 CLINICAL BIOCHEMISTRY (also known as clinical chemistry

or chemical pathology) is the laboratory service absolutely essential

for medical practice or branch of laboratory medicine in which
chemical and biochemical methods are applied to the study of
disease.
 The results of the biochemical investigations carried out in a clinical
chemistry laboratory will help the clinicians to determine the
diseases (diagnosis) and for follow-up of the treatment/recovery from
the illness (prognosis).
The use of biochemical tests:
Biochemical investigations are involved in every branch of clinical medicine.
The results of biochemical tests may be of use in:
 diagnosis and in the monitoring of treatment.
 screening for disease or in assessing the prognosis.
 research into the biochemical basis of disease
 clinical trials of new drugs

Biochemical investigations hold the key for the diagnosis and prognosis of
diabetes mellitus, jaundice, myocardial infarction, gout, pancreatitis,
rickets, cancers, acid-base imbalance etc. Successful medical practice is
unimaginable without the service of clinical biochemistry laboratory.
Clinical biochemical tests comprise over ⅓ of all hospital laboratory
investigations.

1)Core biochemical tests:

 Sodium, potassium, chloride and bicarbonate
 Urea and creatinine
 Calcium and phosphate
 Total protein and albumin
 Bilirubin and alkaline phosphatase
 Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST)
 Glucose
2)Specialized tests:
Not every laboratory is equipped to carry out all possible biochemistry
requests.
Large departments may act as reference centers where less commonly asked
for tests are performed.
Specialized tests:
 Hormones
 Specific proteins
 Trace elements
 Vitamins
 Drugs
 Lipids and lipoproteins
 DNA analyses
TYPES OF LABORATORY TESTS:
The biochemical investigations (on blood/ plasma/serum) carried out in the
clinical biochemistry laboratory may be grouped into different types.
1. Discretionary or on-off tests : Most common clinical biochemistry tests
that are designed to answer specific questions, e.g., does the patient have
increased blood urea/glucose concentration? Normally, these tests are
useful to support the diagnosis.
2. Biochemical profiles : These tests are based on the fact that more useful
information on the patients disease status can be obtained by analysing
more constituents rather than one e.g., plasma electrolytes (Na+, K+, Cl-,
bicarbonate, urea); liver function tests (serum bilirubin, ALT, AST).
3. Screening tests : These tests are commonly employed to identify
the inborn errors of metabolism, and to check the entry of toxic
agents (pesticides, lead, mercury) into the body.
4. Metabolic work-up tests : The programmed intensive
investigations carried out to identify the endocrinological disorders.
5.Emergency tests: is frequently used in the clinical laboratory. It
refers to the tests to be performed immediately to help the clinician
for proper treatment of the patient e.g., blood glucose, urea, serum
electrolytes.
 There are over 400 different tests which may be carried out in
clinical biochemistry laboratories.
 They vary from the very simple, such as the measurement of sodium,
to the highly complex, such as DNA analysis, screening for drugs, or
differentiation of lipoprotein variants.
 Many high volume tests are done on large automated machines.
 Less frequently performed tests may be conveniently carried out by
using commercially prepared reagents packaged in "kit" form.
 Some analyses are carried out manually.
1) Specimen collection:
The biological fluids employed in the clinical biochemistry laboratory
include blood, urine, saliva, sputum, feces, tissue and cells,
cerebrospinal fluid, peritoneal fluid, synovial fluid, stones.
Among these, blood (directly or in the form of plasma or serum) is
frequently used for the investigations in the clinical biochemistry
laboratory.

 Serum is the liquid that remains after the blood has clotted.
 Plasma is the liquid that remains when clotting is prevented with the addition of an
anticoagulant.
2)Identification of patients and specimens
The correct patient must be appropriately identified on the specimen and
request form, as follows:
a. Patient identification data (PID). This usually comprises name plus
unique number.
b. Test request information. This includes relevant clinical details
(including any risk of infection hazard), the tests to be performed and
where the report is to be sent.
c. Collection of specimens. In the correct tube and the appropriate
preservative.
d. Matching of specimens to requests. Each specimen must be easily and
clearly matched to the corresponding request for investigations.
  Some commoner causes of errors arising from use of the
laboratory.
Error Consequence
Crossover of addressograph labels between patients This can lead to two patients each with the other's set of results. Labels between patients ,Where the
patient is assigned a completely wrong set of results, it is important to investigate the problem in case
there is a second patient with a corresponding wrong set of results

Timing error There are many examples where timing is important but not considered. Sending in a blood sample too
early after the administration of a drug can lead to misleadingly high values in therapeutic monitoring.

Sample collection tube error For some tests the nature of the collection tube is critical which is why the Biochemistry Laboratory
specifies this detail. For example, using a plasma tube with lithium-heparin as the anticoagulant
invalidates this sample tube for measurement of a therapeutic lithium level!

Sample taken from close to the site of an intravenous The blood sample will be diluted so that all the tests will be correspondingly site of an intravenous (IV)
infusion infusion. low with the exception of those tests which might be affected by the composition of the
infusion fluid itself. For example, using normal saline as the infusing fluid would lead to a lowering of all
test results but with sodium and chloride results which are likely to be raised.
3) COLLECTION OF BLOOD:
a. Venous blood is most commonly used for a majority of biochemical
investigations. It can be drawn from any prominent vein (usually
from a vein on the front of the elbow).
b. Capillary blood (<0.2 ml) obtained from a finger or thumb, is less
frequently employed.
c. Arterial blood (usually drawn under local anaesthesia) is used for
blood gas determinations.
Precautions for blood collection : Use of sterile (preferably
disposable) needles and syringes, cleaning of patients skin, blood
collection in clean and dry vials/tubes are some of the important
precautions.
 Biochemical investigations can be performed on 4 types of blood
specimens – whole blood, plasma, serum and red blood cells. The
selection of the specimen depends on the parameter to be estimated.
 1. Whole blood (usually mixed with an anticoagulant) is used for the
estimation of hemoglobin, carboxyhemoglobin, pH, glucose, urea,
non-protein nitrogen, pyruvate, lactate, ammonia etc.
 2. Plasma, obtained by centrifuging the whole blood collected with
an anticoagulant, is employed for the parameters—fibrinogen,
glucose, bicarbonate, chloride, ascorbic acid etc.
 3. Serum is the supernatant fluid that can be collected after
centrifuging the clotted blood. It is the most frequently used
specimen in the clinical biochemistry laboratory. The
parameters estimated in serum include proteins
(albumin/globulins), creatinine, bilirubin, cholesterol, uric acid,
electroylets (Na+, K+, Cl-), enzymes (ALT, AST,, CK,,
amylase, lipase) and vitamins.
 4. Red blood cells are employed for the determination of
abnormal hemoglobins, glucose 6-phosphate dehydrogenase,
pyruvate kinase etc.
Collection and preservation of blood specimens
Lack of thought before collecting specimens or carelessness in collection
may adversely affect the interpretation or impair the validity of the tests
carried out on the specimens. Some factors to consider include the
following:
1. Diet Dietary constituents may alter the concentrations of analytes in blood
significantly (e.g. plasma [glucose] and [triglyceride] are affected by
carbohydrate and fat-containing meals
2. Drugs Many drugs influence the chemical composition of blood. Such
effects of drug treatment, for example, antiepileptic drugs, have to be taken
into account when interpreting test results. Details of relevant drug
treatment must be given when requesting chemical analyses, especially
when toxicological investigations are to be performed.
3. Diurnal (of or during the day )variation.
The concentrations of many substances in blood vary
considerably at different times of .Specimens for these
analyses must be collected at the times specified by the
laboratory, as there may be no reference ranges relating
to their concentrations in blood at other times.
Bilirubin (formerly referred to as haematoidin) is the yellow breakdown product
of normal heme catabolism, caused by the body's clearance of aged red blood
cells which contain hemoglobin.
Bilirubin is excreted in bile and urine, and elevated levels may indicate certain
diseases.
It is responsible for yellow discoloration in jaundice. It is also responsible for the
brown color of feces , and the background straw-yellow color of urine via its
breakdown product, urobilin, contributing to urine color along with thiochrome, a
breakdown product of thiamine which produces the more obvious but variable
bright yellow color of urine.

The bilirubin level found in the body reflects the balance between
production and excretion. Blood test results [0.3 to 1.9 mg/dL]s for
adults and [340 µmol/L] for new born.
Creatinine is a chemical waste molecule that is generated from
muscle metabolism. Creatinine is produced from creatine, a molecule
of major importance for energy production in muscles.
Approximately 2% of the body's creatine is converted to creatinine
every day. Creatinine is transported through the bloodstream to the
kidneys. The kidneys filter out most of the creatinine and dispose of
it in the urine.
Because the muscle mass in the body is relatively constant from day
to day, the creatinine production normally remains essentially
unchanged on a daily basis. The kidneys maintain the blood
creatinine in a normal range. Creatinine has been found to be a fairly
reliable indicator of kidney function. Elevated creatinine level
signifies impaired kidney function or kidney disease. Each day, 1-2%
of muscle creatine is converted to creatinine.
The typical human reference ranges for serum creatinine
are 0.5 to 1.0 mg/dl (about 45-90 μmol/l) for women and
0.7 to 1.2 mg/dl (60-110 μmol/l) for men. The
significance of a single creatinine value must be
interpreted in light of the patient's muscle mass. A patient
with a greater muscle mass will have a higher creatinine
level.
While a baseline serum creatinine of 2.0 mg/dl (150
μmol/l) may indicate normal kidney function in a male
body builder,
a serum creatinine of 1.6 mg/dl (110 μmol/l) can indicate
significant renal disease in an elderly female.
Uric acid is a heterocyclic compound
of carbon, nitrogen, oxygen, and hydrogen with
the formula C5H4N4O3.
It forms ions and salts known as urates and acid
urates, such as ammonium acid urate. Uric acid is
a product of the metabolic breakdown
of purine nucleotides. High blood concentrations of
uric acid can lead to gout. The chemical is
associated with other medical
conditions including diabetes and the formation of
ammonium acid urate kidney stones.
Normal values range between 3.5 - 7.2 mg/dL.
Total Cholesterol
To determine if total cholesterol is too high, you simply need
to look at your total cholesterol number. If you suffer from
high cholesterol, DOCTOR will determine the HDL and LDL
levels before they decide if you need treatment as well as
what type would be ideal.
Guidelines in Guidelines in Categories
U.S. Canada

Less than 200 Less than 5.2 Desirable

mg/dL mmol/L

200 to 239 mg/dL 5.2 to 6.2 mmol/L Borderline high

240 mg/dL and Higher than 6.2

higher mmol/L High
LDL Cholesterol
The HDL cholesterol is considered “good cholesterol” so the number
should be high. The goals vary by gender but in general, higher
levels of HDL cholesterol are better. If you have HDL over 60, this
will help protect you against heart attacks. HDL below 40, on the
other hand, will increase your risk of developing future heart
problems. If you have a high HDL number this can help counteract a
high LDL level.