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

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ì Basic Principles in Clinical Biochemistry By Mohsin Al-Saleh Objectives: Define clinical biochemistry. Describe the uses of biochemical tests. Describe the routine tests done in clinical chemistry. Describe sample analysis and interpretation of results. Highlight the importance of routine clinical chemistry tests in the diagnosis, prognosis, monitoring and screening for disease. Describe special chemistry test and correlate lab results with disease states.

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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