PHILIPPINE ASSOCIATION OF SCHOOLS OF MEDICAL TECHNOLOGY AND PUBLIC HEALTH Prototype Course Syllabus

Course Title: Clinical Chemistry 1

Course Description: The course deals with the quantitative measurement of biochemical substances found in body fluids essentially blood. This involves the knowledge and understanding of the basic concepts and principles of their metabolism, laboratory analyses, and pathophysiology. Quality assurance and safety are given due emphasis.

Course Credit: 4 units (3 units lecture, 1 unit laboratory)

Contact Hours: 3 hours lecture, 3 hours laboratory per week (54 hours lecture and 54 hours laboratory per semester)

Prerequisites: Biochemistry, Human Anatomy and Physiology
st

Placement: Third Year, 1 Semester

Terminal Competencies: At the end of this course, the student is able to: 1. explain the different biochemical substances, their metabolism, actions, reference ranges and variables that may affect their analyses 2. correlate test results with pathologic conditions 3. apply concepts and principles of instrumentation in the laboratory 4. perform basic laboratory calculations 5. practice quality assurance and laboratory safety 6. perform correctly laboratory assays used to measure concentration of specific analytes 7. solve common problems encountered in the clinical laboratory 8. manifest professionalism

References: 1. Anderson, Shauna and Susan Cockyane. Clinical Chemistry: Concepts and Applications. USA: Waveland Press Inc., 2007. 2. Arneson, W. and J. Brickell. Clinical Chemistry: A Laboratory Perspective. USA: F.A. Davis Co., 2007. th 3. Ashwood E., D. Bruns and C. Burtis. Tietz’s Fundamentals of Clinical Chemistry 6 ed. Philadelphia: W.B. Saunders Co., 2007. th 4. Ashwood E., D. Bruns and C. Burtis. Tietz’s Textbook of Clinical Chemistry and Molecular Diagnostics 4 ed. Philadelphia: W.B. Saunders Co., 2007. th 5. Bishop, Michael L. et.al. Clinical Chemistry: Principles, Procedures, Correlation’s, 5 ed. Philadelphia: Lippincott Williams, Philadelphia, 2005.
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6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.

Crook, Martin. Clinical Chemistry and Metabolic Medicine 7 ed. USA: Hodder Arnold Publication, 2006. th Furr, Keith. CRC Handbook of Laboratory Safety 5 ed. USA: CRC, 2000. th Garza, Diana and Kathleen Becan-McBride. Phlebotomy Handbook: Blood Collection Essentials 7 ed. USA: Prentice Hall, 2004. Helms, Joel R. Mathematics for Medical and Clinical Laboratory Professionals. USA: Delmar Learning, 2008. Hibbert, Brynn. Quality Assurance in the Analytical Chemistry Laboratory. USA: Oxford University Press, 2007. Hoeltke, Lynn. Phlebotomy: Principles and Procedures. USA: Delmar Learning, 2006. th Kaplan, A., A. Pesce and S. Kazmierczak. Clinical Chemistry: Theory, Analysis, Correlation 4 ed. Edinburgh: Mosby, 2002. Lewandrowski, Kent. Clinical Chemistry: Laboratory Management and Clinical Correlations. USA: Lippincott Williams and Wilkins, 2002. th Marshall, William and Stephen Bangert. Clinical Chemistry 5 ed. Edinburgh: Mosby, 2004. nd McClatchey, Kenneth. Clinical Laboratory Medicine 2 ed. USA: Lippincott Williams and Wilkins, 2002. st Mcpherson, Richard A. and Matthew R. Pincus. Henry’s Clinical Diagnosis and Management by Laboratory Methods 21 ed. Philadelphia: Elsevier Inc., 2007. Prichard, Elizabeth and Victoria Barwick. Quality Assurance in Analytical Chemistry. USA: Wiley-Interscience, 2007. th Sacher, Ronald and Richard McPherson. Widmann’s Clinical Interpretation of Laboratory Tests 11 ed. Thailand: F.A. Davis, 2000. nd Scott M., A. Gronowski and C. Eby. Tietz’s Applied Laboratory Medicine 2 ed. USA: Wiley-Liss, 2007. th Wu, Allan. Tietz’s Clinical Guide to Laboratory Tests 4 ed. Philadelphia: W.B. Saunders, 2006.

th

Electronic References: 1. http://webpages.chhs.niu.edu/williams/AHP318/ClinicalChem.htm 2. http://www.dgrhoads.com/links.shtml 3. http://www.kmcsystems.com/invitro_clinical.asp#1 4. http://www.ualberta.ca~intd410/departments/spoc.html 5. http://www2.apsu.edu/~thompsonj/clin-chem-page1.htm

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Learning Objectives / Intermediate Competencies At the end of this unit, the student is able to: 1. Define terms in clinical chemistry 2. Identify the duties of a Med Tech in Clinical Chemistry section 3. Describe the functions of the measuring devices in terms of when and how to use them 4. Cite the differences between the different measuring devices used in Clinical Chemistry 5. Correctly used pipettes (for measurement and delivery of liquid) & weighing balance At the end of this unit, the student is able to: 1. Compute for Normality, Molarity, % solutions 2. Carry out unit conversions 3. Prepare various dilutions of samples and chemicals

T.A. Content I. Introduction Lecture: 1. Scope of Clinical Chemistry 1.1 Overview 1.2 Importance 1.3 Role of Medical Technologists 1.4 Definition of terms Laboratory: 1. Clinical Laboratory Apparatus and Supplies 2. Volume measurement

Teaching Strategies Lecture Laboratory Demonstration of pipetting technique and volume measurement Discussion of - laboratory wares - water & chemicals - supplies

Skills

Values

Evaluation/Assessment

3 hrs

Large group discussion

Technical skills

Accuracy Honesty Accountability Responsibility

Quiz Recitation Return Demo Practical Exams Performance Checklist

6 hrs

II. Laboratory Mathematics Lecture: 1. Laboratory Mathematics 1.1. Unit conversions 1.2. Percent solutions 1.3. Normality 1.4. Molarity 1.5. Dilutions 1.6. pH and pOH Laboratory: 1. Preparation of solutions and dilutions III. Laboratory Safety Lecture: 1. Universal Precautions 2. Laboratory Hazards 2.1. Biological 2.2. Chemical 2.3. Electrical 2.4. Fire 2.5. Radiation 2.6. Others 3. Safety equipment 4. Laboratory waste management 4.1. Segregation 4.2. Storage 4.3. Treatment

8 hrs

Large group discussion Board work Assignments Seatwork

Demonstration Preparation of solutions Preparation of dilutions

Technical skills Safe handling of samples and chemicals Problem solving skills

Accuracy Honesty Accountability Responsibility Teamwork

Quiz Recitation Return Demo Practical Exams Performance Checklist

3 hrs 3 hrs Large group discussion Board work Assignments Seatwork Demonstration Preparation of solutions Preparation of dilutions Technical skills Safe handling of samples and chemicals Problem solving skills Accuracy Honesty Accountability Responsibility Teamwork Quiz Recitation Return Demo Practical Exams Performance Checklist

At the end of this unit, the student is able to: 1. Apply the universal precautions 2. Discuss the different laboratory hazards 3. Demonstrate laboratory safety practices and proper waste disposal 4. Cite the significance of laboratory waste management

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4.4. Disposal Laboratory: 1. Hand washing 2. Cleaning of glassware 3. Disinfection of working areas 4. Laboratory Waste management IV. Specimen Collection and Processing Lecture: 1. Specimen 1.1. Types 1.1.1. Blood 1.1.2. CSF 1.1.3. Urine 1.1.4. Others 1.2. Collection and Labeling 1.3. Handling, Transport Processing, Storage and Preservation 2. Specimen Variables 2.1. Pre-analytical 2.1.1. Patient identification and preparation 2.1.2. Anticoagulants and preservatives 2.2. Analytical 2.3. Post-analytical Laboratory: 1. Blood Collection 2. Skin Puncture 3. Venipuncture 4. Syringe 5. Evacuated system 6. Arterial Puncture 7. Preparation of Serum, Plasma and Whole Blood 8. Laboratory Safety 9. Laboratory Waste Management V. Quality Management Lecture: 1. Introduction 1.1. Importance 2. Definition of Terms 3. Statistics 3.1. Descriptive 3.1.1. Mean 3.1.2. Median 3 hrs

At the end of this unit, the student is able to: 1. Establish guidelines on acceptability of blood samples submitted to Clinical laboratory 2. Cite the duties of a Medical Technologists with regards to proper specimen collection, processing, and handling 3. Given a request slip, rationalize the steps to be undertaken in patient preparation and specimen collection, processing and handling 4. Correctly perform venipuncture and finger-prick methods of blood collection 5. Enumerate the precautions to be consider in proper specimen collection 6. List the pre-analytical variables that may affect laboratory analyses & effects on test results 7. Prepare serum/plasma 8. Correctly label blood, serum/plasma samples

6 hrs

Large group discussion Assignment Case presentation

Demonstration - skin prick -venipuncture - arterial puncture Centrifugation of blood Preparation of Serum, Plasma and Whole Blood

Technical skills Communication skills Phlebotomy care

Patience Compassion Accountability Responsibility Beneficence Confidentiality Adherence to standards of practice

Quiz Recitation Return Demo Practical Exams Performance Checklist

6 hrs

At the end of this unit, the student is able to: 1. Compute & establish the values of central tendencies, dispersions (x, SD, CV, etc) 2. Prepare guidelines on how to prevent the interference of preanalytic variables on test results 3. Explain the concepts of internal

5 hrs

Large group discussion Board work Compute with set problems Assignment

Preparation of QC chart Case study

Problem solving skills

Patience Compassion Accountability Responsibility Confidentiality Adherence to standards of practice Teamwork

Quiz Recitation Return Demo Practical Exams Performance Checklist

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and external programs

quality

control

4.

5. 6. 7. 8.

3.1.3. Mode 3.1.4. SD 3.1.5. CV 3.1.6. Variance 3.1.7. SEM 3.2. Inferential 3.2.1. t tests 3.2.2. F tests Quality Control Charts 4.1. Levey-Jennings 4.2. Westgard Rules 4.3. Six-sigma 4.4. Others Intra-laboratory QC Monitoring Proficiency Testing Method Selection Issues and Concerns 6 hrs

Case presentation

At the end of this unit, the student is able to: 1. Discuss the concepts & principles of instrumentation 2. Enumerate the components of each instrument and their uses 3. Differentiate instruments according to components, analytes measured & uses; operations 4. Explain correctly proper specimen collection, handling and transport according to tests requested 5. Use spectrophotometer, UV-Vis & IR spectrophotometer 6. Discuss the principles & concepts & advantages of automation 7. Classify the different types of automation used in Clinical Chemistry

Laboratory: 1. Preparation and interpretation of QC chart 2. Application of Westgard Rules VI. Instrumentation Lecture: 1. Methods 1.1. Photometry 1.2. Spectrophotometry 1.2.1. AAS 1.2.2. FES 1.2.3. Reflectance Spectrophotometry 1.3. Nephelometry 1.4. Turbidimetry 1.5. Fluorometry 1.6. Electrophoresis 1.7. Chromatography 1.8. Ultracentrifugation 1.9. Chemiluminiscence 1.10. Electrochemistry 1.11. Immunochemistry 1.12. Dry Chemistry 2. Automation 3. Point of Care Testing 4. Current Trends Laboratory: 1. Operation and maintenance of Spectrophotometer and other laboratory

8 hrs

Large group discussion Assignment

Spectrophotometer Reading Use of available automated machines Calibration of instruments Preventive maintenance of laboratory instruments

Technical skills Troubleshooting skills

Patience Accountability Responsibility Adherence to standards of operation

Quiz Recitation Return Demo Practical Exams Performance Checklist

6 hrs

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At the end of this unit, the student is able to: 1. Define common terms associated with carbohydrates 2. Describe carbohydrates according to composition, classification, chemical properties 3. Discuss the metabolism of CHO in the body 4. Explain the mode of actions of different hormones in the maintenance of blood glucose levels 5. Discuss the different processes involved in the maintenance of normal blood glucose level 6. Rationalize the considerations in patient preparation, specimen collection, transport and processing & handling 7. Describe the specimen of choice, principle involved, advantages of the different laboratory methods of glucose determination At the end of this unit, the student is able to: 1. Define common terms associated with renal function tests 2. Enumerate the different nonprotein nitrogen (NPN) substances present in the blood 3. Discuss the sources, metabolism, formation and excretion of uric acid, urea, creatinine and ammonia 4. Discuss the different factors that may affect the level of uric, urea, creatinine and ammonia in the blood 5. Rationalize the requirements of specimen collection, transport,

instruments Preventive maintenance of laboratory instruments VII. Carbohydrates Lecture: 1. Biochemistry 1.1. Classification 1.2. Metabolism 2. Specimen Considerations 3. Glucose Measurement 3.1. Methods 3.2. Reference Range 4. Clinical Significance 4.1. Diabetes mellitus 4.2. Hyperglycemia 4.3. Hypoglycemia 4.4. Other related diseases 5. Tests for Diabetes mellitus 2. Laboratory: 1. Enzymatic methods for glucose 2. HbA1c 3. Tolerance Tests 4. Laboratory Safety 5. Laboratory Waste Management

Discussion 6 hrs Case presentation

Actual performance of glucose assays and others Case analysis

Technical skills Communication skills Method selection Mathematical skills Validation and Correlation of results

Compassion Accuracy Honesty Confidentiality Responsibility Reliability

Quiz Recitation Return Demo Practical Exams Performance Checklist

6 hrs

VIII. Non-Protein Nitrogen Compounds Lecture: 1. Biochemistry 1.1. Types 1.1.1. Urea 1.1.2. Creatinine 1.1.3. Uric Acid 1.1.4. Ammonia 1.1.5. Amino acid 1.1.6. Others 1.2. Metabolism 2. Specimen Considerations 3. NPN Measurement 3.1. Methods 3.2. Reference Range 4. Clinical Significance 4.1. Uremia 4.2. Azotemia

Discussion 5 hrs Case presentation

Actual performance of assays for NPN Case analysis

Technical skills Communication skills Method selection Mathematical skills Validation and Correlation of results

Compassion Accuracy Honesty Confidentiality Responsibility Reliability

Quiz Recitation Return Demo Practical Exams Performance Checklist

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processing and handling Describe the principle involved, advantages of the commonly used methods of uric, area, creatinine and ammonia determination 7. Recognize the effect of age and sex on the value of BUN, BUA, creatinine At the end of this unit, the student is able to: 1. Correlate test results with pathologic conditions 2. Given an electrophoresis pattern, identify and correlate abnormal result with pathologic findings 3. Compute for the AG ratio and interpret test results with pathologic conditions 4. Enumerate different types of amino acids 5. Explain the process of amino acid synthesis and metabolism 6. Discuss the different types of aminoacidopathies 6.

5.

4.3. Gout 4.4. Hepatic coma 4.5. Others Other Kidney Function Tests 6 hrs

Laboratory: 1. Methods for NPN measurement 2. Laboratory Safety 3. Laboratory Waste Management IX. Proteins Lecture: 1. Biochemistry 1.1. Structure 1.2. Classification 1.3. Functions 1.4. Metabolism 2. Specimen Considerations 3. Measurement of Proteins 3.1. Methods 3.1.1. Colorimetric 3.1.2. Electrophoresis 3.2. Electrophoretic patterns 3.3. Reference Range 4. Clinical Significance 5. Amino acids 5.1. Types of amino acids 5.2. Disease correlations of amino acids Laboratory: 1. Methods for Protein measurement 2. Laboratory Safety 3. Laboratory Waste Management X. Lipids and Lipoproteins Lecture: 1. Biochemistry 1.1. Classification 1.1.1. Lipids 1.1.2. Lipoproteins 1.2. Functions 1.3. Metabolism 2. Specimen Considerations 3. Measurement of Lipids and Lipoproteins 3.1. Methods 3.1.1. Colorimetric 3.1.2. Electrophoresis 3.2. Electrophoretic patterns 3.3. Reference Range

Discussion 5 hrs Case presentation

Actual performance of assays for Proteins Case analysis

Technical skills Communication skills Method selection Mathematical skills Validation and Correlation of results

Compassion Accuracy Honesty Confidentiality Responsibility Reliability

Quiz Recitation Return Demo Practical Exams Performance Checklist

6 hrs

At the end of this unit, the student is able to: 1. Describe terms associated with lipids 2. Describe lipids according to composition, classification, properties 3. Discuss the metabolism of lipids in the body 4. Rationalize the requirements regarding patient preparations; specimen collection; transport processing and handling 5. Discuss the principle involved, advantages and disadvantages

Discussion 5 hrs Case presentation

Actual performance of assays for Lipids and Lipoproteins Case analysis

Technical skills Communication skills Method selection Mathematical skills Validation and Correlation of results

Compassion Accuracy Honesty Confidentiality Responsibility Reliability

Quiz Recitation Return Demo Practical Exams Performance Checklist

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of laboratory methods of lipid & lipoproteins 6. Enumerate the reference value of each lipid measured 7. Correlate laboratory results with patients lipid or lipoprotein status 8. Relate the laboratory data in the assessment of risk or coronary heart disease (CHD) 9. Discuss the significance played by cardiac proteins and enzymes in the diagnosis of heart diseases 10. Perform correctly laboratory methods of lipid determination 11. Demonstrate safely precautions during performance of tests

4. 5.

Clinical Significance 4.1. Hyperlipidemia 4.2. Hyperlipoproteinemia Lipoprotein Phenotyping 6 hrs

Laboratory: 1. Methods for Lipid and Lipoprotein measurement 2. Laboratory Safety 3. Laboratory Waste Management

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Technical Working Group for Prototype Course Syllabi Development (2007-2008) Zennie Aceron Petrona Benitez Sergia Cacatian Zenaida Cajucom Edwin Cancino Jacinta Cruz De Carlos Leon Oliver Shane Dumaoal Bernard Ebuen Nini Lim Frederick Llanera Carina Magbojos Gregorio Martin Fe Martinez Josephine Milan Ferdinand Mortel Magdalena Natividad Rodolfo Rabor Ma. Teresa Rodriguez Celia Roslin Anacleta Valdez Rowen Yolo
and other PASMETH members not cited in this page who in one way or another has contributed greatly to the success of this endeavor…

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