You are not studying to pass exam.

You are studying for that day

when you are the only thing
between the patient and the
grave.
FINALS TOPIC
Clinical Chemistry
Clinical Microscopy
Microbiology
Parasitology
Histopathology
Introduction to Clinical Chemistry
Clinical Chemistry
Clinical -
Greek word “Kline”, meaning bed

Also known as
Chemical Pathology
Clinical Biochemistry
Medical Biochemistry
 Clinical Chemistry
The discipline originated in the
late 19th century with the use
of simple chemical reaction
tests for various components of
blood and urine.
In the many decades since, other
techniques have been applied as
science and technology have
advanced, including the use and
measurement of Enzyme
Activities, Spectrophotometry,
Electrophoresis, and
Immunoassay.
 Clinical Chemistry
Sub-specialties:
▪ General or Routine Chemistry or
Automated Chemistry

▪ Special Chemistry
Clinical Endocrinology
Toxicology
Therapeutic Drug Monitoring
Tumor Marker
The CLINICAL CHEMISTRY
section is the most
automated area of the
laboratory. Instruments
are computerized and
designed to perform
single and multiple tests
from small amounts of
specimen.
 Terminologies:
▪ All samples loaded at the same time.
Batch Testing
▪ Single test is conducted on each sample.
Parallel Testing ▪ One specimen with more than one test is analyzed.
▪ Able to perform individual tests or panels.
Random Access Testing ▪ Allows for STAT samples to be added to run ahead
of other specimens.
▪ Multiple tests analyzed one after another on a given
Sequential Testing
specimen.
Laboratory Information System ▪ A system of computer software designed to
(LIS) handle laboratory data.
▪ The contamination of a sample by a previously
Carry-over
aspirated sample.
 Terminologies:
A set of vertical bars of varying width used to encode
Bar. Code information. Used most frequently in the clinical
laboratory for patient and specimen information
Mechanism for patient/sample identification; used for
Bar Coding reagent identification by an instrument
An algorithm in which the most recent result of a patient is
Delta Check compared with the previously determined value.

Throughput Maximum number of tests generated per hour

Turnaround Amount of time to generate one result

Dead Volume Amount of serum that cannot be aspirated.

 Terminologies:
System other than manufacturer’s reagents can be
Open Reagent System utilized for measurement
The operator can only use the manufacturer’s
Closed Reagent System reagents
Transports specimens quickly from one location to
Pneumatic Tube System another
A multilayered film technology (dry chemicals) use
by automated analyzers.
Dry Chemistry Slide All reagents necessary for a particular test are
contained on the “slide.”
A mechanized device that automatically dips into a
Probe sample cup and aspirates a portion of the liquid.
A round device on some automated analyzers that
Rotor holds sample cups and is capable of spinning.
 Terminologies:
An instrument’s ability to remove the patient’s
Closed Tube Sampling sample for analysis from the primary collection
tube by piercing through the stopper.
At least two analytical modules supported by one
Integrated Modular System sample and reagent processing and delivery
system
Instrument able to perform tests from at least two
Multiple Platform
disciplines.
At least two instruments from a single discipline
Modular Work Cell
with one controller.
Instrument from a single discipline with
Stand-alone
automated capability
Schematic drawing of MODULAR ANALYTICS System
Schematic Drawing of Multiple Platform System
Three Basic Approaches with Clinical Instruments
▪ Liquids (reagents, diluents, and
samples) are pumped through a
system of continuous tubing.
▪ Samples are introduced in a sequential
Continuous Flow Analyzer
manner, following each other through
the same network.
▪ Examples: Simultaneous Multiple
Analyzer (SMA), Technicon Autoanalyzer II
Three Basic Approaches with Clinical Instruments
▪ Analytic technique that uses the force
generated by centrifugation to transfer
and then contain liquids in separate
Centrifugal Analyzer cuvettes for measurement at the
perimeter of a spinning rotor.
▪ Example: Cobas-Bio (Roche
Diagnostics, Centrifichem)
Three Basic Approaches with Clinical Instruments
▪ An approach to automated analysis in which
each sample and accompanying reagents is in
a separate container.
▪ Discrete analyzers have the capability of
running multiple tests one sample at a time or
Discrete Analyzer multiple samples one test at a time.
▪ Require 2 to 6 uL volume of sample.
▪ Random Access Capability (STAT)
▪ Examples: Vitros, Beckman ASTRA System (4 & 8),
Hitachi, Roche Cobas Integra 800, Dupont ACA, Abbott
ABA-100 Bichromatic Analyzer
So, how does the clinical instrument work?

and how does it measures the analyte?

 Sample collection
tubes are identified
with bar code labels Five-position Rack

The four quadrant trays,

each holding ten samples,
fit on a tray carrier.
 Wash stations on a chemistry analyzer .

Dual sample probes of a chemistry

analyzer. Note the liquid level
sensor to the left of probes.
Wash stations on a chemistry analyzer perform the following:
(1) aspirate reaction waste and dispense water;
(2) aspirate and dispense rinse water;
(3) aspirate rinse water and dispense water for measurement of cell blank; and
(4) aspirate cell blank water to dryness.
SPECTROPHOTOMETRY
Summary of Chemistry Analyzer Operations
 Sample Collection and Handling
▪ Chemistry Tests are performed:
Serum (Gel barrier tubes)
Serum (red, green, gray, royal blue tube)
Plasma
Urine and other body fluids
▪ Serum and plasma are obtained by
Gel centrifugation, which should be
Gel
performed within 1 to 2 hours of
collection.
Sample Collection and Handling

Specimens of Concern:
1. Hemolyze Specimens;
2. Icteric Specimens;
3. Lipemic specimens that are
cloudy.
 Sample Collection and Handling
▪ Fasting samples drawn from patients
who have not eaten for 8 to 12 hours.
▪ Samples must be allowed to clot fully
before centrifugation to ensure
complete separation of cells & serum.
▪ Many chemistry tests require special
Gel
Gel
collection and handling procedures,
such as chilling and protection from
light.
Centrifuge
 Chemistry Panel Test
Glucose, BUN, Creatinine, Na+, K+, CO2, Cl-, AST,
Comprehensive
ALT, Total Protein, Albumin, Bilirubin, Ca, and ALP
ALP, ALT, AST, Bilirubin (Total and Direct), Total
Hepatic
Protein, Albumin/Globulin (TPAG)
Glucose, BUN, Creatinine, CO2, Cl-, Na+, K+, Total
Renal
Protein, Albumin, Ca, Phosphorous
Lipid Cholesterol, Triglycerides, HDL, LDL, VLDL
 Tests Performed in the Chemistry Section
Alanine Aminotransferase (ALT) ↑↑↑ levels indicate liver disorders
Alkaline Phosphatase (ALP) ↑↑↑ levels indicate bone or liver disorders
Amylase ↑↑↑ levels indicate pancreatitis
Aspartate Aminotransferase (AST) ↑↑↑ levels indicate MI or liver disorders
Creatine Kinase (CK) ↑↑↑ levels indicate MI or other muscle damage
Gamma-Glutamyl Transferase (GGT) ↑↑↑ levels indicate early liver disorders
Lactic Dehydrogenase (LD [LDH]) ↑↑↑ levels indicate MI or lung or liver disorders
Lipase ↑↑↑ levels indicate pancreatitis
 Tests Performed in the Chemistry Section
Calcium (Ca) Mineral associated with bone, musculoskeletal, or endocrine disorders
Chloride (Cl) Maintain proper blood volume, blood pressure and pH
Sodium (Na) Controls blood pressure and blood volume, needed in muscle and nerve
excitability.
Potassium (K) Regulate fluid balance, muscle contraction and nerve signal.
Iron (Fe) Decreased levels indicate iron deficiency anemia
Lead (Pb) Elevated levels indicate poisoning
Lithium (Li) Monitors antidepressant drug
Magnesium (Mg) Cation involved in neuromuscular excitability of muscle tissue
Phosphorus (P) Mineral associated with skeletal or endocrine disorders
 Tests Performed in the Chemistry Section
Sweat contain 50 mmol/L of sodium and 5 mmol/L of potassium
↑ Na: Excess water loss, Conn’s Disease (Hyperaldosteronism)
↓Na: Diuretic use, Renal failure, SIADH, Aldosterone deficiency
↑K: Acidosis, Acute or Chronic Renal failure, Muscular injury,
↓K: GI and renal loss, alkalosis
↑Cl: RTA, Salicylate intoxication, Metabolic acidosis, prolonged
diarrhea
↓Cl: Prolong vomit, aldosterone deficiency, metabolic alkalosis
 Tests Performed in the Chemistry Section
Albumin ↓↓ levels indicate liver or kidney disorders or malnutrition
Total Protein (TP) Decreased levels indicate liver or kidney disorders
Ammonia Elevated levels indicate severe liver disorders
Bilirubin Elevated levels indicate liver or hemolytic disorders
Blood Urea Nitrogen (BUN) Elevated levels indicate kidney disorders
Creatinine Elevated levels indicate kidney disorders
Creatinine Clearance Urine and serum test to measure glomerular filtration rate
Uric Acid Elevated levels indicate kidney disorders or gout
 Tests Performed in the Chemistry Section

Glucose Elevated levels indicate diabetes mellitus

Glucose Tolerance Test (GTT) Detects diabetes mellitus or hypoglycemia
Hemoglobin A1C Monitors diabetes mellitus
Cholesterol, TAG, LDL, HDL Elevated levels indicate coronary risk
Myoglobin Early indicator of myocardial infarction
Troponin I Early indicators of myocardial infarction
 Tests Performed in the Chemistry Section

Alcohol Elevated levels indicate intoxication

Arterial Blood Gases (ABGs)
Drug Screening
Prostate-specific antigen (PSA)
Determine the acidity or alkalinity and
oxygen and carbon dioxide levels of blood.
Detects drug abuse and monitors
therapeutic drugs.
Screening for prostatic cancer