Overview of Clinical

Chemistry

Lecture 1
Clinical chemistry
 Clinical chemistry is a science, a service, and an
industry.
 As a science, clinical chemistry links the
knowledge of general chemistry, organic
chemistry, and biochemistry with an
understanding of human physiology.
 As a service, the clinical chemistry laboratory
produces objective evidence from which medical
decisions may be made.
 As an industry, clinical laboratories are
businesses which operate under the regulations
and practices that guide commerce

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Clinical chemistry
 A central function of the clinical chemistry
laboratory is to provide biochemical
information for the management of
patients.
 Such information will be of value only if it
is accurate and relevant, and if its
significance is appreciated by the clinician
so that it can be used appropriately to
guide clinical decision-making.

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Purpose of Clinical Chemistry Tests

 Measure levels of substances found normally

in human blood that have biological
functions.
 Examples: Glucose, Calcium
 Detect or measure non-functional
metabolites or waste products.
 Examples: Creatinine, Blood Urea

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Common Clinical Chemistry Tests
TEST REFERENCE RANGE
Sodium 135-145 mEq/L
 The tests listed Potassium 3.5-5.5 mEq/L
Chloride 95-105 mEq/L
are conducted Glucose 60-110 mg/dl

routinely by the Urea (BUN)

Creatinine
10-20 mgN/dl
0.5-1.4 mg/dl

Chemistry Section Uric Acid

Inorganic Phosphate
2.5-8.0 mg/dl
2.3-4.8 mgP/dl

of the Clinical Calcium 8.5-10.8 mg/dl

Total Protein 6.0-8.0 g/dl
Chemistry Albumin 3.5-5.0 g/dl

Laboratory. Bilirubin
Cholesterol
0.1-1.4 mg/dl
125-300 mg/dl
Triglycerides <170 mg/dl
Alkaline Phosphatase 35-125 mU/ml
SGOT (AST) 7-40 mU/ml
SGPT (ALT) 7-80 mU/ml
Lactic Dehydrogenase (LDH) 105-215 mU/ml
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Creatine Phosphokinase (CPK) <100 mU/ml
Types of Specimens for Chemical
Analysis
 Whole blood, serum or plasma.
 The most common specimen is serum, collected
in a tube with no anticoagulant so that the blood
will clot.
 Urine – often 24 hour collections
 Others – Cerebrospinal Spinal Fluid (CSF)
and other fluids

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Clinical chemistry Test Results
 Results from these tests provide valuable
clinical information about:
 whether specific tissue has been damaged,
 and how severely,
 and about the functional status of a variety of organ
systems.
 Test results are interpreted with respect to
reference ranges, which are, most typically,
95% confidence intervals of values found in
clinically healthy populations.

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Clinical chemistry Test Results
 Biochemical tests are used in diagnosis, prognosis, monitoring and
Screening.
 The clinical chemistry laboratory provides accurate, precise
measurements of selected biochemical markers, accompanied by
reference, or comparison, ranges of the concentration of these
biochemical markers in healthy individuals.
 Biochemical marker analysis is one factor in the assessment of the
patient.
 Physicians also gather
 history and symptoms of the complaint;
 examination findings, such as blood pressure;
 and testing by other health-care team members in ancillary fields, such
as radiology.
 The physician uses all data to assess the patient and implement a
plan for treatment.

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Use of biochemical tests

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Diagnosis
 Medical diagnosis is based on the patient's history, if
available, the clinical signs found on examination,
the results of investigations and sometimes,
retrospectively, on the response to treatment.
 Frequently, a confident diagnosis can be made on
the basis of the history combined with the findings
on examination.
 Investigations may be selected to help either
confirm or refute a diagnosis, and it is important that
the clinician appreciates how useful the chosen test
is for these purposes.
 Making a diagnosis, even if incomplete, such as a
diagnosis of hypoglycaemia without knowing its
cause, may allow treatment to be initiated.
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Prognosis
 Tests used primarily for diagnosis may also
provide prognostic information and some are
used specifically for this purpose;
 for example, serial measurements of plasma
creatinine concentration in progressive renal disease
are used to indicate when dialysis may be required.
 Tests can also indicate the risk of developing a
particular condition;
 for example, the risk of coronary artery disease
increases with increasing plasma cholesterol
concentration.
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Monitoring
 A major use of biochemical tests is to follow the
course of an illness and to monitor the effects of
treatment.
 To do this, there must be a suitable analyte,
 for instance glycated haemoglobin in patients with diabetes
mellitus.
 Biochemical tests can also be used to detect
complications of treatment,
 such as hypokalaemia during treatment with diuretics,
 and are extensively used to screen for possible drug toxicity,
particularly in trials, but also in some cases when a drug is in
use.

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Screening

 Biochemical tests are widely used to

determine whether a condition is present
subclinically.
 The best-known example is file mass
screening of all newborn babies for
phenylketonuria (PKU), which is carried
out in many countries.

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Categories of Biochemical Markers
 Biochemical markers are used for assessment and diagnosis of
disease:
 carbohydrates,
 lipids,
 proteins,
 nucleic acids
 and the derivatives of these markers.
 The assessment of inorganic chemicals, provide a measure of
homeostasis in the body.
 such as ions,
 minerals,
 and dissolved gases,
 In addition to the measurement of these endogenous substances,
the clinical chemistry laboratory provides measurement of chemicals
that are exogenous to the body—
 both beneficial chemicals,
 such as therapeutic drugs,
 and harmful substances,
 such as poisons.
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Carbohydrates
 Carbohydrates are chemical substances that contain
only carbon, hydrogen, and oxygen.
 Often carbohydrate molecules consist of one H2O
molecule per carbon, hence the nomenclature
“carbohydrate,” or hydrate of carbon.
 The simplest carbohydrates are monosaccharides,
which usually contain 3 to 6 carbons.
 Monosaccharides are the units that make up more
complex carbohydrates.
 Glucose, fructose, ribose, and galactose are common
monosaccharides of living organisms.

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Carbohydrates as Biochemical Markers of Disease

 The most common carbohydrate disorder in

humans is diabetes mellitus.
 This disease is caused by an inability to
produce or to respond to the hormone insulin.
 Laboratory tests of body fluids of individuals
with this disease show increased
concentrations of glucose.
 The laboratory tests for ketones, acids, and
glycosylated proteins provide measures of
disease severity.

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Lipids
 Lipids are, by definition, organic compounds that are
poorly soluble in solutions such as water and soluble
in organic solutions such as ether.
 Chemically, lipids are either compounds that yield fatty
acids when hydrolyzed or complex alcohols that can
combine with fatty acids to form esters.
 Only a limited number of lipids are clinically important.
This group includes
 fatty acids,
 triglycerides,
 cholesterol,
 and phospholipids.

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Lipids as Biochemical Markers of
Disease
 Clinical chemistry laboratories offer many tests
for lipid disorders. One of the most common
tests is the lipid profile.
 This panel of tests includes measures of
 triglycerides
 cholesterol
 Low density lipoprotein cholesterol (LDL-C)
 and high-density lipoprotein cholesterol (HDL-C).
 The results of testing for these lipids provide
measures of risk for coronary artery disease.

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Proteins and Amino Acids

 The human body requires 20 amino

acids as the building blocks of proteins.
 Humans make some of these amino
acids but must gain the rest, as
essential nutrients, through the diet.
 Plants and bacteria produce the
essential amino acids and many others.

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Proteins and Amino Acids

 Proteins and amino acids have unique

structures and participate in
characteristic chemical reactions.
 Proteins are polymers consisting of
amino acid units.
 Amino acid units within the protein are
joined by peptide bonds. Each amino
acid unit contains a unique R group.

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Total Serum/Plasma Proteins and Plasma Albumin
as Biochemical Markers of Disease

 Plasma proteins have functions in many organ and tissue

systems. They are carrier molecules, receptor chemicals,
immune response agents, and enzymes or catalytic proteins.
 Total plasma protein is a measure of nutrition, the status of
many organs and tissues that are involved in protein
metabolism, and the process of breakdown and excretion of
protein metabolites.
 The measurement of plasma protein fractions provides more
specific evidence for diagnosis and assessment of disorders.
Because of its importance in maintaining osmotic pressure,
the measure of albumin concentration is a reflection of this
pressure.
 As a transport protein, the measurement of albumin monitors
the ability of the body to transport such diverse substances
as bilirubin, fatty acids, and calcium through the blood.

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Enzymes

 An enzyme is a protein catalyst that

accelerates the speed of a chemical
reaction by binding specifically to a
substrate, forming a complex.
 This complex lowers the activation
energy in the reaction without the
enzyme becoming consumed or without
changing the equilibrium of the reaction.

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Enzymes as Biochemical Markers of
Disease
 Damage to tissue can release different types of
enzymes based on their location.
 For example, mild inflammation of the liver reversibly
increases the permeability of the cell membrane and
releases cytoplasmic enzymes such as lactate
dehydrogenase (LD), alkaline phosphatase (ALP), and
aspartate transaminase (AST).
 Distribution of these enzymes within specific types of
hepatic tissues varies. ALP is more concentrated in
the biliary tree or canalicular tissues, while AST, ALT,
and LD are found in parenchymal hepatic cells.

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THE CLINICAL CHEMISTRY LABORATORY
AND ORGAN SYSTEMS

Cardiovascular Circulatory System

 The clinical chemistry laboratory offers analysis of

biochemicals for the assessment of
 acute myocardial infarction,
 congestive heart failure
 and coronary artery disease.
 The laboratory offers measurement of lipids as
predictive factors for the development of heart
disease.
 Measurement of arterial blood gases helps assess the
acid-base and oxygenation status of the patient.

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Respiratory Tract

 The function of the respiratory tract is to

transfer gases from the environment to
tissue cells and from tissues cells to the
environment.
 The respiratory system also helps
maintain the acid-base balance in the
body.

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Respiratory Tract
 Measurement of arterial blood gases helps
assess the function of the respiratory system,
as well as the circulatory system.
 Blood oxygenation and pH are dependent upon
the uptake of oxygen by hemoglobin and
removal of carbon dioxide from red blood cells.
 The assessment of diseases such as chronic
obstructive pulmonary disease is dependent
upon the measurement of partial pressures of
oxygen and carbon dioxide in arterial blood to
monitor the function of the lungs.

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Liver
 The clinical chemistry laboratory offers a lot of
tests that provide information about specific
diseases of the liver.
 Measurement of the concentration of the
enzyme alanine transaminase (ALT) provides
information about hepatitis.
 Measurement of the enzyme alkaline
phosphatase (ALP) provides information about
biliary tract disorders.
 Analysis of the concentrations of proteins that
are made in the liver provides information about
the ability of the liver to perform this function.

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Renal System
 The clinical chemistry laboratory offers
many tests for different biochemical
markers of renal function, including
electrolytes, minerals, and protein
metabolic waste products.
 These biochemical markers are
measured in serum, urine, and other
body fluids.

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Digestive System
 The clinical chemistry laboratory provides
information about nutritional status, intestinal
absorption, and function of the pancreas and
other organs of the digestive tract.
 The concentration of proteins of varying half-
life helps establish the length of time of
nutritional deficiency.
 Analysis of gastric fluid assesses the ability of
the stomach to secrete acid.
 Measurement of serum concentrations of lipase
and amylase monitors the exocrine function of
the pancreas.

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Endocrine System
 The clinical laboratory measures the
concentrations of some hormones.
 For the assessment of other hormones that
vary in concentration over a 24-hour period or
are too labile to measure with accuracy,
 the laboratory scientist establishes hormonal
function by measuring the concentration of the
metabolites of hormone degradation or the
process that the hormone regulates.
 Clear understanding of specimen collection and
handling is essential for offering useful
laboratory tests results of hormonal function.

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