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Clinical Chemistry Lecture

Clinical Chemistry is a branch of laboratory medicine that analyzes body fluids to detect diseases, monitor therapy, and assess health. It operates as a support service in healthcare, providing critical diagnostic information through various tests linked to organ functions. The field relies on rigorous quality control and advanced analytical techniques to ensure accurate and reliable results.

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13 views19 pages

Clinical Chemistry Lecture

Clinical Chemistry is a branch of laboratory medicine that analyzes body fluids to detect diseases, monitor therapy, and assess health. It operates as a support service in healthcare, providing critical diagnostic information through various tests linked to organ functions. The field relies on rigorous quality control and advanced analytical techniques to ensure accurate and reliable results.

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sameerkx692
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INTRODUCTION TO

CLINICAL CHEMISTRY
DR REHAN AKHTAR
LECTURER PATHOLOGY
What is Clinical Chemistry?

• Definition:
Clinical Chemistry (also called chemical pathology or clinical biochemistry) is a field of
laboratory medicine that uses chemical and biochemical tests to analyze body fluids like blood,
urine, and cerebrospinal fluid.
• Purpose:
To detect abnormalities in the composition of body fluids that may indicate disease, monitor
therapy, or assess overall health.
• Example:
Measuring blood glucose in a diabetic patient or cholesterol in a person at risk for heart disease.
Explanation:

• Uses chemical processes to measure substances in blood, urine, CSF, etc.


• Examples include glucose, cholesterol, enzymes, hormones, electrolytes.
• Provides objective data for clinical decisions.
Clinical Chemistry as a Service Industry

• Concept: Clinical chemistry labs function like a support service in a hospital or clinic. They do not
treat patients directly, but provide essential diagnostic information that physicians depend on.
• Key Features:
• 24/7 Operations: Labs often run day and night, especially in emergency departments.
• Rapid Turnaround Time: Results need to be fast and reliable to guide clinical decisions.
• High Throughput: Modern analyzers process thousands of tests per day.
• Client-Focused: The "clients" are patients and doctors.
• Why It Matters:
Just like a restaurant depends on clean water, hospitals depend on lab data for diagnosis, treatment
plans, and emergency response. Mistakes or delays in the lab can delay patient care or lead to wrong
decisions.
Clinical Chemistry as a Science

• Scientific Foundation: Based on biochemistry, physiology, molecular biology, and


pharmacology.
• Investigates the normal and abnormal levels of various substances in the body (e.g., enzymes,
hormones, electrolytes).
• Research and Development:
• New biomarkers and testing technologies are developed using scientific methods.
• Understanding disease mechanisms helps create better diagnostic tools.
• Why It Matters:
A lab technician must understand why a test is done, what the result means, and how to
interpret abnormal findings — not just run the machine
Clinical Chemistry and Organ Systems

 Tests are often linked to organ-specific function:


o Liver: ALT, AST, ALP, Bilirubin
o Kidney: Creatinine, Urea, Electrolytes
o Heart: Troponins, CK-MB, LDH
o Pancreas: Amylase, Lipase
o Endocrine: Glucose, TSH, Insulin
Clinical Chemistry Laboratory & Organ Systems Relationship Between Tests and
Organs

Why It Matters: Lab results reflect how well organs are working. This helps detect diseases before physical symptoms
appear.

Organ System Common Tests Purpose

Liver ALT, AST, Bilirubin, ALP Detect liver injury or disease

Kidney Urea, Creatinine, eGFR, Electrolytes Assess renal function

Heart Troponin, CK-MB Diagnose myocardial infarction

Endocrine TSH, T3, T4, Cortisol, Insulin Evaluate hormonal imbalances

Pancreas Amylase, Lipase, Glucose Detect diabetes or pancreatitis


Preanalytical, Analytical, and Postanalytical Phases

• Explanation of Phases:
• Preanalytical: Patient prep, sample collection and handling
• Analytical: Actual testing, calibration, controls
• Postanalytical: Reporting, interpretation, and record-keeping
• Note: Preanalytical errors are the most common source of lab
mistakes.
Analytical Techniques

• Spectrophotometry (Beer-Lambert Law): Quantifies color intensity to determine analyte


concentration
• Electrochemistry: Ion-selective electrodes for Na⁺, K⁺, etc.
• Immunoassays: ELISA, CLIA for hormone and drug levels
• Chromatography & Mass Spectrometry: Advanced analysis of complex mixtures
Quality Control in Clinical Chemistry

• Internal QC: Daily controls to monitor precision


• External QC (Proficiency Testing): Comparison with other labs
• Quality Assurance (QA): System-wide policies ensuring accuracy and reliability
• Explanation: Without QC, lab results cannot be trusted for diagnosis.
Types of Tests Performed in Clinical Chemistry

• A. Routine Tests
• Done frequently and available in basic hospital labs.
• Examples: Blood glucose, urea, creatinine, liver enzymes, electrolytes, cholesterol.
• Mostly done using automated analyzers.
• B. Specialized Tests
• Require special equipment or procedures.
• Examples:
• Hormonal assays (e.g., TSH, cortisol)
• Drug levels (e.g., digoxin, lithium)
• Tumor markers (e.g., PSA, AFP, CA-125)
• Protein electrophoresis
• Why It Matters:
Routine tests give a general health overview, while special tests are problem-focused to confirm a specific
Reference Ranges and Interpretation

• Definition: Range of values expected in healthy individuals.


• Influenced by age, sex, diet, altitude, and instrumentation.
• Critical values: Results that require immediate clinical action.
Specimen Collection in Clinical Chemistry

• Common Specimen Types:


• Blood (serum or plasma)
• Urine
• Cerebrospinal Fluid (CSF)
• Saliva
• Pleural, pericardial, synovial fluids
• Factors to Consider:
• Tube type (e.g., plain, EDTA, heparin)
• Proper labeling and timing
• Storage and transport conditions (e.g., keep cold, protect from light)
• Why It Matters:
Poor collection or handling leads to false results, potentially harming the patient.
Routine Sampling

 Timing: Fasting vs. post-prandial


 Containers: Red top, lavender top, etc.
 Volume and stability
 Transport and storage conditions
Automation and Informatics

• Modern analyzers: High throughput, reduced error.


• Laboratory Information Systems (LIS): Integrated patient data.
• Point-of-Care Testing (POCT): Rapid bedside testing.
Routine Sampling

• Definition: Standardized procedure of collecting blood or urine without special


preparation, usually in outpatient or inpatient settings.
• Steps:
1.Patient identification (2-point check: name and ID)
2.Patient preparation (e.g., fasting for lipid profile)
3.Correct tube and volume
4.Mixing gently (if anticoagulant is present)
5.Timely transport to lab
• Why It Matters:
Following protocol reduces pre-analytical errors, which make up the majority of lab.
Pediatric Sampling

• Challenges:
• Children have smaller veins.
• Risk of anemia if too much blood is drawn.
• Difficult cooperation and high anxiety.
• Techniques:
• Heel prick: for newborn screening
• Capillary (fingerstick) sampling: small amounts of blood
• Micro sampling tubes: require less volume
• Why It Matters:
Special handling ensures safety, accuracy, and comfort for pediatric patients.
Special Sampling Techniques
Why It Matters:
Timing and procedure affect results. For example, cortisol varies throughout the day — wrong timing =
misleading result.

Technique Description Purpose


Collected from an artery (e.g.,
Arterial Blood Gas (ABG) Measures pH, O₂, CO₂
radial)
All urine in 24 hrs.; stored in a
24-hour urine collection Measures protein, cortisol, etc.
container
Blood drawn before and after
Fasting/Postprandial Glucose monitoring, lipids
eating
Samples collected at specific Drug monitoring (e.g.,
Timed sampling
intervals peak/trough)
Dynamic testing Tests over time after stimulation GTT, ACTH stimulation test

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