Davao Doctors College

Medical Laboratory Science Program

CLINICAL CHEMISTRY 1

ACTIVITY NO. 10A

NPN DETERMINATION
BLOOD UREA NITROGEN
Name:
Course/Yr. /Sec.: _______________ Group No. ____________________ SCORE:
Date Performed: ______ Date Submitted:

LEARNING PRACTICAL EVALUATION:

Rubrics for Grading: 1=POOR 2=FAIR 3=GOOD 4=VERY GOOD

1 2 3 4
Correct pre-analytical procedures
(Proper PPE, correct patient ID, blood collection)
Followed the correct protocol and programming of the
spectrophotometer
Proper pipetting techniques
Knowledgeable and confident in performing the procedure
Correct results

1
 Davao Doctors College
Medical Laboratory Science Program
CLINICAL CHEMISTRY 1

ACTIVITY NO. 10A

NPN DETERMINATION
BLOOD UREA NITROGEN
Name: ________________
Course/Yr. /Sec.: _______________ Group No. ____________________ SCORE:
Date Performed: ______ Date Submitted:

LEARNING OUTCOME EVALUATION:

1. What is the clinical application of urea measurement?

 Evaluate renal function

 Assess hydration status
 Determine nitrogen balance
 Aid in the diagnosis of renal disease
 Verify adequacy of dialysis

2. Differentiate uremia and azotemia. Explain pre-renal, renal and post-renal azotemia.
- Uremia: increased BUN with kidney disease
- Azotemia: increased BUN without kidney disease
A.) Pre-renal: reduced renal blood flow, high CHON metabolism, high CHON diet
B.) Renal: renal disease, renal failure
C.) Post-renal: urinary tract obstruction

3. Enumerate diseases or conditions associated to increased AND decreased BUN levels and
briefly discuss why BUN levels are influenced by such.

Pre-renal HIGH BUN/Crea ratio Increased BUN

Normal Crea

Renal LOW BUN/Crea ratio Increased BUN

Increased Crea
Post- Renal HIGH BUN/Crea ratio Decreased BUN
Normal Crea

2
 4. What is the difference between indirect and direct urea measurement?
MEASURING UREA:
 Direct methods- measure a chromagen produced directly from urea
 Indirect methods- measure ammonia, produced from urea

5. Why should you not use evacuated tubes containing fluoride as preservative and anticoagulant
in BUN measurement?

3
 Davao Doctors College
Medical Laboratory Science Program
CLINICAL CHEMISTRY 1

ACTIVITY NO. 10-B

NPN DETERMINATION
CREATININE
Name: ________________
Course/Yr. /Sec.: _______________ Group No. ____________________ SCORE:
Date Performed: ______ Date Submitted:

LEARNING PRACTICAL EVALUATION:

Rubrics for Grading: 1=POOR 2=FAIR 3=GOOD 4=VERY GOOD

1 2 3 4
Correct pre-analytical procedures
(Proper PPE, correct patient ID, blood collection)
Followed the correct protocol and programming of the
spectrophotometer
Proper pipetting techniques
Knowledgeable and confident in performing the procedure
Correct results

4
 Davao Doctors College
Medical Laboratory Science Program
CLINICAL CHEMISTRY 1

ACTIVITY NO. 10-B

NPN DETERMINATION
CREATININE
Name: ________________
Course/Yr. /Sec.: _______________ Group No. ____________________ SCORE:
Date Performed: ______ Date Submitted:

LEARNING OUTCOME EVALUATION:

1. Explain why creatinine is considered as the most effective indicator of renal function.

2. Is creatinine level dependent on the individual’s muscle mass? Why or why not?

3. Why is creatinine frequently requested with BUN? Explain the clinical significance and
diagnostic application of BUN:CREATININE ratio.

4. Explain what is and the principle of creatinine clearance.

5. Enumerate patient preparation and specimen considerations for creatinine measurement.

5
 Davao Doctors College
Medical Laboratory Science Program
CLINICAL CHEMISTRY 1

ACTIVITY NO. 10-C

NPN DETERMINATION
SERUM URIC ACID
Name: ________________
Course/Yr. /Sec.: _______________ Group No. ____________________ SCORE:
Date Performed: ______ Date Submitted:

LEARNING PRACTICAL EVALUATION:

Rubrics for Grading: 1=POOR 2=FAIR 3=GOOD 4=VERY GOOD

1 2 3 4
Correct pre-analytical procedures
(Proper PPE, correct patient ID, blood collection)
Followed the correct protocol and programming of the
spectrophotometer
Proper pipetting techniques
Knowledgeable and confident in performing the procedure
Correct results

6
 Davao Doctors College
Medical Laboratory Science Program
CLINICAL CHEMISTRY 1

ACTIVITY NO. 10-C

NPN DETERMINATION
SERUM URIC ACID
Name: ________________
Course/Yr. /Sec.: _______________ Group No. ____________________ SCORE:
Date Performed: ______ Date Submitted:

LEARNING OUTCOME EVALUATION:

1. During microscopic examination of the urine, what could possibly be seen in patients with
increased SUA?

2. Enumerate possible sources of error in SUA measurement.

3. Enumerate 3 major diseases associated with either an increase or decrease in SUA and briefly
explain the course of the disease.

4. Breifly explain why and how uric acid affects kidney function.

5. Are there medications that could contribute to the increase of SUA? Enumerate some and
briefly explain its mechanism.

7
 Davao Doctors College
Medical Laboratory Science Program
CLINICAL CHEMISTRY 1

ACTIVITY NO. 11
BlLIRUBIN DETERMINATION
Name: ________________
Course/Yr. /Sec.: _______________ Group No. ____________________ SCORE:
Date Performed: ______ Date Submitted:

LEARNING OUTCOME EVALUATION:

1. What are the 3 phases of jaundice? Differentiate one from the other and site specific diseases
or conditions associated with each.

2. Enumerate specific diseases or conditions associated with increased bilirubin levels and
interpret their expected level (increased, decreased or normal) for total, direct and indirect
bilirubin.

3. What are the patient preparation and specimen considerations for bilirubin measurement?
Explain the effect if each one is not followed.

4. Compare and contrast Jendrassik and Grof method from Evelyn and Malloy method.

8
 Davao Doctors College
Medical Laboratory Science Program
CLINICAL CHEMISTRY 1

ACTIVITY NO. 12-A

CARDIAC ENZYME DETERMINATION
ASPARTATE AMINOTRANSFERASE
Name: ________________
Course/Yr. /Sec.: _______________ Group No. ____________________ SCORE:
Date Performed: ______ Date Submitted:

LEARNING PRACTICAL EVALUATION:

Rubrics for Grading: 1=POOR 2=FAIR 3=GOOD 4=VERY GOOD

1 2 3 4
Correct pre-analytical procedures
(Proper PPE, correct patient ID, blood collection)
Followed the correct protocol and programming of the
spectrophotometer
Proper pipetting techniques
Knowledgeable and confident in performing the procedure
Correct results

9
 Davao Doctors College
Medical Laboratory Science Program
CLINICAL CHEMISTRY 1

ACTIVITY NO. 12-A

CARDIAC ENZYME DETERMINATION
ASPARTATE AMINOTRANSFERASE
Name: ________________
Course/Yr. /Sec.: _______________ Group No. ____________________ SCORE:
Date Performed: ______ Date Submitted:

LEARNING OUTCOME EVALUATION:

1. Can AST be used as a single, diagnostic tool for the evaluation of AMI? Why or why not?

2. Can a hemolyzed specimen be used for AST measurement? Why or why not?

3. Aside from being a cardiac function test, what are other clinical significance of AST? Briefly
explain how it helps in the diagnosis of these diseases or conditions.

4. What substances may falsely increase or decrease AST levels? What are other sources of
error?

5. In most AST assays, what is the indicator reaction employed and what is the purpose of that
indicator?

10
 Davao Doctors College
Medical Laboratory Science Program
CLINICAL CHEMISTRY 1

ACTIVITY NO. 12-B

CARDIAC ENZYME DETERMINATION
CREATINE KINASE-MB
Name: ________________
Course/Yr. /Sec.: _______________ Group No. ____________________ SCORE:
Date Performed: ______ Date Submitted:

LEARNING PRACTICAL EVALUATION:

Rubrics for Grading: 1=POOR 2=FAIR 3=GOOD 4=VERY GOOD

1 2 3 4
Correct pre-analytical procedures
(Proper PPE, correct patient ID, blood collection)
Followed the correct protocol and programming of the
spectrophotometer
Proper pipetting techniques
Knowledgeable and confident in performing the procedure
Correct results

11
 Davao Doctors College
Medical Laboratory Science Program
CLINICAL CHEMISTRY 1

ACTIVITY NO. 12-B

CARDIAC ENZYME DETERMINATION
CREATINE KINASE-MB
Name: ________________
Course/Yr. /Sec.: _______________ Group No. ____________________ SCORE:
Date Performed: ______ Date Submitted:

LEARNING OUTCOME EVALUATION:

1. What technique is routinely used for the separation of CK isoenzymes? Explain its principle.

2. Aside from AMI, what other specific diseases are associated with increased CK-MB levels?

3. Is it possible for CK-MB to be within normal levels even though the patient is diagnosed with
AMI? Explain.

4. Can an increase in AST and normal CK-MB levels be associated with AMI? Explain
thoroughly.

5. Can you use a hemolyzed specimen for CK-MB determination? Why or why not?

12
 Davao Doctors College
Medical Laboratory Science Program
CLINICAL CHEMISTRY 1

ACTIVITY NO. 12-C

CARDIAC ENZYME DETERMINATION
LACTATE DEHYDROGENASE
Name: ________________
Course/Yr. /Sec.: _______________ Group No. ____________________ SCORE:
Date Performed: ______ Date Submitted:

LEARNING PRACTICAL EVALUATION:

Rubrics for Grading: 1=POOR 2=FAIR 3=GOOD 4=VERY GOOD

1 2 3 4
Correct pre-analytical procedures
(Proper PPE, correct patient ID, blood collection)
Followed the correct protocol and programming of the
spectrophotometer
Proper pipetting techniques
Knowledgeable and confident in performing the procedure
Correct results

13
 Davao Doctors College
Medical Laboratory Science Program
CLINICAL CHEMISTRY 1

ACTIVITY NO. 12-C

CARDIAC ENZYME DETERMINATION
LACTATE DEHYDROGENASE
Name: ________________
Course/Yr. /Sec.: _______________ Group No. ____________________ SCORE:
Date Performed: ______ Date Submitted:

LEARNING OUTCOME EVALUATION:

1. What is the difference between the backward reaction and forward reaction of LDH
determination? Which is better? Explain.

2. Is the fractionation of the different LDH isoenzymes significant? Why or why not?

3. What is the coenzyme used in LDH determination? Can a reaction be observed without it?
Why or why not?

4. Can an increase in LDH and normal AST and CK-MB levels be associated with AMI? Explain
thoroughly.

5. Can you use a hemolyzed specimen for LDH determination? Why or why not?

14