2. introduction to clinical chemistry

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BASIC CLINICAL

CHEMISTRY

Abdul Rohman, PhD

Department of Pharmaceutical Chemistry, Faculty

of Pharmacy, Gadjah Mada University, o!ya"arta,

#ndonesia


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CLINICAL CHEMISTRY

$he analysis of individual constituents,proteins, en%ymes, nutrients, &asteproducts, metabolites, hormones, etc' inblood or body fluids that provides

information re!ardin! the function orinte!rity of a tissue, or!an or or!an system

(hile almost anythin! may be analy%ed, the

efficacy of a test depends on its specificityand sensitivity to detect patholo!ical chan!e


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PURPOSE OF CLINICAL CHEMISTRY

TEST

Measure levels of substances found normally in

human blood that have biological functions.

Examples: Glucose, Calcium

Detect or measure non-functional metabolites or

aste products. Examples: Creatinine, !lood

"rea #itrogen $!"#%

Detect or measure substances that indicate cell

damage or disease. Examples: &iver en'ymes,

such as (&), Cardiac en'ymes, such as C*-M!Detect or measure drugs or toxic substances.

Examples: Dilantin, Drugs of abuse screen


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SOME METHODS FOR THE ANALYSIS OF DRUGS AND

OTHER ORGANIC POISONS IN BIOLOGICAL SAMPLES


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SOME METHODS FOR THE ANALYSIS OF DRUGS AND

OTHER ORGANIC POISONS IN BIOLOGICAL SAMPLES


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TYPES OF SPECIMENS FOR

CHEMICAL ANALYSIS

Whole blood, serum or plasma. The mostcommon specimen is serum, collected in atube with no anticoagulant so that the bloodwill clot.

Urine often 24 hour collections

Others Cerebrospinal Spinal luid !CS" and

other fluids


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ANTI-COAGULANT


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ANALYTICAL STEP IN CLINICAL

CHEMISTRY


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#ormal or $eference %alues range of &aluesfor a particular chemistr' test from health'indi&iduals

Chemistr' (anel grouping some tests are)bundled* according to the s'stem or organtargeted. +amples- th'roid panel, li&er panel,cardiac panel, idne' panel, basic metabolicpanel, etc.

CLINICAL CHEMISTRY TESTS


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(roteins essential components of cells andbod' fluids. Some made b' bod', othersac/uired from diet. (ro&ides information aboutstate of h'dration, nutrition and li&er function,

since most serum proteins are made in the li&er.+lectrol'tes sometimes called )l'tes*

0ncludes sodium !#a", potassium !1", chloride !Cl"and bicarbonate !CO3"

Collecti&el' these ha&e a great effect on h'dration,

acidbase balance and osmotic pressure as well as pand heart and muscle contraction

5e&els differ depending on if inside &s. outside cells 0mportant in transport of substances into and out of

cells

Commonl' (erformed Chemistr'Tests or 6nal'tes !7"


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8inerals Calcium

Used in coagulation and muscle contraction99: is in seleton and is not metabolicall' acti&e

0nfluenced b' &itamin ;, parath'roid hormone,estrogen and calcitonin

'percalcemia occurs in parath'roidism, bonemalignancies, hormone disorders, ecessi&e &itamin;, and acidosis< ma' cause idne' stones

'pocalcemia can cause tetan'< occurs inh'poparath'roidism, &itamin ; deficienc', poordietar' absorption and idne' disease



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(hosphorus=>: in bone and rest in energ' compounds such as

6T(0nfluenced b' calcium and certain hormones

0ron+ssential for hemoglobin;eficienc' results in anemia< ma' be caused b'

lac of iron in diet, poor absorption, poor releaseof stored iron or loss due to bleeding

0ncreased in hemol'tic anemia, increased ironintae or bloced s'nthesis of ironcontainingcompounds, such as in lead poisoning



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1idne' unction Tests Serum Creatinine

?est test for o&erall idne' function< not affected b' dietor hormone le&els

Waste product of muscle metabolismSerum creatinine rises when idne' function is impaired

?U# !?lood Urea #itrogen"?U# is surplus amino acids that are con&erted to urea and

ecreted b' idne's as a waste product?U# influenced b' diet and hormones, so it is #OT as good

an indicator of renal function as serum creatinine le&els?U# increased in idne' disease, high protein diet, and

after administration of steroids?U# decreased in star&ation, pregnanc' and in persons on

a low protein diet



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Uric 6cidormed from breadown of nucleic acids and

ecreted as a waste product b' idne's0ncreased in idne' disease, but most often used

to diagnosis gout !pain in @oints, mainl' big toe, dueto precipitated uric acid cr'stals"6lso increased in increased cell destruction, such

as after massi&e radiation or chemotherap'

Commonl' (erformed Chemistr'Tests or 6nal'tes !A"


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5i&er unction Tests 5i&er functions-

S'nthesiBes gl'cogen from glucose8aes plasma proteins !albumin, lipoproteins,

coagulation proteins"orms cholesterol and degrades it into bile acids,

which emulsifies fats for absorptionStores iron, gl'cogen, &itamins and other

substances;estro's old blood cells and rec'cles components

of hemoglobin

Commonl' (erformed Chemistr'Tests or 6nal'tes !"


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Total ?ilirubinWaste production of hemoglobin breadown0ncreased in ecessi&e $?C breadown, such as

hemol'tic anemia, or impaired li&er function or

some sort of obstruction, such as a tumor or gallstone

Commonl' (erformed Chemistr'Tests or 6nal'tes !D"


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5i&er +nB'mes le&els increase following damage to li&ertissues6laline (hosphatase !65( or 6(" Ereatl' increased in

li&er tumors and lesions< moderatel' increased indiseases such as hepatitis

6lanine 6minotransferase !65T< formerl' called SE(T" 0ncreases up to 7> in cirrhosis, infections or tumorsand up to 7>> in &iral or toic hepatitis

6sparate 6minotransferase !6ST< formerl' calledSEOT" 0ncreased in li&er disease, but also in heartattacs

Eamma Elutam'l Transferase !EET" Often used tomonitor patients reco&ering from hepatitis andcirrhosis

5actate ;eh'drogenase !5;" 0ncreased in li&erdisease and following heart attacs

Commonl' (erformed Chemistr'Tests or 6nal'tes !="


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Cardiac unction TestsCreatine 1inase !C1" Widel' used to diagnosis

and monitor heart attacsTroponins

Onl' present in heart muscle, maing it a moreaccurate indicator of heart attac than C1 Cardiac Troponin T !cTnT" Cardiac Troponin 0 !cTn0"



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5ipid 8etabolism TestsCholesterol

(resent in all tissues Ser&es as the seleton for man' hormones $ecommended to be less than 2>> mgFd5 in adults" 5;5 G )bad* cholesterol< ;5 G )good* cholesterol

Trigl'cerides 8ain storage form of lipids, comprising 9A: of fat

tissue 'perlipidemia ha&ing high blood le&els of

trigl'cerides ma' increase ris of heart attac Carboh'drate 8etabolism TestsElucose 5argel' regulated b' insulin

Commonl' (erformed Chemistr'Tests or 6nal'tes !7>"


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Th'roid unction TestsTh'roid Stimulating ormone !TS" 0n&erse

relationship to th'roid function !the higher theTS, the lower the th'roid function and &ice

&ersa"Other less common th'roid tests include T3 andT4

'poth'roidism underacti&e th'roid gland'perth'roidism o&eracti&e th'roid gland



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or more information on most clinicallaborator' tests, &isit-

http-FFwww.labtestsonline.orgF

Clic on an' lab test or condition or diseaseand find all sorts of informationH
http://www.labtestsonline.org/http://www.labtestsonline.org/


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Sample

Collection,Transport,and Storage


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Sample collection


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Advantages and disadvantages ofdierent samples

l d


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Sample transport andstorage It is usually advisable to contact the laboratory

by telephone in advance to discuss urgent orcomplicated cases.

Most specimens, particularly blood and urine,

may be sent by post if securely packaged incompliance ith current regulations.

!oever, if legal action is likely to be taken on

the basis of the results, it is important to be ableto guarantee the identity and integrity of thespecimen from hen it as collected through tothe reporting of the results.

Thus, such samples should be protected during


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Chain of custody is a term used torefer to the process used tomaintain and document the historyof the specimen #$o% &.'(.


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)uidance on free*er storage ofsamples

2. introduction to clinical chemistry

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