Study Set Content:
Basic science that utilizes the specialty of chemistry to study human beings in various stages of health and disease.
clinical chemistry
Primary purpose of clinical chemistry
To facilitate the correct performance of analytic procedures that yield accurate and precise information, aiding patient diagnosis and treatment.
Common clin. chem test
liver function test, renal function test, electrolytes, minerals, glucose, blood disorders, uric acid, arterial blood gases, and cardiac makers.
Liver function test
Total protein (serum)
Albumin
Globulins
A/G ratio (albumin-globulin)
Bilirubin; direct; indirect; total
Alkaline phosphatase (ALP)
Aspartate aminotransferase (AST)
Alanine aminotransferase (ALT)
Gamma-glutamyl transferase (GGT)
Lactate dehydrogenase ( LDH/LD)
renal function test
Creatinine
Blood urea nitrogen
electrolytes
Sodium
Potassium
Chloride
Bicarbonate
cardiac markers
Troponin
Myoglobin
CK-MB
B-type natriuretic peptide (BNP)
minerals
Calcium
Magnesium
Phosphate
glucose
Fasting Blood Sugar (FBS)
2-Hr. Post Prandial Blood Sugar
Oral Glucose Tolerance Test
Glycosylated hemoglobin (HbA1c)
blood disorders
Iron
Transferrin
TIBC
Vitamin B12
Folic acid
arterial blood gases
pH
pCO2
*Toxicological screening and forensic
toxicology (drugs and toxins)
* Neuron-specific Enolase (NSE)
3 important phases
1.Patient preparation
2.Specimen collection and processing
3.Production of the report
Factors contributing to the variation of results
exercise, fasting, diet, alcohol ingestion, tobacco smoking, drugs, posture, stress, and prolonged tourniquet application.
Exercise
-volume shifts between the vascular and interstitial compartment
Increased:
1. Lactate, fatty acid, ammonia
2. CK, AST, LD and aldolase
3. Prolactin, testosterone, leutenizing
hormone (LH)
4. Proteins in urine
Vigorous hand exercise (fist clenching)
- inc K, lactate, Phosphate
Decreased:
Follicle stimulating hormone and leutenizing hormone in long- distance athletes
Fasting
-8 to 12 hrs. fasting for glucose determination. 12 to 14 hrs. fasting for lipids and lipoproteins determination
Prolonged fasting affects the following:
Increased:
-48hrs- bilirubin
-72 hrs- TAG, glycerol and FFA but no change in cholesterol after 72 hrs.
Decreased:
-plasma glucose by 45 mg/dL in healthy women
*Hypertriglyceridemia produced by intake of meals is normally cleared 8 hrs. after eating
• Basal state collection: glucose, chol, triglycerides (TAG) and
electrolytes
• Requires fasting specimen: FBS, GGT, TAG, lipid and lipoprotein test,
gastrin and insulin
Diet
Increased:
A. High-meat protein diet
_____ urea, ammonia, urate
B. High ratio of
unsaturated to saturated FA
_____cholesterol
C. Purine rich foods
( dried fish, sardines, legumes, viscera)
______ urates
D. serotonin-rich food
______ urinary excretion of 5 hydroxyindole
acetic acid
E. Caffeine
______concentration of glucose, promotes
release of catecholamine from the
adrenal medulla and brain tissue
alcohol ingestion
increased:
a. lactate, urate, acetate, acetaldehyde
b. TAG , HDL -cholesterol
c. γ-glutamyl transferase (GGT) = indicator of alcohol consumption
tobacco smoking
Acute effects of smoking are increased in:
catecholamines
cortisol
NEFA
glucose
growth hormone
cholesterol
TAG
urea
Drugs
Drugs interference maybe of two types:
1. physiologic (In vitro)
2. during analysis of metabolite of interests (In vivo)
-Effects of oral contraceptives:
↑ ceruloplasmin,thyroxine binding globulin (TBG)
transferrin, iron, TAG
↑ alanine amino transferase ( ALT) and
γ glutamyl transferase (GGT)
↓ albumin
-Hepatotoxic drugs
-Diuretics
Posture
Effects of sudden change in posture are increase in
a. albumin (TP) d. bilirubin
b. enzymes e. TAG
c. calcium
