Formula
Description

Molarity Number of moles of solute per volume (liter) of Grams of solute

Molarity (M) =
solution

One mole of substance equals its gram molecular Weight (gms)

Moles
weight (GMW)

add the atomic weights of the elements To prepare a molar solution:

GMW -
Grams of solute = M x GMW of the solute x Vol (L) desired

To convert % w/v to molarity (M):

% w/v x 10
ME
 LABORATORY MATHEMAL
18

ASSESSMENT QUIZ
liter of solution.
1. It is defined as the number of equivalent weight of solute per
a. C. molarity
d. normality
b. milliequivalent
2. If BUN is 46 mg/dL, what is the equivalent value in SI?
a. 7.8 c. 220
b. 16.4 d. 1.64
obtained from a set
of control solution
3. A
mean value of 100 mmol/L and a standard deviation of 1.4 were
What is the 95% confidence interval in mmol/L?
a. 97.2-102.8 c. 114-118.1
b. 108.3-112.7 d. 119.4-124.9
_ 4. How many milliliters of 8N H2SO4 will neutralize 45 mL of 6N KOH?
a. 26.45 ml C. 37.10 mL

b. 33.75 mL d. 40.98 mL

5. Solve for the equivalent weight of H2CO3.

(MW = H-1; C-12; 0-16)
a. 24 C. 31

b. 29 d. 48

6. What is the molarity of 10N H2SO4?

C.

b. 10M d. 20M

7. What is the wavelength in nanometer of EMR ing a frequency of 1.58 x 1015 Hz?
a. 190 C. 276

b. 232 d. 287

8. Which of the following is the correct way of expressing absorbance?

1. A =- log T
2. A = 2-log%T
3. A = log 1/T

a. only C. 1 and 2

b. 2 only d. 1, 2, and 3

9. Convert 9.8 mg/dL of calcium to mmol/L.

a. 1.63 mmol/L C. 4.9 mmol/L
b. 2.45 mmol/L d. 6.7 mmol/L
10. A glucose quality control chart has the following data:
Mean = 98 mg/dL
2SD = 6.0

What is the coefficient of variation?

a. 2.45 mmol/L
b. 2.77 mmol/L
C. 3.31 mmol/L
d. 3.68 mmol/L
 QUALITY CONTROL IN
5 THE CLINICAL CHEMISTRY
CHAPTER LABORATORY

LEARNING OUTCOMES
At the end of this chapter, the students should be able to:

1. differentiate the types of quality control and its purpose;

2. explain the variations encountered in clinical chemistry; bodeten
3. interpret quality control data using multiple rules;
4. calculate and establish reference interval including the analytical parameters;
5. relate the significance of statistics to quality management; and
6. discuss the procedure in method evaluation.

Quality control is a system of ensuring accuracy and precision in the laboratory by including quality control reagents
in every series of measurements. It is process of ensuring that analytical results are correct by testing known
samples that resemble patient samples.
In this chapter, the types of quality control and charts will be discussed, including the causes of variations.

QUALITY CONTROL
It involves the process of monitoring the characteristics of the analytical processes and detects analytical
errors during testing, and ultimately prevent the reporting of inaccurate patient test results.
It is one component of quality assurance and is part of the performance monitoring that occurs after a test has
been established.

PARAMETERS OF QUALITY CONTROL

1. Sensitivity
It is the ability of an analytical method to measure the smallest concentration of the analyte of interest.
2. Specificity
It is the ability of an analytical method to determine only the analyte of interest.
3. Accuracy
It is the nearness or closeness of the assayed value to the true or target value.
It is estimated using three types of studies: recovery, interference, and patient sample comparison.
Recovery study determines how much of the analyte can be identified in the sample; interference study
determines if specific samples affect the laboratory tests such as hemolyze, turbid, and icteric; sample
comparison study is used to assess the presence of an error (inaccuracy) in the actual patient sample.
4. Precision or Reproducibility
It is the capacity of an assay to give repeated results on the same sample that agree with one another.
5. Practicability
It is the degree by which a method is easily repeated.
6. Reliability
It is achieved when the assay is able to maintain accuracy and precision over an extended period of time
during which equipment, reagents, and personnel may change.
 THE CLINICAL CHEMISTRY LABORATO
36 QUALITY CONTROL IN

ASSESSMENT QUIZ
1. The following are the characteristics of quality control material, EXCEPT:
c. with known analyte concentration
d. high temperature stability
b. resembles human sample d. with matrix effects

2. What is the most common cause of trend?

a. improper calibration of the instrument C. improper mixing of sample and reagent
d. deterioration of reagents
b. pipetting error
3. It measures the precision of an analytical method.
standard deviation index variance
a.

b. d. coefficient of variation
target mean
4. Which of the following statements is NOT TRUE regarding commutable reference materials (CRMs)?
a. They have no calibration bias.
b. They are the commonly used reference samples.
C. The results are same with the findings from clinical samples across all procedures.
d. The test results using CRMs are comparable with results from actual human samples.
5. What is the ideal SD range?
a. +/-1SD c. +/-3SD
b. d. +/-4SD
b. Which of the following are sources of systematic errors?
1. deteriorating tungsten lamp
2. leaky ion selective electrode instrument
3. pipetting error
4. improper mixing of tube samples and reagents

a. 1 only c. 1, 2, and 3
b. 1 and 2 d. All of the above

7. Using the quality control chart below, when control values are either on the upper or lower side of the mean
for six consecutive days, how do you interpret the QC result?

a. shift TRIGLYCERIDE (mg/dL)

b. trend

C. outliers

d. in-control values

7 8 9 10 11 12 13 14 15 16
Days of the month

Which type of quality control monitors the reliability of the clinical laboratory results on a daily basis?
a. external QC C.
b. internal QC d. proficiency test
QUALITY CONTROL IN THE CLINICAL CHEMISTRY LABORATORY 37

0. It is a system of reducing non-valued steps in the laboratory work flow or in generating test results.
a.
C.
b. Lean
d. Sigma
10. In establishing control limits, these should be taken into consideration, EXCEPT:
a.
Minimum of 40 observationsis recommended for an initial estimate of standard deviation.
b. +/-2SD is the only reference point.
C.
Mean and SD values for the unassayed controls should also be determined.
d. When changing the control sample to a new lot number, use the newly calculated mean value and
retain the previous SD value.
11. It is the problem-solving method in six sigma.

b. 5 S
d. TEA
12. It is also known as the twin plot with control values distributed in the and y axes:
a. Levey-Jennings C.

d. Westgard
13. Which of the following is not included in proficiency testing?
a.
Analysis of the unknown samples should be completed and reported within 48 hours.
b. Unknown samples must be tested using the same reagents and equipment for actual patient
specimens.
C.
Unknown samples should be processed and treated like a patient.
d. It allows each participating laboratory to compare and evaluate test results with those laboratories
that use the same methods after the testing period.

14. This is the most commonly used quality chart that can be utilized even without a computer device.
a. Gaussian curve
b. Levey-Jennings d. Youden

15. In Westgard control rules, if there are three consecutive control values outside the lowest standard
deviation and the values are located on the upper mean, how do you interpret this result?
a.

d.
 6 ANALYTICAL METHODS
CHAPTER

LEARNING OUTCOMES

At the end of this chapter, the students should be able to:

1. discuss the principle and significance of each analytical method;

2. contrast the components and distinct feature of the analytical methods;

3. apply Beer's law to determine the concentration of the unknown analyte; and
4. relate the clinical applications of the emerging techniques.

Measurement of colors is the historical basis of quantifying the concentrations of the unknown analytes in the
clinical chemistry laboratory. Portable spectrophotometers are utilized to determine the transmittance which is then
converted to absorbance following Beer's Law.
Currently, fully automated biochemistry analyzers have replaced manual photometric readings to meet the desired
turnaround time of each assay. The principles and distinguishing characteristics of each analytical method are
presented in this chapter.

Light Energy, Wavelength, and Radiant Energy

Energy is transmitted via electromagnetic waves that are characterized by their frequency and wavelength.
Wavelength is the distance between two successive peaks and it is expressed in nanometer (nm).
Nominal wavelength represents the wavelength in nanometer at peak transmittance.
A slight error in wavelength adjustments can introduce a significant error in absorbance readings.
The relationship between wavelength and energy (E) is described by
Planck's formula.

motion per second.

Frequency is the number of vibrations of wave
The lower the wave frequency, the longer the wavelength.
inversely related to frequency and energy; the shorter the wavelength, the higher the
The wavelength is

frequency and energy, and vice versa.

Wavelength Regions Planck's formula: E = hv

Visible spectrum: 400-700nm

where:
Ultraviolet region (UV): E - is the energy of a photon in Joules or eV
Infrared region (IR): > 700nm
h - constant (6.626 x 10-34 erg sec)
v - frequency

MAJOR ANALYTICAL METHODS IN THE CLINICAL CHEMISTRY LABORATORY

I, COLORIMETRY
a. Spectrophotometric measurement - is the measurement of light intensity in a narrower wavelength.
b. Photometric measurement - is the measurement of light intensity using a specific wavelength.
 60 ANALYTICAL METHOD~

ASSESSMENT QUIZ
1. Which type of filter is best for measuring stray light?
didymium
b. sharp cut-off d. gratings
2. Which part of the spectrophotometer allows only a narrow light to reach the sample cell?
entrance slit c. exit slit

b. prism d. photomultiplier tube

This electrochemistry technique measures chloride in sweat.
a. potentiometry C. chloridometry

b. coulometry d. polarography
4. It involves dissociation of analytes by heat energy into atoms and measures minimal concentrations.
a. electrophoresis c. nephelometry
b. fluorometry d. atomic absorption spectrophotometry
5. Ion selective electrode is a "selective" method due to which factor?

a. membrane composition c. quality of reference electrodes

b. use of stable voltage d. specificity of indicator electrode
6. What is the most sensitive photodetector that measures light in the visible and UV regions?
a. photocell C. photodiode
b. photomultiplier tube d. holographic gratings
7. This photoanalytical method does not require an excitation radiation and monochromators to determine the
concentration of the unknown substances.
a. turbidimetry c. chemiluminescence
b. flame emission d. voltametry
8. Which type of molecular luminescence spectrometry utilizes two monochromators?
a. proteomics C. nephelometry
b. mass spectrometry d. fluorometry
9, It has a great advantage over other analyticals in its capacity to measure substances with small molecular
sizes.

C.
tandem mass spectroscopy
b. d. MALDI-TOF
10. What is the
ideal concentration of the buffer in serum protein electrophoresis?
a. pH 5.2 C. pH 7.4
b. pH 6.5 d. pH 8.6
11. In electrophoresis, if
the electrodes are not fixed and properly aligned, the proteins will migrate
on the side with more current.

a. closer
C. very near
b. farther
d. faster
12. Which separation technique is a requirement in mass
spectrometry before the unknown analytes can be
detected and quantified?
a. gas chromatography C. time of flight
b. electrophoresis
13. In electrochemistry, it is a type of pH electrode with
measurement of carbon dioxide.
a sodium bicarbonate buffer utilized in the

a. Clark
C. Calomel
b. Valinomycin d. Severinghaus
ANALYTICAL METHODS 61

14. It
measures proteins with large molecular complexes using scattered light and sensitive enough
quantitate concentrations less than
to even

grams per deciliter.

a.
spectrophotometry
C. proteomics
b. nephelometry
d. tandem mass spectrophotometry
15.
What is the preferred method in measuring ions with minimal serum levels such as magnesium?
a. AAS
C. fluorometry
b.
mass spectrometry d. Desorption Electrospray Ionization
 INSTRUMENTATION AND
AUTOMATION
CHAPTER

LEARNING OUTCOMES

At the end of this chapter, the students should be able to:

00101170 000531
1. discuss the types of glassware according to their purpose;
2. contrast the
classification of pipettes;
3. elucidate the calibration of pipettes;
4. explain the principle of automation and their
distinguishing characteristics; and
5. differentiate open reagent system from closed reagent system. egrin bodode 20oom imoneedd

The selection and proper use of pipettes are very important to ensure the reliability of the laboratory results. The
differential characteristics of chemistry analyzers are equally significant and are part of the management decision in
choosing the kind of diagnostic robotics that will be tilized in the clinical laboratory.

TYPES OF GLASSWARE

Borosilicate Glass

It is used for heating and sterilization purposes; most commonly used.

It is characterized by a high degree of thermal resistance, has low alkali content, and is free from the

magnesium lime- zinc group of elements.

It does not contain heavy metals, arsenic, and antimony.
Examples: Pyrex and Kimax glassware
Strain point: 515° C (Pyrex)
Boron-free Glassware/Soft Glass
It has high resistance to alkali. 011001001010710

Its thermal resistance is less as compared to borosilicate glass.

Corex (Corning)
It is a special alumina-silicate glass that has been strengthened chemically than thermally; six times stronger
than borosilicate.

Vycor (Corning)
and extreme chemical treament with acids (except
It is utilized for high thermal, drastic heat shock,
hydrofluoric) and dilute alkali; it can be heated to 900° C.

Flint Glass
It is made up of soda-lime glass
and a mixture of calcium, silicon, and sodium oxides.

It is used to make disposable glassware.

melt.
It has poor thermal resistance; easy to
 70 INSTRUMENTATION AND AUTOMATIOn

ASSESSMENT QUIZ
1. This type of chemistry analyzer uses the acceleration and deceleration of the rotor to transfer reagents from
the sample cup to the reaction vessel.
continous flow
a. discreet analyzer C.

d. Vitros analyzer
b. centrifugal analyzer
the tip and should not be allowed to touch the
2. Which of these pipettes does not contain calibration marks to
vessel while the pipette is draining?
a. serological pipette C.

Ostwald-Folin pipette
displacement pipette
b. air d.

3. Which type of glassware is the most commonly used in the clinical laboratory?
a. c. Corning
b. Flint d. Borosilicate

4. This automation utilizes a single analytic pathway with a positive liquid-displacement pipette to dispense
samples and reagents.
a. centrifugal analyzer C. discreet analyzer
b. random access d. continuous flow
5. What type of mechanical pipette requires: disposable tip and is commonly used for samples and reagents?
a. Sahli hellige pipette air displacement
b. positive displacement pipette d. dispenser pipette
b. It is a set of data that are embedded in the bar-coded reagent label which includes the calibration
information and concentration of the reagent.
a. RFID C. middleware

b. master lot d. reagent label

7. It is considered as the routine and standard technique in automatic pipetting.
a. forward mode C. channel format
b. reverse mode d. forward and reverse mode

What is described as system in automation where there is tracking of tagged samples starting from the
collection of specimens down to release of laboratory results, and patient's personal data are encrypted i
the chip?
Laboratory information system C. Patient information system
b. Radio-Frequency Identification d. Healthcare software
9 It is a
cluster of devices such as chemistry analyzers, hematology cell counters, or coagulation instruments
that is linked through a middleware instead of connected using a physical track.
a. Virtual work cell C. Master lot
Workstation d. Parallel
testing cell
10. Which of the following techniques is used to reduce the carryover contamination?
a. sample evaporation C. aliquoting
b. reusable probes d. back-flush
 PATIENT PREPARATION
CHAPTER

LEARNING OUTCOMES
At the end of this chapter, the students should be able to:
1. discuss the bioanalytes that are influenced by pre-analytical variables;
2. decipher the effects of incomplete fasting, prolonged tourniquet application, and posture changes
to routine analytes; and
3. explain the importance of proper patient preparation in the reliability of the laboratory results.

Prior to blood collection, patients must be given accurate instructions on how to prepare for each assay. Utmost care

must be observed to eliminate variations or errors that influence laboratory results.

Factors that may contribute to variations of the patient laboratory results

Exercise
Physical activity can have different effects on analyte concentrations - volume shifts between the vascular and

interstitial compartments, volume loss by sweating, and changes in hormone concentrations.

Transient increased: lactate, fatty acid, ammonia
Long-term increased (skeletal muscle enzymes): CPK, AST, LD, and aldolase
Increased plasma level due to vigorous hand exercise (fist clenching): Potassium, phosphate, and
lactate

Chronic aerobic exercise: Slight increase of muscle enzymes (CK, AST, LD) and ALT
sex steroids; increase in prolactin
Long-distance exercise: Decrease of FSH, LH,
Elevated levels of proteins in urine (proteinuria) are observed.
Variations in the plasma concentrations of hormones such as increase in prolactin
and somatotrophin while

decrease in follicle stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and testosterone

Vigorous hand exercise results in 0.9 mg/dL to 20 mg/dL increase in plasma lactate within
10 seconds.

Fasting
Fasting requirement is between 8 hours to 12 hours.
hormonal assays such as growth hormone and cortisol
Fasting specimen: FBS, lipids, lipoproteins, and some
Fasting for 48 hours may increase serum bilirubin.
in an increase in plasma triglyceride in males while glucose decreases in
Fasting for 72 hours may result
healthy women to 45 mg/dL.
collection; 12 hours after last ingestion of food.
Basal state collection is early morning blood
Basal state collection: Glucose, lipids, lipoproteins, and electrolyte
Bastc metabolic panel: Glucose, BUN, creatinine, sodium, potassium, chloride, Coz; and
calcium
 74
PATIENT PREPARATION

ASSESSMENT QUIZ
eliminate dietary interferences?
1. Which of the following may require 12-hour fasting to
C. cholesterol
a. lipoproteins
d. cortisol
b. fasting glucose
2. Blood sample for this assay should not be drawn after
physical exercise otherwise the plasma concentration
may be falsely decreased.
a. somatotrophin C. glucose
d. lactate
b. ammonia

blood collection, the patient should be in a stable posture for at least minutes to
3. Prior to

prevent the variations of results.

30 minutes
a. 5 minutes C.

b. 15 minutes d. 45 minutes

8 hours before sample collection

4. In measuring this enzyme, the patient should not take any alcohol at least
since results will be immediately increased.
a. ALT

b. d. 5' nucleotidase
5 The presence of this supplement in serum affects oxidation-reduction method, hence it is included in the
patient pre-sampling inquiry and should be written in the requisition form.
a. biotin c. glutathione
b. retinol d. ascorbate

6. It is greatly influenced by prolonged application of tourniquet resulting to false increased values:

a. cortisol cholesterol

b. potassium d. catecholamines

7. The following tests are included in a basic metabolic panel, EXCEPT:

a. LDL c. glucose
b. chloride d. carbon dioxide

8. When measuring this routine analyte, a decreased concentration may be observed during period of stress.

a. prolactin C.

b lactate d. ACTH

9. Intense fist-clenching results in sudden high concentration of this metabolic product.

a. creatinine C. lactate

b. ammonia d. pyruvate
10. For better diagnosis and correlation of the current health condition, the patient should be advised to avoil

dietary changes hours before sampling.

a. 2 hours c. 12 hours

b. 6 hours d. 24 hours
 SAMPLE COLLECTION,
HANDLING, AND
CHAPTER TRANSPORT

LEARNING OUTCOMES
At the end of this chapter, the students should be able to:

1. explain the process of correct patient identification; ewmMx07ggsto

2. differentiate the sites of venipuncture and skin puncture; b fisup
3. cite various skin disinfectants that : utilized prior to sample collection;
4. discuss the order of draw and the other tubes that can be used in blood collection;
5. outline the tubes selected in special chemistry tests; and
6. distinguish the processes of sample transport.

"Proper patient identification is the first step in sample collection" this is a prime factor to attain accurate results
in the clinical laboratory. Likewise, proper techniques in specimen collection must be strictly followed including the

observance of the confidentiality of results.

PATIENT IDENTIFICATION PROCEDURES

1. Conscious In-patients/Hospitalized Patients
Verbally ask their full names including middle names.
Verify the name using the identification (ID) bracelet which includes
first and last names, hospital/unit

number, room/bed number, and physician's name.

Patients who are sleeping should be awakened before sample collection.
2. Unconscious, Mentally Incompetent Patients
the attending nurse or relative; having an ID bracelet is a must.
They are identified by asking

3. Infants and Children

means of an identification bracelet.
A nurse or relative may identify the patient, or by

4. Outpatient/Ambulatory Patient countercheck with national license cards,

names, address or birth date, and
or ID
Verbally ask their full
card with a photo.
is the same with hospitalized patients.
the manner of identification
If the patient has an ID bracelet,
3-Way ID
a 3-Way ID system, in which the patient is identified by:
To avoid misidentification, a phlebotomist may require
the patient's verbal ID statement
a check of the ID band
labeled specimen with the patient's ID band before leaving the bedside
visual comparison of the

the labeled specimen to the patient to ensure accurate labelling of the

Some facilities are also showing
tubes.
radiofrequency technology help identify patients accurately.
Patient ID bracelets with bar codes or
 SAMPLE COLLECTION, HANDLING,
AND IRANSD.
92

ASSESSMENT QUIZ
1. For ethanol testing, it is the recommended skin cleanser.
a.
chlorhexidine gluconate c. hydrogen peroxide
b.
benzalkonium chloride d. iodine
2,
Which of the following is used in the analysis of lactate?
a. tan top C. gold top
b. yellow top d. gray top
3.
Traumatic draw due to a vessel wall injury results in elevated levels of which analyte?
a. C. triglyceride
b. myoglobin d. phosphate
4.
Storage of samples in cold temperature should be avoided when measurement includes these enzymes since
values will be false increased and decreased, respectively.
a. CK and ALT C. ALP and LD
b. ALT and ALP d. LD and CK
5. What is the preferred distance of the tourniquet from the site of puncture?
1 inch c. 5 inches
b. 3 inches d. 7 inches
6.
This tube is used in the analysis of glycosylated hemoglobin.
a. royal blue top C. white pearl top
b. orange top d. purple top
7. If the sample will be recentrifuged, the serum concentration
of this analyte may falsely increase.
a. potassium C.
b.
cardiac troponins d. magnesium
8. At
whatconcentration ofserum triglyceride willit start to cause interferences in the quantification of other
a. 200 mg/dL C. 400 mg/dL
b. 300 mg/dL d.
500 mg/dL
9.
These sampling preparations may produce aerosols, EXCEPT:
a. rimming of test tube
b. pipetting c. centrifugation with lid closed
d.
10.
reagent aspiration
The following statements are true
regarding blood collection, EXCEPT
a.
When blood is put into a vacuum tube with
b. If blood pressure cuffis a narrow needle,red blood cells are destroyed.
used as a tourniquet, it is inflated to 60
Blood samplecollected inanadditivetubecan be transferred tommHg.
C.

The another
sauge ofthe needle isinversely related to the sizeoftheneeaneo tube of the
d.
same kind.
 10 CARBOHYDRATES
CHAPTER

LEARNING OUTCOMES
At the end of this chapter, the students should be able to:
1. outline the endocrines related to glucose;
2. contrast the types of diabetes mellitus;
3. explain the
various tests in hyperglycemia and hypoglycemia and interpret the results; 10100 51S0T
4. distinguish the types of
glycomonitoring tests and their clinical significance;
5. relate the classifications of glycogen storage disease and enzyme deficiency; orl
uRn IN OuTelm
6. cite the hypoglycemic values and their interpretations; and

7. discuss the samples and methods utilized in the quantification of glucose based on patient
preparation.

Carbohydrates are hydrates of aldehyde or ketone derivates based on the location of the carbon-oxygen functional
group. They are grouped as monosaccharides, disaccharides, oligosaccharides, and polysaccharides. Glycolaldehyde
is the simplest carbohydrate (CHO).
Glucose is the only carbohydrate to be directly used for energy or stored as glycogen. It does not accumulate in the
muscle. Likewise, it does not enter the muscle cell freely, and when it gains entry with the help of insulin, it is quickly
metabolized.

The brain is blood glucose for energy production where two thirds of glucose utilization
completely dependent on
in resting adults occurs the central
in nervous system (CNS). Glucose metabolism generates pyruvic acid, lactic
acid, and acetylcoenzyme A as intermediate products; the complete oxidation yields carbon dioxide, water, and ATP.
Pyruvate carboxylase is the principal regulatory enzyme in gluconeogenesis.
In theabsence of insulin, glucose will remain in the blood resulting in hyperglycemia. Hence, the classification of
diabetes mellitus is presented in the discussion and the different diagnostic tests.

Reducing and Non-reducing Sugars

Reducing substances/sugars: glucose, maltose, fructose, lactose, and galactose
The presence of a double bond and a negative charge in the enol anion makes glucose an active reducing
substance.
Sucrose is the most common non-reducing sugar. TOE

an active ketone or aldehyde group.

Non-reducing sugars do not contain
PANCREAS
It is both an endocrine and exocrine organ in the control of carbohydrate metabolism.
As an endocrine gland, it secretes insulin, glucagon, and somatostatin from different cells residing in the
pancreatic islets of Langerhans.
As an exocrine gland, it secretes amylase which is responsible for the breakdown of ingested complex

carbohydrates.
CARBOHYDRATES 111

ASSESSMENT QUIZ
1. A 42-year-old female patient with loss of consciousness was presented to the emergency room. She has
diabetes mellitus and is currently under insulin therapy. She was about to report to work when she suddenly
lost her balance and fell on the floor. Which of the following tests should be prioritized immediately to assess
her condition?

a. glycosylated hemoglobin C.

b. random blood sugar d. fasting plasma glucose

2. What is the standard glucose load in screening gestational diabetes?
a.
C.
b. 75 gms d. 150 gms
It monitors
3.
the non-enzymatic glycosylation of proteins over the past 3 weeks.
a. fructosamine C. 5-hour GTT
b. 1,5 AG d. 2-hour post prandial glucose
4. Which of the following differentiates type 1 diabetes from type 2 diabetes using fasting serum with the
former having decreased or undetectable levels while the latter has normal concentration?
a. ketone test C. mixed meal tolerance
b. d. C-peptide
5. After OGTT, which of the following values would be classified as impaired glucose tolerance at the second
hour?

a. 205 mg/dL C. 123 mg/dL

b. 174 mg/dL d. < 110 mg/dL
To confirm hypoglycemia, the symptoms must be comparable with this diagnostic criteria.
a. Mixed Meal C. Whipple

b. Tolbutamide tolerance d. Exton-Rose

7. If after 9-hour fasting the plasma glucose level of a non-pregnant woman is 117 mg/dL, how will you

categorize the patient?

a. non-diabetic c. with history of gestational diabetes

b. impaired glucose d. a starting diabetes mellitus

8. It is also known as the Type III GSD.

C.
a.

b. Andersen d. Cori Forbes

Which glucose "trend analysis" is non-invasive and

can assist in the detection of unsuspected nocturnal or
postprandial hypoglycemia?
a. dextrostics
C.interstitial glucose measuring
b. fasting plasma glucose by glucometer d. Janney Isaacson

10. It is the most specific method in measuring glucose in body fluids.

c. o-toiluidine
a. polarographic glucose oxidase
d. glucose dehyrogenase
b.
 11 LIPIDS AND
LIPOPROTEINS
CHAPTER

LEARNING OUTCOMES
At the end of this chapter, the students should be able to:
1.
outline the properties and clinical significance of lipids and lipoproteins;
2.
elucidate the normal and abnormal lipoproteins;
3. correlate the serum concentrations of cholesterol and triglyceride with development of
atherosclerosis;
4. relate the plasma levels of lipids and lipoproteins in the assessment of dyslipidemia; and
5. discuss the samples and methods utilized in the quantifications of lipids and lipoproteins.

Lipids are commonly referred to as fats and composed mostly of carbon-hydrogen bonds. They are insoluble in blood
and water but soluble in organic solvents (chloroform and ether). They require special transport mechanisms known
as lipoproteins for circulation in the blood. Increased plasma concentrations of lipids contribute to the development
of atherosclerosis and coronary artery disease.

Major Functions of Lipids Major Lipids in Plasma (arranged according to abundance)

1. Primary sources of fuel 1. Phospholipids
2. Provide stability to cell membrane 2. Cholesterol

3. Sources of hormones 3. Triglycerides

4. Fatty acid
5. Fat soluble vitamins (ADEK)

LIPIDS

Definitions, Structure, Functions, and Fatty Acids

Steroids Cholesterol

Saturated Unsaturated
Alcohol Ester
Fatty Acids Fatty Acids

Hydrophilic
Head

Hydrophobic -
Tail

Phospholipids
Glycerol

FIGURE 33. Structures of Lipids.

Source: Sapkota, 2021
LIPIDS AND LIPOPROTEINS 135

ASSESSMENT QUIZ
It transports endogenous TAG to fat depot.
a. alpha lipoprotein
c. beta lipoprotein
b. pre-beta lipoprotein
2. What is described as an
abnormal lipoprotein found in patients with obstructive biliary disease?
C. IDL
b.
d. floating B-Lipoprotein
3.
Hypertriglyceridemia with values > 500 mg/dL may be observed in this condition.
a. myocardial infarction nephrotic syndrome
b. recurrent pancreatitis d. type 1 diabetes
4.
Which of the following statements is not true regarding cholesterol?
a. Aldosterone and estrogen are derived from cholesterol.
b. It is the third major lipid in plasma.
C.
Elevated concentration may lead to myocardial infarction.
d. 85% of plasma cholesterol is from the liver.
5. The accumulation of sphingomyelin in the spleen and bone marrow would lead to what disease?
a. Tay-Sach's disease C. Niemann-Pick disease
b. Basses-Kornzweig syndrome d. Tangier's disease
6. Uniform turbidity in the refrigerated serum indicates elevated concentration of these lipoprotein and lipid.
1. chylomicrons
2. pre beta lipoprotein
3. dietary triglyceride
4. endogenous triglyceride

a. 1 and 4 C. 1 and 3

b. 2 and 3 d. 2 and 4

7. If the serum cholesterol concentration is 352 mg/dL, what is the equivalent SI value?
a. 9.2 mmol/L c. 21.8 mmol/L
b. 92 mmol/L d. 352 mmol/L
8. It connects the forward and reverse cholesterol transport pathways.
a. HMG-CoA reductase C. ABCG5 transporter
b. d. ABCA1 transporter
9. What is the reference method in measuring serum triglyceride?
Liebermann-Burchardt
a. Abell, Levy, and Brodie C.

Bloor's method
b. Modified Van Handel and Zilversmith
d.

10. The concentration of this apolipoprotein is directly related to the development of atherosclerosis.
a. ApoA-1
C. ApoB-100

b. ApoB-48 d. ApoE
 12 PLASMA PROTEINS
CHAPTER

LEARNING OUTCOMES
At the end of this chapter, the students should be able to:
1. discuss the structures and functions of proteins;
2.
cite the different plasma proteins and their clinical applications;
3. explain the causes of aminoacidopathies and the related diagnostic tests;
4. distinguish the cardiac proteins such as myoglobin and troponins in the diagnosis myocardial
infarction; and
5. discuss the samples and methods used in the measurement and detection of plasma proteins.

Protein comes from theGreek word proteios, meaning "first rank of importance." They are synthesized in the liver
and secreted by the hepatocytes into the circulation, except immunoglobulins which are from the plasma cells.
They are macromolecules composed of polymers of covalently linked amino acids that are involved in every cellular
process.

Moreover, proteins bear positive and negative charges (amphoteric) because of their acidic and basic amino acid
compositions. They can be both a weak base or weak acid, hence, proteins are effective blood buffers. Their solubility
is due to their high dielectric property. They are very effective antigens due to their molecular mass, tyrosine
content, and their specificity. They provide 12% to 20% of the total daily body energy requirement. Proteins are 50%
to 70% of the cell's dry weight.
Functions of Proteins
1. Repair body tissues
2. Important in blood coagulation and immunologic function
3. For transport of metabolic substances
4. Maintenance of osmotic pressure
5. Maintenance of blood pH (buffers)
6. Biocatalysts
Structures of Proteins

Primary Structure
It is the linear sequence of the amino acids.
It determines the identity of protein, molecular structure, function-binding capacity, and recognition ability.
Any change in the amino acid composition can significantly alter the protein.

Secondary Structure
It involves the winding of the polypeptide chain.

It refers to specific three-dimensional conformations: alpha helix, beta pleated, and bend form.
Tertiary Structure
It is the actual three-dimensional configuration; the folding pattern of proteins.
chemical properties of proteins.
It is responsible for many of the physical and
 158 PLASMA
PROTEIN

ASSESSMENT QUIZ
Which aminoacidopathy is characterized by the deficiency of homogentiae oxidase leading to brownish
black color of the urine?
a. phenylketonuria C.

b. maple syrup urine disease d. homocystinuria

2.
This globulin is associated with the pathogenesis of Alzheimer's disease since it is
an
important component
of the amyloid deposits found in persons with such disorder.
a. fibrinogen c. siderophilin
b. Gc-Globulin d. alpha-1 antichymotrypsin
13.
Elevated serum level of this plasma protein in renal transplant patients indicates organ rejection.
a.
C.

b. a2-macroglobulin d 32-microglobulin
Which of the
following statements is NOT TRUE regarding troponin (Tn)?
a. TnT, TnI, and TnC are all normally present in the cardiac and skeletal muscles.
b.Cardiac troponins (cTnT and cTnI) are components of the contractile apparatus of myocardial cells
and are expressed almost exclusively in the heart.
C. The plasma concentration of cTn may rise even in the absence of CK-MB elevation.
d. Serum troponin is not influenced by physiologic factors such as exercise.
5.
Increased levels of this protein in maternal serum are seen in spina bifida, and neural tube defects.
a. alpha-feto protein C.

b. alpha-1-antitrypsin d. orosomucoid

6. In bacterial infection, increased plasma level is observed compared to viral infection, hence it may be used
as arapid differential test in the assessment of COVID-19.
a. albumin
b. a2-macroglobulin
7. What protein is used as hepatic and gonodal tumor marker? our i
a. alpha-feto protein c. haptoglobin
b. alpha-1-antitrypsin d. albumin

8. The function binding capacity and molecular make-up of proteins are detected through this functional
structure.

a. primary structure C. tertiary structure

b. secondary structure d. quaternary structure
9. What biologically active peptide hormone is measured to monitor the extent of and recovery from heart
failure and to confirm the cause of shortness of breath and fatigue?
161

C. Troponin I
d. Troponin T
10. It is classified as a simple and fibrous protein.
a. hemoglobin C.

b. enzymes d. erythropoetin
 13 KIDNEY FUNCTION TESTS
CHAPTER

LEARNING OUTCOMES
At the end of this chapter, the students should be able to:
1. discuss the renal functions and related tests;
2. explain the role of the kidneys in the balance of electrolytes;
3.
cite the etiologies of azotemia and uremia and the adjunct renal markers;
4. correlate the results of the
non-protein nitrogenous compounds with the electrolytes, blood pH,
and
osmolality in the diagnosis of kidney injury;
5. compute the creatinine clearance with interpretation; and
discuss the samples and methods used in the measurement and detection of renal markers,
including the assay interferences.

The kidneys are paired and bean-shaped organs located retroperitoneally on either side of the spinal column, and
with two (2) regions, an outer region called the cortex and an inner region called the medulla.

The functional units of each kidney or the nephrons are composed of five basic parts namely, glomerulus, proximal
convoluted tubule, loop of Henle, distal convoluted tubule, and collecting duct. The kidneys conserve fluids by
building high-sodium-chloride gradients in the interstitial space between the descending and ascending limbs of the
loop of Henle, using the countercurrent multiplier mechanism.
The proximal convoluted tubule is responsible for the reabsorption of electrolytes (sodium, chloride, bicarbonate,
and other ions) glucose, amino acids, proteins, urea, and uric acid. The plasma contains 20 to 35 mg/dL of non-protein

nitrogenous compounds.
The juxtaglomerular apparatus produces renin that affects the blood pressure by converting angiotensinogen to
angiotensin. The enzyme 1-a-hydroxylase, which is primarily secreted in the kidney, catalyzes the synthesis of the
active vitamin D.
About 180 liters of water filtered daily in humans, wherein 150 liters are reabsorbed in the proximal tubule
are

and about 5 liters in the descending limb of Henle of cortical nephrons. The collecting duct is the final site for either
concentrating or diluting urine.
This chapter will present the major groups of kidney function tests and the diagnostic significance of each assay.

The renal basic metabolic panel is composed of clearance, creatinine, and electrolytes (magnesium and phosphorus).
Adjunct tests such as serum albumin and urine protein may be requested to determine the cause of edema in which
renal disease is related.

Functions of the Kidneys

1. Elimination of waste products
2, Maintenance of blood volume
3. Maintenance of electrolyte balance
4. Maintenance of acid-base balance
5. Endocrine function (erythropoietin secretion)
KIDNEY FUNCTION TESTS 175

ASSESSMENT QUIZ
1. In kidney disease, which NPN is the first to be elevated in plasma?
a. urea
C. uric acid
b. creatinine d. ammonia
2. Given the following data, compute the creatinine clearance of a 34-year-old female patient in mL./minute.
Serum creatinine = 1. 68 mg/dL
Urine creatinine = 82 mg/dL
Urine volume = 935 mL
Body surface area = 1.68

a. 32.6 c. 14.56
b. 26.8 d. 0.0137
used in the
3. What is described as a measure of the completeness of 24-hour urine collection that is
assessment of hormone metabolites?
a. urea c. uric acid
b. creatinine d. ammonia

4. What is the expected concentration of serum creatinine in muscular disease but with normal renal function?

a. increased C. decreased

b. normal markedly decreased

5. Which GFR analyte is freely filtered by the glomeruli, totally reabsorbed but not secreted by the renal
tubules?
a. creatinine C.

b. urea

6. Low BUN:Creatinine ratio is seen in which condition?

a. dehydration c. nephrolithiasis
b. acute nephritis d. repeated dialysis

7. It is used as direct measure of urine osmolality.

a. freezing point C.

d. inulin
b.

This enzyme produced in the kidneys catalyzes the formation the active vitamin
of D.
8.

a. renin c. 1-a-hydroxylase
d. 5-a-reductase
b. 21-hydroxylase
9. What is the reference method when measuring blood urea nitrogen?
C.
a. Urease
b. Urease-GLDH

10. Which of the following denotes a normally functioning renal tubules?

a. 1.010 urine specific gravity and < 300 mOsm/kg urine osmolality
b. 1.010 urine specific gravity and - 800 mOsm/kg urine osmolality

C. 1.025 urine specific gravity and < 300 m0sm/kg urine osmolality
1.025 urine specific gravity and > 800 mOsm/kg urine
d.
osmolality
 14 LIVER FUNCTION TESTS
CHAPTER

LEARNING OUTCOMES
At the end of this chapter, the students should be able to:
1. explain the functions of the hepatic cells and their relationship to the total activity of the liver;
2. relate the liver test with the function of the organ;
3.
outline the types of jaundice, their causes, and the differential results of the bilirubin assay; ROLAM
4.
discuss the clinical significance of each hepatic function test;
5. analyze and interpret the various serum protein electrophoretic patterns; and
6. discuss the samples and methods used in the measurement and detection of hepatic chemistry.

The liver is the chief metabolic organ in the body with lobules as its microscopic and functional units. Its framework

The liver receives 15 mL of blood per minute from the portal vein for filtration while it also delivers toxins to the liver

for processing and detoxification. To eliminate toxins such as alcohol, two enzymes are essential in the pathway, the
alcohol dehydrogenase and acetaldehyde dehydrogenase.
The liver is a unique organ with the capacity to regenerate cells that have been damaged, injured, or removed.
Hypertrophy of the remaining tissue in case of tissue injury due to biliary obstruction or toxic exposure is a
distinguishing feature of the liver. Hepatocytes are the primary liver parenchymal cells and play complicated roles
in fibrosis and cirrhosis; and the targets for most hepatotoxic agents, including hepatitis viruses, alcohol metabolites,
and bile acids (Bataller and Brenner, 2005, as cited in Zhou et al., 2014)

Repeated damage to this vascular organ, however, may result in irreversible changes, and
it will become completely

dysfunctional when blood sugar level is very low. Severe loss of hepatic functions may lead to diagnostic changes
in synthetic capacities and in the functions of excretion, detoxification, and metabolic activity that are reflected
tests. To suppress liver tissue function, more than 80% of the liver must be
in multiple standard and specialized
destroyed.
The primary hepatic function markers which are frequently requested in clinical chemistry laboratories will be

discussed in this learning section.

Major Cell Types

1. Hepatocyte - represents 80% of the volume of the liver; performs the major hepatic functions; responsible for
the regenerative property.
role; it is the hepatic macrophage, engulfing organisms and toxins.
2. Kupfer cell - has the phagocytic
Functions of the Liver

Synthetic Function
Liver secretes plasma proteins, carbohydrates, lipids, lipoproteins, clotting factors, ketone bodies, enzymes,
and xenobiotics.

The normal liver produces about 12 grams of albumin daily,

of cholesterol into bile acids.
It is also involved in the metabolism
LIVER FUNCTION TESTS 193

ASSESSMENT QUIZ

A neonate was subjected to biochemistry assay due to jaundice. Laboratory results reveal bilirubin test
with the unconjugated fraction having markedly increased concentration compared to normal conjugated
bilirubin. Which of the following conditions is related with the laboratory findings?
a.
Dubin-Johnson syndrome C.

b. Gilbert syndrome d. Biliary atresia

It is the
most widely used method in the measurement of total serum protein, which requires at least two
peptide bonds and an alkaline medium.
a. Folin-Ciocalteu
c. Berthelot reaction
b. Biuret reaction
Ultraviolet Absorption
d.
3.
It is an excellent marker that determines the lost of hepatic detoxification function?
a. bilirubin C. total protein
b. ALT d. ammonia

4. Which reagent in Van den Berg is used to solubilize the non-polar bilirubin?
a. caffeine sodium benzoate c. alkaline tartrate
b. sodium acetate d. sodium nitrite
5. In cirrhosis, what are the expected plasma levels of total protein, albumin and globulin, respectively?
a. increased, decreased, increased
b. increased, increased decreased
C. decreased, decreased, increased
d. decreased, decreased, normal
6. If the serum albumin is 4.4 g/dL and the total protein concentration is 7.1 g/dl, what is the expected level of
the globulin fraction?
a. 1.75 g/dL C. 11.5 g/dL
b. 2.7 g/dl d. 31.2 g/dL

7. Hypoalbuminemia is observed in the following conditions, EXCEPT:

a. nephrotic syndrome C. severe dehydration
b. cirrhosis d. malignancy
In electrophoresis, what is the pattern of migration if the serum sample was collected from an individual
with hepatic cirrhosis?
a. gamma spike c. high peak of the alpha-1-globulin band
d. elevated albumin band
b. beta-gamma bridging
In active liver diseases with almost total destruction of hepatocytes but with normal renal function, what is
the expected concentration of plasma albumin?
a. normal plasma concentration because of normal renal function
b. increased, because of the overactivity in the secretion of albumin by the hepatocytes
C. decreased, concentration, because of decreased synthesis due to damaged liver
d. normal level, because liver has the capacity to regenerate

10. It is a transient form of familial hyperbilirubinemia that may be caused by a circulating inhibitor of bilirubin
or mother's blood resulting in elevated unconjugated bilirubin.
conjugation in the baby's
C. Criggler-Najar
a. Lucey-Driscoll Syndrome
b. Rotor syndrome
d. Panhepatitis
 15 ENZYMOLOGY
CHAPTER

LEARNING OUTCOMES
At the end of this chapter, the students should be able to:
1. explain
the factors influencing enzymatic reactions;
2. outline the classification of enzymes and their
catalytic actions;
3. distinguish the enzymatic theories, rate of reaction, kinetics, and units of measurement;
4. discuss the
tissue sources of enzymes and correlate with their diagnostic significance;
5. design an algorithm for the clinical enzymes and disease correlations; and
6. discuss the
samples and methods used in the detection and measurement of the clinically
significant enzymes including assay interferences.

Enzymes are proteins in nature produced by living cells that hasten chemical reactions in organic matter. They are
large molecules that are normally confined within cells unless increased membrane permeability allows them to
They frequently appear in the serum after cellular injury, degradation of cells or from storage areas.
enter the blood.

Enzymes are measured in terms of their activity and not in terms of their absolute values. Abnormal large amounts
of enzymes in serum are used clinically as evidence of organ damage. Each enzyme catalyzes a single reaction or :
limited number of chemical reactions and is specific for substrate that it converts to a defined product.
The tissue and cellular locations of enzymes are crucial in the diagnosis and management of organ dysfunctions and
diseases.

Factors Affecting Enzymatic Reactions

Enzyme Concentration
The higher the enzyme concentration, the faster is the reaction because more enzyme is present to bind with
the substrate.

Substrate Concentration
With the amount of enzyme exceeding the amount of substrate, the reaction rate steadily increases as more
substrate is added.
However, when substrate concentration reaches a maximal value, higher concentration of substrate no longer
results in increased rate of reaction (saturation kinetics).
Cofactors
that must bind to particular enzymes before a reaction occurs.
These are nonprotein entities
a. Coenzyme
It is an organic cofactor (second substrate).
It is essential to achieve absolute enzymatic activity.

•Increasing its concentration will increase the velocity of an enzymatic reaction.

0 Examples: Nicotinamide adenine dinucleotide (NAD)

Nicotinamide adenine dinucleotide phosphate (NADP)
ENZYMOLOGY 221

ASSESSMENT QUIZ
1. It represents the first digit in enzyme nomenclature.
a.
serial number of enzyme C. rate of reaction
b.
subclass of enzyme
d. classification of enzyme
2. It is a marker for bone remodeling and
disease.
for bone mineral disease (BMD) in patients with chronic kidney
d.
c. ACP
b. TRAP-5b
d. ALP
3. A 35-year-old female patient was presented to the
emergency room. Biochemistry test reveals:
ALT = 458 U/L
AST = 402 U/L
CK = 13 U/L
ALP: 119 U/L

What is the most likely cause of these laboratory findings?

a. muscular dystrophy C. myocardial injury

b. viral hepatitis d. obstructive jaundice

4. Which enzyme is considered small in size and the concentration in serum is increased during decreased
renal clearance?
a. ACE C. trypsin
b. amylase d. G-6-PD

It is considered the most specific substrate in the measurement of ACP.

d. alpha-naphthyl PO c. thymolphthalein monophosphate

b. para-nitrophenyl PO 4 d. beta-glycerol PO4
b. It is a tumor marker with increased serum level in ovarian and gynecological cancer.
a. C. Lipase
b. Pseudocholinesterase d. ALP

7. This clinically significant enzyme determines acute exposure to organophosphates and monitors the effects
of succinylcholine after surgery:
a. acetylcholinesterase C. ornithine carbamoyltransferase
b. pseudocholinesterase d. gamma-glutamyl transferase
This is an inflammatory enzyme marker that is located in various human body organs and tissues; thus,
it can be included in the COVID-19 biochemistry tests.
a.
d. AST

9 What is the serum level of lipase in majority of cases of chronic pancreatitis?

c. normal serum level
d. markedly increased
d. decreased level
b. slight increased
and serves as a diagnostic marker in sarcoidosis.
10. It is predominantly found in the lungs and kidneys
C. ornithine carbamoyltransferase
a. ACE
d. 5' nucleotidase
b. ceruloplasmin
 16 ELECTROLYTES
CHAPTER

LEARNING OUTCOMES
At the end of this the students should be able to:
chapter,
1. identify the ions responsible for each function of the electrolytes in the human body;
2. explain the relationship of the blood volume and the plasma levels of electrolytes;
3. discuss the role of the kidneys and endocrines in the regulation of ions;
4.
cite the clinical significance of serum electrolytes and its role in the calculation of osmolality and
anion gap;
5. delineate the critical values of electrolytes and the corresponding clinical manifestations; and
6. discuss the samples and methods used in the measurement of electrolytes including the assay
interferences.

Electrolytes are ions capable of carrying an electric charge. Fluid always contains equal numbers of cations and
anions, and this balance of charges is referred to as electroneutrality. Dissociation of solutes into charged particles
(ions) depends on the chemical composition of the compound and on the concentration of other charged particles in
the medium.

The volume of the extracellularfluid varies on water retention controlled by the arginine vasopressin and sodium
retention is regulated by aldosterone. On the contrary, intracellular fluids are made to be stable with constant
osmolality because of the chemical reactions that take place in that cellular space with 60% of the body's water
inside the cells and the remaining is in the bloodstream or tissue fluids.
and the influence of the endocrines.
The balance of electrolytes in plasma is an interplay between the renal function
Hence, this chapter will present a clinical synopsis of the correlation of the kidneys, hormones, and the development
of pathologies.
Water Distribution
and adults are 50% to 60% water (Brinkman et al.,
Human infants are approximately 75% water by mass
2022).
the human body.
40% to 75% is the average water content of
in the bloodstream or tissue fluids; about 30 liters of
body's water is inside the cells, and the rest
is
60% of the
fluid passes from the blood to the tissue spaces daily (Brinkman al., 2022).
et

Extracellular fluid (ECF) is one third or 16 liters of the total body water.
Intracellular fluid (ICF) is two thirds
or 24 liters of the total body water.
About 30 liters of fluid passes from the blood to the tissue spaces daily.
Advanced age and obesity decrease the water content of the body.
7% solutes.
Normal plasma is composed of 93% water and
NPN, amino acids, and ions.
The major solutes are composed of glucose, lipids, proteins,
of whole blood.
The water content of plasma is 12% higher than that
Retention of 3 liters of fluid in the tissues will result in edema.
liters of water excreted daily.
Deficiency in arginine vasopressin (AVP) causes 10 to 20
 246 ELECTROLY-

ASSESSMENT QUIZ
Chvostek and Trousseau signs are indicators of low plasma levels of some electrolytes and
these are
1. Seen in

which condition?
brin
a. Addison's disease C. primary hypogonadism
b.
pheochromocytoma d. tetany
2. Compute the serum osmolality in m0sm/kg using the values below.
112 mg/dL
BUN = 14.7 mg/dL
Sodium = 136 mmol/L
a. 283.47 mOsm/kg C. 335.12 mOsm/kg
b. 293.78 mOsm/kg d. 340.54 mOsm/kg
Anaerobic blood sample is a of this ion, otherwise test result is false
3.
requirement in the measurement
decreased.

a. magnesium c. ionized calcium

b. potassium d. inorganic phosphate
4. Laboratory findings: Decreased serum magnesium, phosphorus, sodium, but elevated potassium and
calcium. What is the most likely cause of these results?
a. Conn's disease, diabetes mellitus c. renal failure, barium poisoning
b. diabetes mellitus, renal failure d. barium poisoning

5. Which of the following hormones is secreted during increased plasma osmolality?

a. vasopressin c. cortisol
b. aldosterone d. PTH

b. In rocky mountain spotted fever, which electrolyte has decreased plasma level?
a. magnesium c. chloride
b. sodium d. calcium

7. What is considered as an important supplemental marker in sepsis resulting in low plasma concentration?
a. chloride c. calcium

b. sodium d. magnesium
8. In what health condition are low levels of phosphorus and magnesium observed?
a. acute pancreatitis c. alcoholism

b. diabetes insipidus d. fluoride poisoning

9. Which of the following is not true in cystic fibrosis?
a. Diagnosis includesmeasurement of sodium, potassium, and chloride in sweat sample.
b. Cystic fibrosis transmembranous conductance regulator is the defective gene.
Pilocarpine is the sweat inducer.
d. Trypsin may be deficient in affected individuals.
10. What is the correct formula for anion gap?
C.

b. (Na* + K*) (CI-) d. K+

 17 BLOOD GASES AND ph
MEASUREMENTS
CHAPTER

LEARNING OUTCOMES

At the end of this chapter, the students should be able to: omeelg hanW 00116 DOMITILNS
1. explain the physiologic role of the blood;
2. relate the reference ranges of the parameters used to determine the acid-base balance and
interpret the abnormal values;
Henderson-Hasselbach equation and the expanded
calculate correctly the blood pH utilizing the
formula;
4. discuss the abnormal states including the causes of each acid-base imbalance;
5. cite the samples and methods used in the measurement
of blood pH and gases including the assay
interferences; and
6. explain the quality control monitoring of the blood gas and pH analyzers.

form carbonic acid (H,CO3), which dissociates

Most of the carbon dioxide (CO2) combines with water (H2O) to
while the reaction is accelerated by carbonic anhydrase.
immediately into hydrogen (H') and bicarbonate (HCO3
into the plasma. HC03 and H,CO, are
H,CO§ increases HC0& in RBC, causing it diffuse
to
The dissociation of

renewable, that is, even before

renal mechanisms restore the constituents, the lung alters the ratio of numerator
(HCO2 ) to denominator (H,CO3) by blowing off CO2•
acid-base balance will be presented
The synopsis of the relationship of the lungs and the kidneys in maintaining the
in this learning section as well as the
role of the blood buffers in controlling the pH imbalances.

REGULATION OF ACID-BASE BALANCE: LUNGS AND KIDNEYS

and Base:
Bronsted and Lowry's Definition of Acid
chemical reaction.
Acid is a substance that donates a proton in

Base is a substance that accepts a proton in chemical reaction.

Lungs
rapid and very sensitive adjustments in blood pH.
Respiratory control of CO2 excretion allows and H2CO3
to resist accumulating H*, the proportion between HCO3
As the lungs eliminate excess CO2
readjusts to 20:1, although
the absolute concentrations of each can fall below normal.
at or about 20:1, thereby minimizing
the lungs can maintain the ratio
By regulating the rate of CO2 excretion,
pH changes.
The CO, diffuses into the alveoli and is eliminated through ventilation.
lungs results in increase in H* ion concentration
Respiratory acidosis: Slow non-removal of CO> by the
or

Respiratory alkalosis: Rapid or

fast elimination of CO, results in decreased H* ion concentration
BLOOD GASES AND PH MEASUREMENTS 257

ASSESSMENT QUIZ
1,
All blood
a.
gas analyzers have electrode chambers maintained at what temperature?
22° C
C. 320 C
b. 28° C
d. 37° C
Which electrode measures the amount of current flow in a
at the cathode?
circuit that is related to the amount of 02 reduced
a. calomel
C. severinghaus
b. clark
d. silver-silver chloride
The main role of the
3.
kidneys in maintaining acid-base balance:
a. excretion of bicarbonate c. reclamation of bicarbonate
b. excretion of acid
d. reabsorption of acid
4. What is used for the measurement of blood pH?
a. potentiometry ¢. amperometry
b. polarography d. voltametry
5. During acid-base imbalance, when the body tries to return the pH of blood between 7.35-7.45, it is an

evidence of which body response?

a. metabolism c. normal feedback mechanism

b. compensation d. regulation
6. Transcutaneous electrodes are used for continuous measurement of which analyte?
a. C.

b. p02 d. blood pH
7. What is the solubility coefficient of carbon dioxide in plasma?
a. 0.03 c. 1.6

b. 1:20 d. 6.1

8. Which of the following is not associated with respiratory acidosis?

a. chronic obstructive pulmonary disease
b. decreased pCO2
C. overdosage of morphine
d. reclaimation of bicarbonate
buffer solutions use for the calibration of pH electrode?
9, Which among these organizations specified the
c. ACS
d.
b. CAP

10. A patient's blood gas results are: ph 7.50; pCO2 = 55mmHg; HCO3 = 40mmol/L. What is indicated by these
laboratory results?
c. metabolic alkalosis
a. metabolic acidosis
d. respiratory alkalosis
b. respiratory acidosis
 VITAMINS, TRACE
18 ELEMENTS, AND
CHAPTER TUMOR MARKERS

LEARNING OUTCOMES
At the end of this chapter, the students should be able to:
1. outline the micronutrients such as the vitamins and trace elements
and their functions in the
human body;
2. state the clinicalsignificance of vitamins and trace elements, and the effects of deficiency and
overdosing;
3. explain the purpose of each tumor marker; and
4.
discuss the samples and methods used in the measurement of micronutrients and tumor markers
including the assay interferences.

Vitamins are essential organic substances that the body cannot synthesize or does not sufficiently synthesize.
Essential trace elements are important for maintenance of normal health and
tissue and organ functions. Tumor
markers are substances in the body that are associated with the presence of a cancer.

A synopsis of the micronutrients and cancer markers are presented in this chapter, including their significance and
clinical significance.

VITAMINS

These are present in almost all food, but no single food group is the source of all vitamins.
The liver has the capacity to synthesize vitamins such A, D, and B12.
Functions: Antioxidants, enzyme cofactors, hormones and important in blood cell, maturation, and bone
formation and active in energy metabolism
Samples: Serum, plasma, urine, and white blood cells (ascorbic acid)
Method: Immunoassay
VITAMINS,
TRACE ELEMENTS, AND TUMOR MARKERS 263

ASSESSMENT QUIZ
1. Deficiency of which micronutrient leads to the formation of the "Casal's necklace"?
a. panthotenic acid c. Pteroylglutamic acid
b. nicotinic acid d. Riboflavin
2. Wernicke-Korsakoff syndrome characterized by impaired vision and ataxia is related to the reduced
concentration of this supplement.
a. Thiamine c. Retinol
b. Ergocalciferol d. Pyridoxal
3. What is the routine method in clinical trace element analysis?
a. Graphite furnace AAS
b. Neutron activation analysis
C.
Inductively coupled plasma/mass spectroscopy
d. Atomic absorption spectrometry
_ 4. Which of the following monitors malignancy affecting the head and neck?
a. Cathepsin-D
b. Thyroglobulin
C. Parathyroid hormone-related peptide
d. CEA

5. Which substance below is a marker for brain cancer?

a. c. Nuclear matrix protein (NMP)
b. 2-hydroxyglutarate d. CA-50

Low content of this trace element in the diet promotes alcohol abuse and infertility.
a. chromium III C. zinc

b. molybdenum d. manganese
7. What is the recommended sample collection tube for analysis of trace elements?
C. yellow top
a. pink top
b. royal blue top d. tiger top
8. Overdose of which supplement results in hair loss with odor of garlic breath?
C. cobalt
a. copper
b. iron d. selenium

9. Which of the following serves as a best sample for measurement of ascorbic acid?
white blood cells C. 24-hour urine
a.

b. nails d. whole blood

10. It is essential in protein synthesis and gene expression.

C. iodine
a. Tocopherols
d. iron
b. zinc
 19 ENDOCRINOLOGY
CHAPTER

LEARNING OUTCOMES

At the end
of this chapter, the students should be able to:
1. classify the hormones correctly;
2. explain the importance of feedback loop in the secretion of hormones:
3. list the hormones and their role in disease diagnosis and
patient management;
4. discuss the general principle of the dynamic function test;
5. compare screening test with confirmatory test in aid of disease identification; and
6. discuss patient preparation, sampling, and methods used in the measurement of hormones
including the assay interferences.

Endocrine System is a network of ductless glands that secrete hormones directly into the blood. It is considered as
the regulatory system of the body. It is controlled by hormone synthesis rather than degradation.
In this chapter, endocrinopathies and diagnostic tests are included in the discussion.

HORMONES

These are chemical signals produced by specialized cells secreted into the blood stream and carried to target
tissue.

They act at tissues or sites different from where they are synthesized and released.
They play an important role in growth and development of an individual.
They are regulated by metabolic activity either by positive or negative feedback mechanism.
Sometimes they are influenced by physiologic factors such as age, as in the case of the elderly who secrete less
and cortisol.
triiodothyronine, parathyroid hormone, aldosterone,
Major functions: To maintain the constancy of chemical composition of extracellular and intracellular fluids;
and control metabolism, growth, fertility, and responses to stress.
Control of Hormone Secretion
the pituitary gland, which in turn is controlled by
The majority of endocrine functions are regulated through
secretions from the hypothalamus.

Feedback Mechanism
1. Positive Feedback System (PFM)
It is a system in which an increase in the product results to elevation of the activity of the system and the
production rate (e.g., gonadal, thyroidal and adrenocortical hormones).
2.
Negative Feedback System (NFM-common feedback mechanism)
decreased activity of the system and the
It issystem in which an increase in the product results to
production rate (e.g., luteinizing hormone).
ENDOCRINOLOGY 315

ASSESSMENT QUIZ
This hormone
gotten out of bed.
Is sensitive to postural changes, hence blood sample should be collected before the patient has
a. epinephrine
C. cortisol
b. triiodothyronine d. aldosterone
2. What hormone is only secreted during the dark period of the day and with known anti-oxidant and anti-
aging properties?
a. somatotropin C. serotonin
b. melatonin
d. dopamine
3. This immunoassay are utilized in
autoantibody testing, forensic chemistry, toxicology, antimicrobial
surveillance, and in the detection of antibodies against the SARS-CoV-2.
a. Chemiluminescence
c. Radioimmunoassay
b. Enzyme Immunoassay d. Immunometric Assay
4. The following processes are promoted by parathormone, EXCEPT:
a. conversion of inactive vitamin D to

b. promotes bone resorption

C. promotes urinary excretion of calcium

d. prevents hypocalcemia
5. Which form of estrogen is used in the assessment of ovarian function?

a. C.

b. estriol

6. This hormone secreted by the G cells of the antrum is the diagnostic marker in Zollinger Ellison syndrome.
a. gastrin C. serotonin
b. somatostatin d. pepsin
7. structurally similar to growth hormone and is abnormally increased in galactorrhea.
It is described as

a. human placental lactogen C. human chorionic gonadotropin

b. prolactin d. estrogen

8. Which layer of the adrenal cortex is the site of glucocorticoid synthesis?

a. zona reticularis C. zona glomerulosa
b. zona adrenalis d. zone fasciculata

9. This thyroid disorder is characterized by circulating antibodies to TSH receptor.

d. Grave's disease C. Hashimoto's disease

b. De Quervain's thyroiditis d. cretinism

10. Whcih type of immunoassay uses chemical probes which could generate light emission through chemical
reaction to label the antibody and measure the absolute concentration of the analytes?
a. Immunochemiluminometric
b. Immunoradiometric
C. Chemiluminescence

d. Enzyme Amplified Sensitivity Immunoassay

11. This disorder resembles primary hyperaldosteronism
with salt crave and high plasma renin but without

hypertension.
c. Bartter's syndrome
a. Gitelman syndrome
d. Addison's disease
b. Liddle's syndrome
 20 THERAPEUTIC DRUG
MONITORING
CHAPTER

LEARNING OUTCOMES

At the end of this chapter, the students should be able to:

1. discuss the purpose of therapeutic drug monitoring (DM);
2. outline the characteristics of the drugs that qualify them for monitoring;
3. cite the groups of drugs included in TDM;
4. differentiate trough from peak concentration; and
5. discuss the samples and methods used in TDM including the assay interferences.

This learning section involves the analysis, assessment, and evaluation of circulating
concentrations of drugs in
drugs
serum, plasma, or whole blood. Therapeutic drug monitoring (TDM) is a quantitative procedure performed for
with a narrow therapeutic index. It allows for the safe use of drugs that would otherwise be potentially toxic.
TDM ensures that a given drug produces maximal therapeutic benefit and minimal side effects to achieve a constant
of their concentrations.
serum level of the drug that will be therapeutic. Most drugs have a half-life independent
The half-life of the drug determines the time to reach the steady-state or average concentration while only the free
fraction of the drugs can interact with the site of action and result in biologic response.
greatest portion of drug
The mixed function oxidase (MFO) system is the biochemical pathway responsible for the
metabolism.

Indications for Therapeutic Drug Monitoring (TDM) bus nottcluotla abeded

1. The consequences of overdosing and underdosing are serious.
dose.
2. There is a small difference between a therapeutic and toxic
drug and circulating concentrations but a good correlation
3. There is a poor relationship between the dose of
between circulating concentrations and therapeutic and toxic effects. affect circulating drug
4. There is a change in the patient's physiologic state that may unpredictably
concentrations.
5. A drug interaction is or may be occurring.
b. It helps in monitoring patient compliance.
Routes of Administration
of action.
that can effectively deliver most drugs to their site
The circulatory system is a convenient route all the drugs enter the
100% bioavailability, that is,
Intravenous route of administration is associated with
bloodstream (1.0 bioavailable fraction).
bioavailability fraction.
Orally administered drug should achieve a 0.7 distribution and elimination rates

When drugs are intravenously (most immediate route) administered, the

are constant.
Routes, intravenous oral intramuscular, subcutaneous, inhalation, suppostory, and transcutaneous
328 THERAPEUTIC DRUG MONITORING

ASSESSMENT QUIZ
1. This is used for management of patients with atomic seizure while hyperammonemia is an indication of

overuse of this drug.

a. valproic acid C.

b. carbamazepine d. gabapentin
2. What is considered as the best sample for quantification of cyclosporine?
a. serum, SST c. plasma, heparin
b. serum, plain tube d. whole blood, EDTA
3. Toxic dose of acetaminophen starts at what concentration?
a. 70 mg/kg C. 140 mg/kg
b. 100 mg/kg d. 180 mg/kg
4. At very high dose, which of the drugs below can cause hepatic failure?
a. C. methotrexate

b. acetaminophen d. fluoxetine

.5. Measurement of the concentration of this drug in blood is the best predictor of toxicity rather than the early
signs and symptoms.
a. lithium C.

b. digoxin d. theophylline
6. It is a common cause of fatal drug poisoning in children resulting to Reye's syndrome.
a. salicylate C. lidocaine

b. doxepin d. chloramphenicol
7. Red man syndrome is one of the toxic effects of this drug, hence, it is part of TDM.
a. c. phenobarbital
b. vancomycin d. phenytoin
8. When taken above the prescribed dose, which of these drug may inhibit thyroid hormone synthesis and
release, causing hypothyroidism?
a. aminoglycoside c. lithium

b. quinidine d. procainamide
9. The following statements regarding therapeutic drug monitoring, EXCEPT:
are true

a. Some drugs with wide therapeutic index are potentially toxic.

b. Altered pharmacokinetics may create toxic effects even when dosage is correct.
C. Drug metabolites in plasma do not cause toxicity even in high levels.
d. Some drugs enter the enterohepatic circulation and excreted in stool.

10. Aside from serum and plasma, which sample is accepted in forensic therapeutic drug test?
a. urine C. throat swab
b. saliva d. dried blood spot
 21 TOXICOLOGY AND
DRUGS OF ABUSE
CHAPTER

LEARNING OUTCOMES

At the end of this chapter, the students should be able to:

1.
define related terminologies in toxicology;
2. explain the routes of exposure;
3. classify toxins and drugs of abuse, and discuss their severe effects to humans;
4. cite samples for drug testing and the protocol in collection, handing, transport, and processing of
specimens; and
5. discuss the adulterated samples in drug testing and the causes of alterations.

Toxicology is the study of substances toxic to the body. Ingestion, inhalation, and transdermal absorption of toxins
are the usual routes of exposure. Absorption of toxins in the gastrointestinal tract is by passive diffusion where the
toxins cross cellular barriers.

Toxins that are not absorbed through the GIT do not produce systemic effects but may produce local effects such as
diarrhea, bleeding, and malabsorption of nutrients. Alcohol, acetaminophen, salicylate, abuse substances, and carbon
monoxide are the common substances causing acute
In cases of drug overdose, complete blood count (CBC), serum electrolytes, BUN, glucose, urinalysis, and blood gas
must be determined.

Terminologies
1. Acute toxicity single and short-term exposure to a substance
2. Chronic toxicity - repeated exposure for an extended period of time

3.
TD 50 dose that would be predicted to produce a toxic response in 50% of the population
4. LD50 - dose that would predict death in 50% of the population
5. ED 50 dose that would be predicted as effective or has therapeutic benefit in 50% of the population 132

TOXIC AGENTS
Alcohol
These arecommon CNS depressants.
They cause disorientation, euphoria, confusion, and may progress to unconsciousness, paralysis, and even
death.
blood alcohol).
Symptoms of alcohol intoxication begin when the concentration is > 0.05% w/v(> 50 mg/dL
1.
Ethanol (Grain Alcohol)
It is the most common abused drug; a CNS depressant.
It causes diuresis by inhibiting ADH.
 342 TOXICOLOGY AND DRUGS OF ABUSE

ASSESSMENT QUIZ
1. It is a complementary method to GC-MS in confirming drugs of abuse.
a. c. LC-MS
arb to alsvel wol lo nolhale5
b. MS/MS d. DESI
error?
In the measurement of blood alcohol, which of the following may be considered as a source of
a. Blood was drawn using alcohol-based skin disinfectant.
b. Processing was delayed in a sealed tube.

C. Sample was transported in ice water.

d. EDTA is the anticoagulant used.

What described as a homogenous competitive-binding

is assay that uses an enzyme-labeled drug that
competes with the drug in the sample?
a. ELISA
b. EMIT d. IRMA
and is used for small molecule
4. Which method quantifies the molecular "tumbling" of the sample-analyte
analysis?
a. GC-MS
s ord oi vlishaues T204 ul bean be men1
b.
al belin_
5. It detects the distance of separation of the drugs from the point of application.
a. DESI C.

b. paper spray ionization

What is the purpose of using blood over serum in the analysis of drugs of abuse?
a. It is done to detect theprevailing circulating drugs.
b. It is used to determine the entire composition of drugs.

c. Drugs and their metabolites are present in higher concentrations.

d. Larger sample volumes are easily collected.
7. Which of these methods is ideal in field studies since it detects biofluids even in dried blood spots with rapid
identification?
a. DESI C. EMIT

b. d. paper spray ionization

8. This substance interferes with the analysis of methamphetamine drug and cause a false-positive screening
result.

a. Bath Salts Aisle mond

b. Tryptamines d. Methaqualone m1 bae
9. Which of the following drugs of abuse binds to mu-receptors in the CNS producing analgesic effect?
a. heroin C. amphetamine
b. cocaine d. morphine
10. All of these substances may cross the placenta, EXCEPT:
a. cocaine C. cadmium

b. arsenic d. codeine
ANSWER KEY: Review Handbook in Clinical Chemistry [Rodriguez] c2023

CHAPTER 1 – INTRODUCTION – (no assessment quiz)

CHAPTER 2 – LABORATORY SAFETY AND EQUIPMENT QUALITY CONTROL

Page 10

1. D 6. C
2. B 7. C

In on
3. A 8. B
4. B 9. A

g, cti
c.
5. D 10. B

3 hin du
, 2 ub ep ly
17 P R n
02 lis ro
or y o
CHAPTER 3 – REAGENT PREPARATION
Page 14
M C on op
1. A
of uti C

2. B
ty ib t's

3. D
er istr en

4. D
E

5. C
op D ud

ay &
pr for St

CHAPTER 4 – LABORATORY MATHEMATICS

Page 18

1. D 6. A
2. B 7. A
3. A 8. D
ot

4. B 9. B
N

5. C 10. A
a
ANSWER KEY: Review Handbook in Clinical Chemistry [Rodriguez] c2023

CHAPTER 5 – QUALITY CONTROL IN THE CLINICAL CHEMISTRY LABORATORY

Page 36-37

1. D 9. B
2. D 10. A
3. D 11. C
4. B 12. C
5. B 13. A

In on
6. B 14. B

g, cti
7. A 15. B

c.
3 hin du
8. B

, 2 ub ep ly
17 P R n
02 lis ro
CHAPTER 6 – ANALYTICAL METHODS
Page 61-62 or y o
M C on op
1. B 9. A
of uti C

2. C 10. D
ty ib t's

3. B 11. B
4. D
er istr en

12. A
E

5. A 13. D
op D ud

ay &

6. B 14. B
pr for St

7. C 15. A
8. D

CHAPTER 7 – INSTRUMENTATION AND AUTOMATION

ot

Page 70
N

1. B 6. B
a

2. C 7. A
3. D 8. B
4. C 9. A
5. C 10. D
ANSWER KEY: Review Handbook in Clinical Chemistry [Rodriguez] c2023

CHAPTER 8 – PATIENT PREPARATION

Page 74

1. A 6. C
2. B 7. A
3. B 8. C
4. C 9. C
5. D 10. D

In on
g, cti
CHAPTER 9 – SAMPLE COLLECTION, HANDLING, AND TRANSPORT

c.
3 hin du
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, 2 ub ep ly
17 P R n
1. B 6. D

02 lis ro
2. D
or y o 7. B
M C on op
3. B 8. D
4. C 9. C
of uti C

5. B 10. C
ty ib t's
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CHAPTER 10 – CARBOHYDRATES
E
op D ud

Page 112
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1. B 6. C
pr for St

2. B 7. B
3. A 8. D
4. D 9. C
5. B 10. B
ot
N

CHAPTER 11 – LIPIDS AND LIPOPROTEINS

a

Page 135

1. B 6. D
2. A 7. A
3. B 8. B
4. B 9. B
5. C 10. C
ANSWER KEY: Review Handbook in Clinical Chemistry [Rodriguez] c2023

CHAPTER 12 – PLASMA PROTEINS

Page 158

1. C 6. D
2. D 7. A
3. D 8. A
4. D 9. B

In on
5. A 10. C

g, cti
c.
3 hin du
, 2 ub ep ly
CHAPTER 13 – KIDNEY FUNCTION TESTS

17 P R n
Page 176

02 lis ro
1. A
or y o 5. C
M C on op
2. A 6. D
3. B 7. A
of uti C

4. B 8. C
ty ib t's

9. D 10. D
er istr en

E
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CHAPTER 14 – LIVER FUNCTION TESTS

ay &
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1. B 6. B
2. B 7. C
3. D 8. B
4. A 9. C
ot

5. C 10. A
N
a

CHAPTER 15 – ENZYMOLOGY
Page 221

1. D 6. D
2. A 7. B
3. B 8. A
4. B 9. D
5. C 10. A
ANSWER KEY: Review Handbook in Clinical Chemistry [Rodriguez] c2023

CHAPTER 16 – ELECTROLYTES
Page 246

1. D 6. B
2. A 7. D
3. C 8. C
4. B 9. A

In on
5. A 10. C

g, cti
c.
CHAPTER 17 – BLOOD GASES and pH MEASUREMENTS

3 hin du
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17 P R n
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2. B 7. A
M C on op
3. B 8. B
of uti C

4. A 9. D
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5. B 10. A
er istr en

CHAPTER 18 – VITAMINS, TRACE ELEMENTS, AND TUMOR MARKERS

op D ud

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1. A 6. C
2. A 7. B
3. D 8. D
4. C 9. A
5. B 10. B
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ANSWER KEY: Review Handbook in Clinical Chemistry [Rodriguez] c2023

CHAPTER 19 – ENDOCRINOLOGY
Page 315

1. D 7. B
2. B 8. D
3. A 9. A
4. C 10. C
5. A 11. A

In on
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CHAPTER 20 – THERAPEUTIC DRUG MONITORING

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2. D 7. B
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5. D 10. D
er istr en

CHAPTER 21 – TOXICOLOGY AND DRUGS OF ABUSE

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2. A 7. A
3. B 8. A
4. C 9. D
5. D 10. D
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