basic principles in clinical biochemistry - mohsin al-saleh · basic principles in clinical...

ìBasicPrinciplesinClinicalBiochemistryByMohsinAl-Saleh

• Objectives:

• Defineclinicalbiochemistry.• Describetheusesofbiochemicaltests.• Describetheroutinetestsdoneinclinicalchemistry.• Describesampleanalysisandinterpretationofresults.• Highlighttheimportanceofroutineclinicalchemistrytestsinthediagnosis,prognosis,monitoringandscreeningfordisease.• Describespecialchemistrytestandcorrelatelabresultswithdiseasestates.

ClinicalBiochemistryProcess

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ClinicalBiochemistry

ì  Also known as chemical pathology, clinical chemistry, and ormedicalbiochemistry.Itsanareawhichconcernedgenerallyintheanalysisofbodyfluids.Forexample;serum,plasma,urine,whole blood, CSF, sweat, and others. For diagnostic andtherapeutic purpose. Wide variety of techniques (chemicalprocesses) used to analyze substances like; substrates,enzymes,proteins,ions,aminoacids,cholesterols,etc.

UsesofBiochemicalTest

SomeofmostCommonClinicalBiochemistryProfiles/Tests/Markers

KidneyFunctionTest(Kidney) SerumProteinElectrophoresis(MM)

LiverFunctionTest(Liver) UrineProteinElectrophoresis(MM)

BoneProfile(Bonemineralization) MSUDProfile(InbornErrorsofMetabolism)

LipidProfile(Heart) PKUProfile(InbornErrorsofMetabolism)

CardiacMarkers(Heart) AminoAcidsProfile(InbornErrorsofMetabolism)

SweatTests(InbornErrorsofMetabolism) Stoneanalysis(Kidney)

FertilityTests(Hormones) IronProfile

TherapeuticDrugsMonitoring(Drug) CatecholaminesTest

DrugofAbuseTest(Toxicology) Porphyrins/PBGTest

RoutineBiochemicalTests

SomeofRoutineClinicalBiochemistryTests

KidneyFunctionTest Na+,K+,Cl-,ureaandcreatinine

LiverFunctionTest ALT,AST,ALP,Alb,Tbili,andtotalprotein

BoneProfile ALP,phosphate,Ca2+,Alb,andAlbCoRCa

LipidProfile Tchol,LDL,HDL,VLDL,andTriglycerides

CardiacMarkers CK,CKMB,andTroponin(I)

TherapeuticDrugsMonitoring Benz,TCA,ACETO,etc

DrugofAbuseTest Morphine,Tramadol,Cocaine,etc

IronProfiles S-IronandTransferrin

Sampleanalysis

ì  Itvariesfromsampletosample(types).Orfromtesttotest

ì  Somesamplesrequiresimmediaterunningandsomemaystore

ì  Dependsalsoonspecificsamplecollectioncriteria

ì  Dependsonpatientsdiagnosis

ì  Typesofclinicalbiochemistrytest(screening,definitive,confirmatory)

ì  Analytesnature(stability)e.g.bloodgas

Sampleanalysis

Interpretationofresults

ì  Dependsontypeofdata

ì  TAT

ì  Typeofthetest(screening,definitive,andconfirmatory)

ì  Severityofpatientcondition(disease)

ì  BMS(Professionalism)

ì  Profiletesting

Interpretationofresults

ì  TypesofData(Results):

1.  QualitativeResults(+/-)

2.  Semi-QuantitativeResults(Fractionor%)

3.  Quantitativeresults(e.g.concentration)

Interpretationofresults

ImportanceofRoutineClinicalChemistryTests

ì  DiagnosticTest:Isaprocedureperformtoconfirm,ordeterminethepresenceofdisease inan individual suspectedofhaving thediseaseusuallyfollowingthereportsofsymptoms.(Troponin/Glu)

ì  PrognosticTest:Isusedtopredictapatient’slikelihoodofdevelopingadisease.(Freelambda/KappaRatio)

ì  MonitoringTest:Testdoneonknownpatientconditionforfollowinguptheresultsattimelybasis.(HBA1c,SPE)

ì  ScreeningTest:Helpstoidentifypeoplewithincreaseriskforadiseasebeforetheyhavesymptoms.

SpecialChemistryTests

SpecialChemistryTestingatSQUH

MSUDProfilePKUProfile

QualitativeandQuantitativeAminoAcidsProfilesPlasmaandUrineCatecholamines

StoneAnalysisTotalPorphyrinsScreeningtest

PBGToxicologyTesting

ClinicalParameter&Diseasestates

ì  HighserumcreatinineandK+ècorrelateswithrenalfailure

ì  HighphenylalanineandtyrosineèIndicatePKUinchildren

ì  HighB-hCGèEctopicpregnancy

ì  TroponinIèMI