introduction Clinical Chem Flashcards by Loui Mojica

It is a branch of laboratory medicine that is concerned with the quantitative measurement of analytes in body fluids to facilitate the diagnosis of diseases.

Clinical chem

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Analytes: given atleast (5)

Proteins
Enzymes
Metabolites
Drugs
Ions
salts
minerals

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Several types of proteins:

Transport protein
Protein that fight for infection
Organic specific protein
Enzymes

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Monitor effect of treatment by nothing changes in specific parameters

Measurement of Serum Cholesterol level, months after taking cholesterol lowering drugs.

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is a quantitative science.

Clinical chemistry

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It is concerned with measurement of amounts of biologically important substances in body fluids

Analytes

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The methods to measure these substances are carefully designed to provide accurate assessments of the concentrations.

Clinical chemistry

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All of the analytes have their own reference method.
Glucose:

Hexokinase

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All of the analytes have their own reference method.

HbA1C:

High-performance liquid
chromatography

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is defined as the gold standard or the best method to measure such concentrations of the analytes.

Reference methods

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According to Bishop, we must test at least 200 patients for us to be able to derive a
correct reference value.

Reference value

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is where the medical
diagnosis are being get.

Reference value

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to provide diagnostic and clinical meaning for the values.

Medical Decision Level (MDL)

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itlinkstheknowledgeof general chemistry, organic chemistry, and biochemistry with an understanding of human physiology; leads the foundation of all the
sciences involved in the program.

Science

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it produces objective evidence from which medical decisions may be made; it is where we acquire
the results

Service

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clinicallaboratoriesare
businesses, which operate under the regulations and practices that guide commerce in the United States.

Industry

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Computer Also known as

Laboratory information systems/ hospital information systems

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Importantinstoringthedataofthe
patients

Computer

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4 fundamental biomolecules:

Proteins
Carbohydrates
Nucleic Acids
Glucose

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composed of carbon and hydrogen atoms

Lipids

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composedof carbon, hydrogen, and oxygen atoms

Carbohydrates

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composed of carbon, hydrogen, oxygen, and nitrogen atoms

Protein

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Termed as automated analyzers

Instrumentation

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Used to measure the concentration of analytes

Instrument

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monitors the amount of substance or drugs in the body

Therapeutic drug monitoring

Give example of Pharmacology

Cardiac drug Antidepression drug Drugs

Different hormones for the specific diagnosis of the function on the specific organ

Endocrinology

Overlapping with the machines of clinical chemistry

Immunology

screening of drugs of abuse

Forensic toxicologists

Ana Chem and Clinical are both quantitative science which means they measure the amount of substances.

Analytical chemistry

Diagnosis of Glucose

Diabetes mellitus

Diagnosis of Glucose

Diabetes mellitus

Glucose core test

FastingBloodSugar RandomBloodSugar 2-hourpostprandial OralGlucoseToleranceTest(OGTT)

Renal function tests non protein nitrogen

Urea, Creatinine, and Uric Acid

Used to measure/assess the functions of the kidney

Renal function test

Renal function test also known as

Kidney function test

Liver/Hepatic function panel test for

Bilirubin, Albumin, Total protein, ALP, AST, ALT

Bilirubin test for

o Totalbilirubin o Directbilirubin(B2) o Indirectbilirubin(B1)

AlbuminandTotalProtein test

o Testcollectively o Total Protein, Albumin, Globulin and A/G ratio (TPAG)

Used for the management of heart disease or cardiac, coronary artery disease etc.

Lipid profile

Enzymes example

Amylase Lipase Creatinine kinase

Marker of liver problems

Enzymes

Aspartate aminotransferase also known as

SGOT

Alanine Transaminase also known as

SGPT

used for the diagnosis of MI or myocardial infarction (heart attack)

Creatinine kinase

Body hydration

Electrolytes

Electrolytes example

Sodium Potassium Chlorine

SPECIALIZED TESTS

Hormones Specific proteins Trace elements Vitamins Drugs Lipoprotein

3 under Hormones

TSH(Thyroid-StimulatingHormone) FT3(FreeTriiodothyronine) FT4(Freethyroxin)

Ovarian hormones

Progesterone, Estrogen, testosterone

Drugs example

Vancomycin Theophylline Dioxin

Drugs that is anti-cardiacglove

Dioxin

transport substances in the blood

Lipoproteins

3 reasons why they are considered as special test:

Less frequently performed Costprohibitive sent out to bigger laboratories

COMMON ANALYTES IN THE CLINICAL CHEMISTRY LABORATORY

Ions, Salts, and Minerals Small Organic Molecules Large Molecules

are analytes for metabolism.

Metabolites

Most common specimen used in clinical chem

Blood

Blood method of collection: A. Adult: B. Infant:

A. Adult:Venipuncture B. Infant:Skinpuncture/Heelprick

Blood Site: A. Adult: B. Infant:

A. Adult:antecubitalfossa B. Infant: side of the heel/plantar heel

Forms of Blood

Wholeblood Plasma Serum

Liquid portion of unclotted blood

Plasma

Liquid portion of clotted blood

Serum

Additive is anticoagulant

Plasma

Component that present in plasma but absent in serum:

Fibrinogen or factor 1

The act of drawing a blood sample from a blood vessel. For clinical chemistry testing blood is usually drawn from a vein, typically a vein in the arm or back of the hand.

Phlebotomy

Collecting blood from a vein is called

Venipuncture

The medical professional drawing the blood sample is called a

Phlebotomist

most commonly used because it is the most anchored/supported vein

Median

second most common because it has a tendency to roll

Cephalic

third choice because it has a close proximity to branchial artery.

Basilic

deoxygenated blood from vein

Dark red

oxygenated blood from artery

Bright red

Use for evaluating kidney functions and test that look at waste products excreted by kidneys.

Urine

Indication of kidney function:

Urination of protein

Urine Method of collection:

Midstream specimen

Urine For chemistry testing:

24 hour urine

is clear and colorless fluid surrounding brain and spinal cord.

Cerebrospinal fluid

CSF Formed in the

Choroid plexus

CSF Collected in

3-4 or 4-5 column

CSF Method of collection:

Lumbar tap Spinal tap Lumbar puncture

CSF Intended for:

Meningitis CSF leakage

CSF COLLECTION IS DONE USING 3-4 TUBES: 1 tube

Clinical Chemistry or Serology

CSF COLLECTION IS DONE USING 3-4 TUBES: 2 tube

Microbiology

CSF COLLECTION IS DONE USING 3-4 TUBES: 3 tube

Hematoloy

CSF COLLECTION IS DONE USING 3-4 TUBES: 4tube

Histopathology/ cytology/ serology/ special test

Csf tube that Diagnosis of malignancy/benign cancer

4 tube

Why Clinical Chemistry is included in the first tube? I

1 tube is unstrerile

Microbiology Mostcommonskincontaminant:

Staphylococcus epidermidis

OTHER BODY FLUIDS

1. PLEURAL FLUID - Thoracentesis 2. PERICARDIAL FLUID 3. PERITONEAL FLUID – paracentesis; also known as acetic fluid 4. AMNIOTIC FLUID 5. SYNOVIAL FLUID

is excessive amniotic fluid surrounding the fetus.

Polyhydraminos

FLUIDS TYPICALLY USED FOR CLINICAL CHEMISTRY TESTS

Blood (whole blood, serum, or plasma) Urine Cerebrospinal fluid (CSF) Amniotic fluid Saliva Synovial fluid Pericardial fluid Pleural fluid Peritoneal fluid

quality standards for all clinical laboratories to ensure accuracy, reliability and timeliness of patient test results regardless of where the test was performed

Clinical laboratory improvement amendments

defines clinical laboratories broadly

Clinical laboratory improvement amendments

Clinical laboratory improvement amendment current name

Clinical and laboratory safety institute

Two Levels of Regulations

Waived test and nonwaived test

simple laboratory examinations and procedures that are cleared by the U.S. Food and Drug Administration (FDA) for home use

Waived test

moderately and highly complex tests as defined by the requirements for operator skill, reagent preparation, and automation and the difficulty of interpretation of results. These are regulated under guidelines that cover quality standards for proficiency testing (PT), patient test management, quality control, personnel qualifications, and quality assurance.

Non Waived test

a system of comparing one laboratory result to the result of the other laboratory.

Proficiency test

PhilippinesReferenceLaboratorythat tests for all clinical analytes:

Lung center of the Philippines

Found that urea, an ‘organic’ substance, could be synthesized in vitro without any ‘vital force’ or living organism.

Friedrich Woḧ ler

discovered that urea could be produced by evaporating an isomeric solution of ammonium cyanate.

Friedrich wohler

Person that This work removed the requirement for any mysterious ‘vital force’ that separated in vivo biochemistry from in vitro chemistry.

Friedrich wohler

Who looked back on experiments of Antoine-Laurent de Lavoisier in pneumatic chemistry.

Henry bence jones

Bence jones proteinuria cam from

Henry bence jones

Who stated “few and scanty, indeed, are the rays of light which chemistry has flung on the vital mysteries.”

Robert james graves

Who complained that clinicians do not use their chemistry laboratory services except when needed for “luxurious embellishment for a clinical lecture.”

Max Josef von Pettenkofer

When urine test for diabetes and carbohydrate investigation started

1815

Who was the first used the term “ clinical chemical laboratory (klinisch chemischem Laboratorium)

John joseph scherer

an outstanding clinical chemist able to give an excellent interpretation of analytical results obtained from in body fluids. Published a book in 1932 along with John P. Peeters entitled Clinical Chemistry.

Donald D. van Slyke

He is also the founder of Modern Clinical Chemistry.

Donald D. van Slyke

invented the first Technicon Auto Analyzer

dr. Leonard skeggs

Crude techniques but advances to understand the living material were made despite limitations. What century

19 century

Year Radioisotopes were used in assay Scintillation counting device

1970

During 1970 they tested the alpha, beta, and gamma using ________

radioisotopes

During 1970 they tested the alpha, beta, and gamma using ________

radioisotopes