LECTURE OUTLINE

1. Basic definitions & terminologies in Chemical

Pathology

2. Biochemical laboratory Process-Sample Collection &

Handling

3. Alternate site Testing/Side Room Testing/Point of Care

Testing/ Near Patient Testing
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 LEARNING OBJECTIVES
§ Understand terms used in clinical biochemistry laboratories

§ Outline a number of tests performed by clinical

biochemistry laboratories

§ To understand the typical laboratory processes- sample -

results - clinician

§ Collecting the right specimens for laboratory investigations

under the right conditions.
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 LEARNING OBJECTIVES

§ Understand basic quality assurance procedures used in clinical

biochemistry laboratories to ensure the standard of results
meets the needs of the clinicians and patients

§ Understand alternate site testing, describe advantages &

limitations of POCT

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Chemical Pathology
Clinical Biochemistry
Clinical Chemistry
Medical Biochemistry
Pure Blood Chemistry
Physiological Chemistry

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 CHEMICAL PATHOLOGY
-DEFINITION
is the study of the changes in the chemical constitution &
biochemical mechanisms of the body as a result of
disease.

is the study of the biochemical basis of disease and the

application of biochemical and molecular techniques in
diagnosis.

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 Chemical Pathology

is the understanding of the abnormal metabolic processes which

trigger symptoms of an illness/disease

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 ROLE OF CHEMICAL PATHOLOGY
IN HEALTHCARE
Diagnosis: is the clinical decision reached by a clinician after initial
history and examination and laboratory investigations
-Serves as tools to assist clinicians in the diagnosis of various disorders, as well as management and follow-up
of patients

Treatment- application of medicine and therapy to treat/cure a

diagnosed condition

Monitoring: the use of diagnostic testing evaluate disease changes i.e.

progression or response to therapy e.g. monitoring DM patients
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 ROLE OF CHEMICAL PATHOLOGY IN
HEALTHCARE

Screening: to investigate for presence of disease in an apparently

healthy population or detection of disease before it is clinically
evident e.g. Phenylketonuria, haemoglobinopathies

Prognosis: prediction of the clinical outcome of a disease or

providing information on disease susceptibility .
e.g. cholesterol can predict the risk of coronary artery disease.

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 SAMPLE/SPECIMEN & ANALYTES

Clinical samples or specimens are materials obtained

from patients for the investigation of their clinical
conditions or diseases.

Analytes are substances tested for in the sample, using

appropriate laboratory analytical methods.
 SAMPLES
Every sample must be treated as potentially infective!!!
Quality of result depends on quality of specimen
Whole Blood, plasma or serum (drawn by trained phlebotomists & nurses)

Urine- Spot collection (random, early morning, midstream) OR timely

(24hrs)
Body fluids (cerebrospinal fluid (CSF), gastric fluid, amniotic
fluid)
Solid tissue samples (nail, hair clippings) for drug & metal
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 ANALYTES
An analyte is the substance whose nature and/or
concentration is determined by a clinical analysis.
Includes:
• Blood Glucose
• Electrolytes
• Proteins & Enzymes
• Hormones
• Lipids
• other metabolic substances
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Analyses performed within the Chemical Pathology
laboratory includes:

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 Analyses performed within the Chemical Pathology
laboratory includes:
Test Name tests
Lipid Profile Triglycerides Total LDL HDL, VLDL
Cholesterosl
Acid-Base pH PCO2 H2CO3 PO2
Carbohydrate FBG RBG Ketone HBA1C
metabolism bodies
Cardiac Markers CK Troponin
Endocrinology
Sex hormones Estrogen Testosterone
Pitutary Hormones LH FSH ACTH TSH

Adrenal Hormones Aldosterone Cortisol

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Analyses performed within the Chemical Pathology
laboratory includes:
Test Name Tests
Tumour markers PSA CA 125
Therapeutic drug Digoxin
monitoring
Specialised Occupational Drug of Environ Insura
testing Health Abuse mental nce
Testing testing

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 BLOOD SAMPLE & SAMPLE TUBES

The sample must be collected into a suitable container before

analyses. An error made at this stage, nullifies the whole process.

Blood tubes include a preservative & are colour coded

consistent with the anticoagulant used.

Some have an inert separator gel barrier to aid separation of

plasma or serum from the cells.

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Biochemical
Investigation
Process
 SAMPLE/SPECIMEN COLLECTION
Many factors associated with specimen collection can
influence the validity and interpretation. Eg.

§ the collection of the specimen from the wrong patient

§ incorrect identification of specimen after collection and

§ subsequent handling of specimen prior to analysis

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 SAMPLE/SPECIMEN COLLECTION
Every sample must be accompanied by a filled request form for proper
sample identification.

Must state:
• patient’s name, address, date of birth
• time and date of sampling
• the requests

other information which might help interpretation.

-eg. patient’s sex, LMP,
drug monitoring information, eg the time of last treatment & symptoms

• Requesting Clinician’s name LA FONDJO

SPECIMEN HANDLING
 FACTORS TO CONSIDER BEFORE
SPECIMEN COLLECTION

Patient’s Diet: glucose, lipids (TG, HDL-c)

Patient’s current medication:

Oral Contraceptives, Cough Mixtures

Time of day/ ( Diurnal Variation):

Iron & Cortisol

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 FACTORS TO CONSIDER BEFORE
SPECIMEN COLLECTION
Specimen container:
§ Availability of appropriate Tubes eg. FBG- Flouride oxalate
tubes

§ Other required materials:

§ Syringe
§ Cotton wool
§ Rubbing alcohol
§ Plaster
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 FACTORS TO CONSIDER AT THE TIME OF
COLLECTING THE SPECIMEN
Specimen container:
§ Tubes into which the blood is expelled must be appropriate
FBG- Flouride oxalate tubes

§ Anticoagulant in tube should be mixed with the blood by

gentle rotation/ inversion

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 FACTORS TO CONSIDER AT THE TIME OF
COLLECTING THE SPECIMEN

Identification of specimen- (request form/codes)

§ Patient’s name
§ Location/ward
§ Identification number
§ Date
§ Time of specimen collection
§ Suspected pathology

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 FACTORS TO CONSIDER AT THE TIME OF
COLLECTING THE SPECIMEN
Appropriate selection of equipment-

Specimen container/tubes
Specimen volume
Heamolysis
Icterus (jaundice)
Lipemia

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 FACTORS TO CONSIDER AT THE TIME OF
COLLECTING THE SPECIMEN
Patient posture: proteins & protein-bound constituents
change with posture e.g. Albumin, calcium, cholesterol, cortisol
and protein bound iodine

Venostasis: Prolonged use of tourniquet raises conc. of

plasma proteins, haemoglobin, hormones, calcium & lipids.

Site of venipuncture: eg. site of infusion- fluid is likely not

have mixed with the entire blood volume.

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 FACTORS TO CONSIDER AT THE TIME OF
COLLECTING THE SPECIMEN
Haemolysis: release of erthrocytic content eg. K+,
Lactate dehydrogenase, acid Phosphatase.

§ The plunger of the syringe should not be drawn too

fast
§ There should be an easy flow of blood.
§ Tubes with additives must be thoroughly mixed by
gentle inversion.
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 FACTORS TO CONSIDER AT THE TIME OF
COLLECTING THE SPECIMEN
Collecting specimens through lines or catheters X

obtaining specimen from IV lines poses a risk of

specimen dilution or increased analyte concentration, if
analyte is contained in IV fluid.

IV Lines are for fluid administration and not for sample

collection.
§ .
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 PRESERVATION OF SPECIMEN IN TRANSIT
Specimen for Blood GasAnalysis:PCO2,PO2

• sample must be kept at 4oC from the time sample is drawn till serum
or plasma is separated from cells.

• Transfer of specimen to the lab must be done by placing the specimen

in a container of ice.

• Specimen for bilirubin & carotene must be protected from both

sunlight and fluorescent light to avoid photo degradation.
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 PRESERVATION OF SPECIMEN IN TRANSIT
Specimen for Blood GasAnalysis:PCO2,PO2
• Specimen for hormonal assays e.g. gastrin, rennin and parathyroid
hormone must be separated from the cells in a refrigerated
centrifuge.

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SIDE ROOM TESTING
POINT OF CARE TESTING
NEAR PATIENT TESTING

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 POINT OF CARE TESTING

alternative site testing

Near patient testing
Side room testing
point of care testing
bedside testing
physician office laboratory testing
limited service laboratory testing
ancillary testing
out of laboratory testing
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 POINT OF CARE TESTING

Refers to tests performed outside the hospital laboratory

by untrained healthcare professionals or non-laboratory
personnel.

• Bedside
• Clinic
• By patients themselves at home

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 CATEGORIZATIONS OF SIDE-ROOM TESTS

Simple side-room tests:

Qualitative : mostly performed on urine eg. urine dipsticks
tests

Semi-quantitative or Quantitative:
mostly performed on blood specimens. e.g. Glucometers

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 ADVANTAGES OF SRT/PCT
• Spot/Small blood volume, whole blood, urine

• Turn Around Time- Relatively short analysis time/immediate

results

• Early treatment and shortens patient wait

• Ease of use– can be perform by less trained personnel or by

the patients themselves
• Prompter stabilization of life-threatening crises (eg drug
overdose)
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 ADVANTAGES OF SRT/PCT
• Closer therapeutic management (e.g. diabetes)

• Better patient compliance with therapy (diabetes,

hyperlipidaemia)

• Reduces:
– Repeat clinic/patient visits
– Length of stay in hospital

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 DISADVANTAGES OF SRT/PCT
• Analytical performance can be inferior to lab (eg. some
glucometers)

• Risk of poor "operator" competence

• Risk of poor equipment maintenance

• Cost per test relatively more expensive

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 Egs. of commercially available POC tests

Quantitative tests
Qualitative tests
• Glucose
• hcG • Blood gases
• Drugs of Abuse • Electrolytes
• Urinalysis • Creatinine
• HBA1c
• Troponin

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 Where are NPT devices useful?
ACCIDENT & EMERGENCY
Quick turnaround time for results
e.g. Diagnosis of acute MI- whole blood troponin NPT device.
Drug overdoses- plasma p’mol, cocaine

DRUG ADDICTION CLINICS

ümeasure misused drugs and alcohol ( Alcohol breath test)
üscreen workers for substance abuse.
Roche Diagnostics– for qualitative testing for ethanol in either
saliva or urine
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 Where are NPT devices useful?
GENERAL PRACTICE, OUT-PATIENT CLINICS & WARDS
use urine dipstick testing for screening patients. eg. screening for
UTI, urine protein.

NEONATAL CARE AND ADULT INTENSIVE CARE

Neonatal units: determination of blood bilirubin using
bilirubinometers.

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 Where are NPT devices useful?
PATIENT SELF-TESTING
eg. Pregnancy self-testing using over-the-counter pregnancy test kits

NPT self monitoring is often used in the management of diabetes

mellitus

• glucose determinations in urine

• ketones in urine or plasma
• blood glucose measurements
• Urinary microalbumin tests

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