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BASIC CLINICAL

CHEMISTRY

Abdul Rohman, PhD


Department of Pharmaceutical Chemistry, Faculty
of Pharmacy, Gadjah Mada University, Yogyakarta,
Indonesia

CLINICAL CHEMISTRY

The analysis of individual constituents,


proteins, enzymes, nutrients, waste
products, metabolites, hormones, etc. in
blood or body fluids that provides
information regarding the function or
integrity of a tissue, organ or organ system

While almost anything may be analyzed, the


efficacy of a test depends on its specificity
and sensitivity to detect pathological change

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
waste products. Examples: Creatinine, Blood
Urea Nitrogen (BUN)
Detect or measure substances that indicate cell
damage or disease. Examples: Liver enzymes,
such as ALT, Cardiac enzymes, such as CK-MB
Detect or measure drugs or toxic substances.
Examples: Dilantin, Drugs of abuse screen

SOME METHODS FOR THE ANALYSIS OF DRUGS AND


OTHER ORGANIC POISONS IN BIOLOGICAL SAMPLES

SOME METHODS FOR THE ANALYSIS OF DRUGS AND


OTHER ORGANIC POISONS IN BIOLOGICAL SAMPLES

TYPES OF SPECIMENS FOR


CHEMICAL ANALYSIS
Whole

blood, serum or plasma. The most


common specimen is serum, collected in a
tube with no anticoagulant so that the blood
will clot.

Urine

often 24 hour collections

Others

Cerebrospinal Spinal Fluid (CSF) and


other fluids

ANTI-COAGULANT

ANALYTICAL STEP IN CLINICAL


CHEMISTRY

CLINICAL CHEMISTRY TESTS


Normal

or Reference Values range of values


for a particular chemistry test from healthy
individuals
Chemistry Panel grouping some tests are
bundled according to the system or organ
targeted. Examples: thyroid panel, liver panel,
cardiac panel, kidney panel, basic metabolic
panel, etc.

Commonly Performed Chemistry


Tests or Analytes (1)
Proteins

essential components of cells and


body fluids. Some made by body, others
acquired from diet. Provides information about
state of hydration, nutrition and liver function,
since most serum proteins are made in the liver.
Electrolytes sometimes called lytes

Includes sodium (Na), potassium (K), chloride (Cl)


and bicarbonate (HCO3-)
Collectively these have a great effect on hydration,
acid-base balance and osmotic pressure as well as pH
and heart and muscle contraction
Levels differ depending on if inside vs. outside cells
Important in transport of substances into and out of
cells

Commonly Performed Chemistry


Tests or Analytes (2)
Minerals

Calcium
Used in coagulation and muscle contraction
99% is in skeleton and is not metabolically active
Influenced by vitamin D, parathyroid hormone,
estrogen and calcitonin
Hypercalcemia occurs in parathyroidism, bone
malignancies, hormone disorders, excessive vitamin
D, and acidosis; may cause kidney stones
Hypocalcemia can cause tetany; occurs in
hypoparathyroidism, vitamin D deficiency, poor
dietary absorption and kidney disease

Commonly Performed Chemistry


Tests or Analytes (3)

Phosphorus
80% in bone and rest in energy compounds such as
ATP
Influenced by calcium and certain hormones
Iron
Essential for hemoglobin
Deficiency results in anemia; may be caused by
lack of iron in diet, poor absorption, poor release
of stored iron or loss due to bleeding
Increased in hemolytic anemia, increased iron
intake or blocked synthesis of iron-containing
compounds, such as in lead poisoning

Commonly Performed Chemistry


Tests or Analytes (4)
Kidney

Function Tests

Serum Creatinine
Best test for overall kidney function; not affected by diet
or hormone levels
Waste product of muscle metabolism
Serum creatinine rises when kidney function is impaired
BUN (Blood Urea Nitrogen)
BUN is surplus amino acids that are converted to urea and
excreted by kidneys as a waste product
BUN influenced by diet and hormones, so it is NOT as good
an indicator of renal function as serum creatinine levels
BUN increased in kidney disease, high protein diet, and
after administration of steroids
BUN decreased in starvation, pregnancy and in persons on
a low protein diet

Commonly Performed Chemistry


Tests or Analytes (5)

Uric Acid
Formed from breakdown of nucleic acids and
excreted as a waste product by kidneys
Increased in kidney disease, but most often used
to diagnosis gout (pain in joints, mainly big toe, due
to precipitated uric acid crystals)
Also increased in increased cell destruction, such
as after massive radiation or chemotherapy

Commonly Performed Chemistry


Tests or Analytes (6)
Liver

Function Tests

Liver functions:
Synthesizes glycogen from glucose
Makes plasma proteins (albumin, lipoproteins,
coagulation proteins)
Forms cholesterol and degrades it into bile acids,
which emulsifies fats for absorption
Stores iron, glycogen, vitamins and other
substances
Destroys old blood cells and recycles components
of hemoglobin

Commonly Performed Chemistry


Tests or Analytes (7)

Total Bilirubin
Waste production of hemoglobin breakdown
Increased in excessive RBC breakdown, such as
hemolytic anemia, or impaired liver function or
some sort of obstruction, such as a tumor or gall
stone

Commonly Performed Chemistry


Tests or Analytes (8)

Liver Enzymes levels increase following damage to liver


tissues
Alkaline Phosphatase (ALP or AP) - Greatly increased in
liver tumors and lesions; moderately increased in
diseases such as hepatitis
Alanine Aminotransferase (ALT; formerly called SGPT)
- Increases up to 10x in cirrhosis, infections or tumors
and up to 100x in viral or toxic hepatitis
Asparate Aminotransferase (AST; formerly called
SGOT) - Increased in liver disease, but also in heart
attacks
Gamma Glutamyl Transferase (GGT) - Often used to
monitor patients recovering from hepatitis and
cirrhosis
Lactate Dehydrogenase (LD) - Increased in liver
disease and following heart attacks

Commonly Performed Chemistry


Tests or Analytes (9)

Cardiac Function Tests


Creatine Kinase (CK) - Widely used to diagnosis
and monitor heart attacks
Troponins

Only present in heart muscle, making it a more


accurate indicator of heart attack than CK
Cardiac Troponin T (cTnT)
Cardiac Troponin I (cTnI)

Commonly Performed Chemistry


Tests or Analytes (10)

Lipid Metabolism Tests


Cholesterol
Present in all tissues
Serves as the skeleton for many hormones
Recommended to be less than 200 mg/dL in adults)
LDL = bad cholesterol; HDL = good cholesterol
Triglycerides
Main storage form of lipids, comprising 95% of fat
tissue
Hyperlipidemia having high blood levels of
triglycerides may increase risk of heart attack
Carbohydrate Metabolism Tests
Glucose - Largely regulated by insulin

Commonly Performed Chemistry


Tests or Analytes (11)

Thyroid Function Tests


Thyroid Stimulating Hormone (TSH) - Inverse
relationship to thyroid function (the higher the
TSH, the lower the thyroid function and vice
versa)
Other less common thyroid tests include T3 and
T4
Hypothyroidism underactive thyroid gland
Hyperthyroidism overactive thyroid gland

For more information on most clinical


laboratory tests, visit:
http://www.labtestsonline.org/
Click on any lab test or condition or disease
and find all sorts of information!

Sample
Collection,
Transport,
and Storage

Sample collection

Advantages and disadvantages of


different samples

Sample transport and


storage
It is usually advisable to contact the laboratory
by telephone in advance to discuss urgent or
complicated cases.
Most

specimens, particularly blood and urine,


may be sent by post if securely packaged in
compliance with current regulations.

However,

if legal action is likely to be taken on


the basis of the results, it is important to be able
to guarantee the identity and integrity of the
specimen from when it was collected through to
the reporting of the results.

Thus,

such samples should be protected during

Chain of custody is a term used to


refer to the process used to
maintain and document the history
of the specimen (Box 2.4).

Guidance on freezer storage of


samples