2. Introduction to Clinical Chemistry
-
Upload
ega-hida-prabowo -
Category
Documents
-
view
218 -
download
1
Transcript of 2. Introduction to Clinical Chemistry
-
7/26/2019 2. Introduction to Clinical Chemistry
1/28
BASIC CLINICAL
CHEMISTRY
Abdul Rohman, PhD
Department of Pharmaceutical Chemistry, Faculty
of Pharmacy, Gadjah Mada University, o!ya"arta,
#ndonesia
-
7/26/2019 2. Introduction to Clinical Chemistry
2/28
CLINICAL CHEMISTRY
$he analysis of individual constituents,proteins, en%ymes, nutrients, &asteproducts, metabolites, hormones, etc' inblood or body fluids that provides
information re!ardin! the function orinte!rity of a tissue, or!an or or!an system
(hile almost anythin! may be analy%ed, the
efficacy of a test depends on its specificityand sensitivity to detect patholo!ical chan!e
-
7/26/2019 2. Introduction to Clinical Chemistry
3/28
PURPOSE OF CLINICAL CHEMISTRY
TEST
Measure levels of substances found normally in
human blood that have biological functions.
Examples: Glucose, Calcium
Detect or measure non-functional metabolites or
aste products. Examples: Creatinine, !lood
"rea #itrogen $!"#%
Detect or measure substances that indicate cell
damage or disease. Examples: &iver en'ymes,
such as (&), Cardiac en'ymes, such as C*-M!Detect or measure drugs or toxic substances.
Examples: Dilantin, Drugs of abuse screen
-
7/26/2019 2. Introduction to Clinical Chemistry
4/28
SOME METHODS FOR THE ANALYSIS OF DRUGS AND
OTHER ORGANIC POISONS IN BIOLOGICAL SAMPLES
-
7/26/2019 2. Introduction to Clinical Chemistry
5/28
SOME METHODS FOR THE ANALYSIS OF DRUGS AND
OTHER ORGANIC POISONS IN BIOLOGICAL SAMPLES
-
7/26/2019 2. Introduction to Clinical Chemistry
6/28
TYPES OF SPECIMENS FOR
CHEMICAL ANALYSIS
Whole blood, serum or plasma. The mostcommon specimen is serum, collected in atube with no anticoagulant so that the bloodwill clot.
Urine often 24 hour collections
Others Cerebrospinal Spinal luid !CS" and
other fluids
-
7/26/2019 2. Introduction to Clinical Chemistry
7/28
ANTI-COAGULANT
-
7/26/2019 2. Introduction to Clinical Chemistry
8/28
ANALYTICAL STEP IN CLINICAL
CHEMISTRY
-
7/26/2019 2. Introduction to Clinical Chemistry
9/28
#ormal or $eference %alues range of &aluesfor a particular chemistr' test from health'indi&iduals
Chemistr' (anel grouping some tests are)bundled* according to the s'stem or organtargeted. +amples- th'roid panel, li&er panel,cardiac panel, idne' panel, basic metabolicpanel, etc.
CLINICAL CHEMISTRY TESTS
-
7/26/2019 2. Introduction to Clinical Chemistry
10/28
(roteins essential components of cells andbod' fluids. Some made b' bod', othersac/uired from diet. (ro&ides information aboutstate of h'dration, nutrition and li&er function,
since most serum proteins are made in the li&er.+lectrol'tes sometimes called )l'tes*
0ncludes sodium !#a", potassium !1", chloride !Cl"and bicarbonate !CO3"
Collecti&el' these ha&e a great effect on h'dration,
acidbase balance and osmotic pressure as well as pand heart and muscle contraction
5e&els differ depending on if inside &s. outside cells 0mportant in transport of substances into and out of
cells
Commonl' (erformed Chemistr'Tests or 6nal'tes !7"
-
7/26/2019 2. Introduction to Clinical Chemistry
11/28
8inerals Calcium
Used in coagulation and muscle contraction99: is in seleton and is not metabolicall' acti&e
0nfluenced b' &itamin ;, parath'roid hormone,estrogen and calcitonin
'percalcemia occurs in parath'roidism, bonemalignancies, hormone disorders, ecessi&e &itamin;, and acidosis< ma' cause idne' stones
'pocalcemia can cause tetan'< occurs inh'poparath'roidism, &itamin ; deficienc', poordietar' absorption and idne' disease
Commonl' (erformed Chemistr'Tests or 6nal'tes !2"
-
7/26/2019 2. Introduction to Clinical Chemistry
12/28
(hosphorus=>: in bone and rest in energ' compounds such as
6T(0nfluenced b' calcium and certain hormones
0ron+ssential for hemoglobin;eficienc' results in anemia< ma' be caused b'
lac of iron in diet, poor absorption, poor releaseof stored iron or loss due to bleeding
0ncreased in hemol'tic anemia, increased ironintae or bloced s'nthesis of ironcontainingcompounds, such as in lead poisoning
Commonl' (erformed Chemistr'Tests or 6nal'tes !3"
-
7/26/2019 2. Introduction to Clinical Chemistry
13/28
1idne' unction Tests Serum Creatinine
?est test for o&erall idne' function< not affected b' dietor hormone le&els
Waste product of muscle metabolismSerum creatinine rises when idne' function is impaired
?U# !?lood Urea #itrogen"?U# is surplus amino acids that are con&erted to urea and
ecreted b' idne's as a waste product?U# influenced b' diet and hormones, so it is #OT as good
an indicator of renal function as serum creatinine le&els?U# increased in idne' disease, high protein diet, and
after administration of steroids?U# decreased in star&ation, pregnanc' and in persons on
a low protein diet
Commonl' (erformed Chemistr'Tests or 6nal'tes !4"
-
7/26/2019 2. Introduction to Clinical Chemistry
14/28
Uric 6cidormed from breadown of nucleic acids and
ecreted as a waste product b' idne's0ncreased in idne' disease, but most often used
to diagnosis gout !pain in @oints, mainl' big toe, dueto precipitated uric acid cr'stals"6lso increased in increased cell destruction, such
as after massi&e radiation or chemotherap'
Commonl' (erformed Chemistr'Tests or 6nal'tes !A"
-
7/26/2019 2. Introduction to Clinical Chemistry
15/28
5i&er unction Tests 5i&er functions-
S'nthesiBes gl'cogen from glucose8aes plasma proteins !albumin, lipoproteins,
coagulation proteins"orms cholesterol and degrades it into bile acids,
which emulsifies fats for absorptionStores iron, gl'cogen, &itamins and other
substances;estro's old blood cells and rec'cles components
of hemoglobin
Commonl' (erformed Chemistr'Tests or 6nal'tes !"
-
7/26/2019 2. Introduction to Clinical Chemistry
16/28
-
7/26/2019 2. Introduction to Clinical Chemistry
17/28
Total ?ilirubinWaste production of hemoglobin breadown0ncreased in ecessi&e $?C breadown, such as
hemol'tic anemia, or impaired li&er function or
some sort of obstruction, such as a tumor or gallstone
Commonl' (erformed Chemistr'Tests or 6nal'tes !D"
-
7/26/2019 2. Introduction to Clinical Chemistry
18/28
5i&er +nB'mes le&els increase following damage to li&ertissues6laline (hosphatase !65( or 6(" Ereatl' increased in
li&er tumors and lesions< moderatel' increased indiseases such as hepatitis
6lanine 6minotransferase !65T< formerl' called SE(T" 0ncreases up to 7> in cirrhosis, infections or tumorsand up to 7>> in &iral or toic hepatitis
6sparate 6minotransferase !6ST< formerl' calledSEOT" 0ncreased in li&er disease, but also in heartattacs
Eamma Elutam'l Transferase !EET" Often used tomonitor patients reco&ering from hepatitis andcirrhosis
5actate ;eh'drogenase !5;" 0ncreased in li&erdisease and following heart attacs
Commonl' (erformed Chemistr'Tests or 6nal'tes !="
-
7/26/2019 2. Introduction to Clinical Chemistry
19/28
Cardiac unction TestsCreatine 1inase !C1" Widel' used to diagnosis
and monitor heart attacsTroponins
Onl' present in heart muscle, maing it a moreaccurate indicator of heart attac than C1 Cardiac Troponin T !cTnT" Cardiac Troponin 0 !cTn0"
Commonl' (erformed Chemistr'Tests or 6nal'tes !9"
-
7/26/2019 2. Introduction to Clinical Chemistry
20/28
5ipid 8etabolism TestsCholesterol
(resent in all tissues Ser&es as the seleton for man' hormones $ecommended to be less than 2>> mgFd5 in adults" 5;5 G )bad* cholesterol< ;5 G )good* cholesterol
Trigl'cerides 8ain storage form of lipids, comprising 9A: of fat
tissue 'perlipidemia ha&ing high blood le&els of
trigl'cerides ma' increase ris of heart attac Carboh'drate 8etabolism TestsElucose 5argel' regulated b' insulin
Commonl' (erformed Chemistr'Tests or 6nal'tes !7>"
-
7/26/2019 2. Introduction to Clinical Chemistry
21/28
Th'roid unction TestsTh'roid Stimulating ormone !TS" 0n&erse
relationship to th'roid function !the higher theTS, the lower the th'roid function and &ice
&ersa"Other less common th'roid tests include T3 andT4
'poth'roidism underacti&e th'roid gland'perth'roidism o&eracti&e th'roid gland
Commonl' (erformed Chemistr'Tests or 6nal'tes !77"
-
7/26/2019 2. Introduction to Clinical Chemistry
22/28
or more information on most clinicallaborator' tests, &isit-
http-FFwww.labtestsonline.orgF
Clic on an' lab test or condition or diseaseand find all sorts of informationH
http://www.labtestsonline.org/http://www.labtestsonline.org/ -
7/26/2019 2. Introduction to Clinical Chemistry
23/28
Sample
Collection,Transport,and Storage
-
7/26/2019 2. Introduction to Clinical Chemistry
24/28
Sample collection
-
7/26/2019 2. Introduction to Clinical Chemistry
25/28
Advantages and disadvantages ofdierent samples
l d
-
7/26/2019 2. Introduction to Clinical Chemistry
26/28
Sample transport andstorage It is usually advisable to contact the laboratory
by telephone in advance to discuss urgent orcomplicated cases.
Most specimens, particularly blood and urine,
may be sent by post if securely packaged incompliance ith current regulations.
!oever, if legal action is likely to be taken on
the basis of the results, it is important to be ableto guarantee the identity and integrity of thespecimen from hen it as collected through tothe reporting of the results.
Thus, such samples should be protected during
-
7/26/2019 2. Introduction to Clinical Chemistry
27/28
Chain of custody is a term used torefer to the process used tomaintain and document the historyof the specimen #$o% &.'(.
-
7/26/2019 2. Introduction to Clinical Chemistry
28/28
)uidance on free*er storage ofsamples