Clinical Chemistry Examination

Laboratory tests based on chemical reactions may use blood, urine or other body fluids. There are many blood
chemistry tests in clinical laboratories, including liver function tests, heart muscle, kidney, blood fat, blood
sugar, pancreatic function, electrolytes and some chemical tests can also be used to help diagnose anemia.

Liver function tests include examination of total protein & albumin, total bilirubin & direct bilirubin, serum
glutamic oxaloacetate transaminase (SGOT / AST) & serum glutamic pyruvate transaminase (SGPT / ALT),
gamma glutamyl transferase (γ-GT), alkaline phosphatase (ALP). ) and cholinesterase (CHE). Examination of
total protein and albumin should be complemented by examination of the serum protein fraction by
electrophoresis technique. By examining serum protein electrophoresis, it can be seen the changes in the protein
fraction in serum. This serum protein electrophoresis examination showed changes in protein fraction more
accurately than just checking total protein and serum albumin levels.

Cardiac function tests can be used to test creatine kinase (CK), creatine kinase isoenzymes, namely CKMB, N-
terminal pro brain natriuretic peptide (NT pro-BNP) and Troponin-T. Damage to the heart muscle can be
detected by examining the activity of CKMB, NT pro-BNP, Troponin-T and hsCRP. LDH examination is not
specific for heart muscle disorders, because increased results can be found in several body tissue damage such
as liver, pancreas, malignancies especially with metastases, hemolytic anemia and leukemia.

Renal function tests are mainly urea and creatinine tests. Ureum is the end product of protein metabolism in the
body which is produced by the liver and excreted in the urine. In renal excretion disorders, the excretion of urea
into the urine is inhibited so that urea levels will increase in the blood. Creatinine is a substance produced by
muscles and excreted from the body in urine. Therefore creatinine levels in serum are influenced by muscle size,
sex and kidney function. In Bio Medika's Main Clinical Laboratory, creatinine levels are reported in mg / dl and
estimated GFR (eGFR), which is the value used to determine the estimated glomerular filtration rate that can
estimate the severity of kidney function abnormalities.

The severity of the kidney disorder is determined by measuring the creatinine clearance test (CCT). Creatinine
clearance test / CCT requires a 24-hour collection of urine, so if urine collection is not carried out properly the
measurement results will affect the CCT value. Recently, the assessment of kidney function was carried out by
examining cystatin-C in blood which was not affected by errors in urine collection. Cystatin is a low molecular
weight substance, produced by all nucleated cells in the body that are not affected by inflammation or tissue
damage. These substances will be excreted through the kidneys. Therefore, Cystatin levels are used as a
sensitive indicator for deteriorating kidney function.

Examination of blood fats includes checking levels of total cholesterol, triglycerides, HDL and LDL cholesterol.
This examination is mainly performed on patients who have abnormalities in the blood vessels such as patients
with brain blood vessel disorders, blockage of the heart arteries, patients with diabetes mellitus (DM) and
hypertension and patients with families who show elevated blood lipid levels. For this blood fat check, you
should fast for 12-14 hours. If the blood chemistry examination, the serum obtained is very cloudy because of
the increase in triglyceride levels, the examination should be repeated after fasting> 14 hours to reduce the
existing turbidity. To check total cholesterol, HDL cholesterol and LDL cholesterol, you do not need to fast. In
addition, it is known that lipoprotein (a) examination if it is increased can be a risk factor for coronary heart
disease.

Examination of blood sugar levels is used to determine an increase or decrease in blood sugar levels and to
monitor the results of treatment of patients with Diabetes Mellitus (DM). Increased blood sugar levels are
usually caused by Diabetes Mellitus or hormonal disorders in the body. High sugar levels will be excreted
through urine which is called glucosuria. There are several types of examinations to assess blood sugar levels,
namely instantaneous blood sugar checks, fasting sugar levels, blood sugar levels 2 hours after eating, oral
glucose tolerance tests, HbA1c, insulin and C-peptide. The blood sugar level at any time is an examination of
the sugar level at an unspecified time. Fasting blood sugar levels when the examination is carried out after the
patient has fasted 10-12 hours before taking blood or after eating 2 hours which is known as blood sugar 2 hours
post-prandial. DM patients in treatment, do not need to stop the drug at the time of checking fasting blood sugar
and continue to use the drug for post-prandial blood sugar checks. Checking fasting blood sugar levels is used to
screen for DM, monitor DM patients who use anti-diabetes drugs; whereas glucose 2 hours post-prandial is
useful for knowing the patient's response to food after 2 hours of breakfast or 2 hours after lunch. Blood sugar
levels when used to evaluate DM sufferers and help establish a diagnosis of DM. In addition, there is also a
daily blood glucose curve check, which is blood sugar checked at 7 am, 11 noon and 4 pm, which aims to
determine blood sugar control for 1 day with the diet and drugs used. In patients with doubtful blood sugar
levels, an oral glucose tolerance test (TTGO) is performed. In this situation the inspection must meet the
following requirements:
1. Three days before examination the patient should eat enough carbohydrates.
2. Do not drink alcohol.
3. Patients should fast for 10-12 hours without taking medication, smoking and exercise before the examination
is carried out.
4. In the laboratory the patient is given sugar 75 g of glucose dissolved in 1 glass of water which must be
consumed within 10 - 15 minutes or 1.75 g per kg of body weight for children.
5. Blood sugar is taken during fasting and 2 hours after drinking glucose.
Insulin is a hormone produced by the pancreas on the beta cells of islets of Langerhans. Reduced insulin activity
will lead to Diabetes Mellitus. Inspection of insulin activity if insulin insufficiency is suspected, increased
insulin levels in patients with hypoglycemia. This measurement of insulin activity is not influenced by
exogenous insulin. Insulin comes from pro-insulin which undergoes proteolysis to C-peptide. C-peptide is used
to determine basal insulin secretion.

For DM monitoring, the HbA1c test is carried out. This examination shows the average blood sugar level for 1 -
3 months. Under normal circumstances, the HbA1c level ranges from 4 - 6% and if the blood sugar is not
controlled, the HbA1c level will increase. Therefore, patients with normal blood sugar levels are not a sign of
controlled diabetes. DM is controlled when HbA1c levels are normal. The results of the HbA1c examination
will be lower than the actual if hemoglobinopathy such as thalassemia is obtained. Therefore, people with
diabetes should do a hemoglobin analysis to determine the abnormality in assessing the results of the HbA1c
examination. Recently, the HbA1c test, in addition to monitoring treatment, is used for the diagnosis of DM.

The pancreas produces amylase and lipase enzymes. Apart from being produced by the pancreas, amylase is
also produced by the salivary glands and liver, which digest starch / carbohydrates. Amylase levels in the serum
are elevated in acute inflammation of the pancreas. In this situation, the amylase state increases after 2-12 hours
and reaches a peak of 20-30 hours and becomes normal again after 2 - 4 days. Symptoms that arise are severe
pain in the stomach. Amylase levels can also be increased in people with gallstones and after gastric surgery.

Lipase is an enzyme produced by the pancreas which functions to digest fat. Lipase will increase in the blood if
there is damage to the pancreas. Increased levels of lipase and amylase occur at the onset of pancreatitis, but
serum lipase increases for up to 14 days, so lipase testing is useful in advanced acute inflammation of the
pancreas.

For the formation of hemoglobin, iron, folic acid and vitamin are needed. B12. Iron is the most abundant
element found in the blood in the form of hemoglobin, serum iron (SI), total iron binding capacity (TIBC) and
ferritin. SI examination aims to determine the amount of iron in the serum which is bound to transferrin, which
functions to transport iron to the bone marrow. Serum iron is transported by a protein called transferrin, the
amount of iron that can be transported by transferrin is called total iron binding capacity (TIBC). Transferrin
saturation measures the ratio between SI levels to TIBC levels expressed in percent. Ferritin is a sensitive body
iron reserve, its levels decrease before anemia occurs. In anemia, there is not always a change in SI, TIBC and
ferritin depending on the cause of anemia. In iron deficiency anemia, SI levels and transferrin saturation
decrease, while TIBC will increase / normalize and body iron reserves decrease. Measurement of folic acid and
vitamin B12 aims to determine the cause of anemia.

Sodium (Na) is the most extracellular cation, which functions to hold water in the body. Na has many functions
such as in muscles, nerves, regulating acid-base balance along with chloride (Cl) and bicarbonate ions.
Potassium (K) is the most abundant intracellular cation. Eighty - ninety percent of K is excreted by urine
through the kidneys. Therefore, in kidney disorders, there is a change in the level of K. Chloride (Cl) is the main
anion in extracellular fluid. This element has the function of maintaining fluid balance in the body and
regulating acid-base balance.

Calcium (Ca) is mainly found in bones. Fifty percent is in the form of calcium ions (Ca), this Ca ion that can be
used by the body. Protein and albumin will bind to Ca in the serum which results in a decrease in the levels of
Ca ions that function in the body. Therefore, for the assessment of Ca levels in the body, it is necessary to check
the levels of total Ca, total protein, albumin and Ca ion.

Phosphorus (P) is an anion present in cells. Phosphorus is in the serum in the form of phosphate. Eighty to
eighty five percent of phosphate levels in the body are bound to Ca found in teeth and bones so that phosphate
metabolism is related to Ca metabolism. High P levels are associated with impaired kidney function, while low
P levels may be due to malnutrition, indigestion, high Ca levels, drinking alcohol, vitamin D deficiency, using
antacids in large quantities in gastric pain.

In Bio Medika's Main Clinical Laboratory, the aforementioned examinations are carried out using an automatic
chemical examination tool (chemistry analyzer) by ensuring the quality of the examination results with adequate
quality assurance.