Welcome Advanced Clinical Chemistry BISC 6360

Dr Atef Masad PhD Biomedicine Uinited Kingdom Advanced Clinical Chemistry BISC 6360

Course Overview  This course is proposed to offer basic and advanced skills in Clinical Chemistry which frequently used in Biomedical Sciences field.  This course will start by simple introduction to Clinical Chemistry, followed by a detailed study of the body fluids markers which are used in clinical laboratory diagnosis.

1/28/2016Dr Atef Masad4 Overview of Clinical Chemistry

1/28/2016Dr Atef Masad5 5 Definition  Clinical chemistry The analysis of individual constituents, proteins, enzymes, nutrients, waste products, metabolites, hormones, etc. in blood or body fluids that provides information regarding the function or integrity of a tissue, organ or organ system  Clinical chemistry is the area of pathology that is generally concerned with analysis of body fluids and the diagnosis of diseases.

1/28/2016Dr Atef Masad6 6  Clinical chemistry is a science, a service, and an industry.  As a science, clinical chemistry links the knowledge of general chemistry, organic chemistry, and biochemistry with an understanding of human physiology.  As a service, the clinical chemistry laboratory produces objective evidence from which medical decisions may be made and considered as an important part of patient management.

1/28/2016Dr Atef Masad7 7  As an industry, clinical laboratories are businesses which operate under the regulations and practices that guide business.  A central function of the clinical chemistry laboratory is to provide biochemical information for the management of patients.  It can be used to guide clinical decision- making.

1/28/2016Dr Atef Masad8 8 Purpose of Clinical Chemistry Tests

1/28/2016Dr Atef Masad9 9 Types of Specimens for Chemical Analysis  Whole blood, serum or plasma. The most common specimen is serum,  Urine – often 24 hours collection  Cerebrospinal Spinal Fluid (CSF), synovial fluid, gastric secretions and other fluids

1/28/2016Dr Atef Masad10 Clinical chemistry Test Results  Results from these tests provide valuable clinical information about: the functional status of a variety of organs. tissue damage and how severely damaged  Test results are interpreted with respect to reference ranges, which are 95% confidence intervals of values found in clinically healthy populations.

1/28/2016Dr Atef Masad11  Biochemical tests are used in diagnosis, prognosis, monitoring and Screening.  The clinical chemistry laboratory provides accurate and precise measurements of selected biochemical markers.  Biochemical marker analysis is one factor in the assessment of the patient.  The physician uses all data to assess the patient and implement a plan for treatment.

1/28/2016Dr Atef Masad12 Screening  Biochemical tests are widely used to determine whether a condition is present subclinicaly.  The best-known example is screening of all newborn babies for phenylketonuria (PKU).

1/28/2016Dr Atef Masad13 Diagnosis  Medical diagnosis is based on the patient's history, if available, the clinical signs found on examination, and on the results of investigations.  Investigations may be selected to help either confirm or disprove a diagnosis  Making a diagnosis, even if incomplete, such as a diagnosis of hypoglycaemia without knowing its cause, may allow treatment to be initiated.

1/28/2016Dr Atef Masad14 Monitoring  A major use of biochemical tests is to follow the course of an illness and to monitor the effects of treatment. for example glycated haemoglobin in patients with diabetes mellitus.  Biochemical tests can also be used to detect complications of treatment, such as hypokalaemia during treatment with diuretics, possible drug toxicity espacially in some cases when a drug is in use.

1/28/2016Dr Atef Masad15 Prognosis  Tests used primarily for diagnosis may also provide prognostic information  for example, serial measurements of plasma creatinine concentration in progressive renal disease are used to indicate when dialysis may be required.  Tests can also indicate the risk of developing a particular condition; for example, the risk of coronary artery disease increases with increasing plasma cholesterol concentration,GP, Hemocytein etc.

1/28/2016Dr Atef Masad16 Categories of Biochemical Markers  Biochemical markers are biochemical analytes that are useful for disease detection, progression of the illness  Biochemical markers are used for assessment and diagnosis of disease such as:  carbohydrates,  lipids,  proteins,  nucleic acids and the derivatives of these markers such as enzymes.

1/28/2016Dr Atef Masad17 Categories of Biochemical Markers  In addition to the measurement of these endogenous substances, the clinical chemistry laboratory provides measurement of chemicals that are exogenous to the body beneficial chemicals,  such as therapeutic drugs and harmful substances  such as poisons.

1/28/2016Dr Atef Masad18 Carbohydrates as Biochemical Markers of Disease  The most common carbohydrate disorder in humans is diabetes mellitus.  This disease is caused by an inability to produce or to respond to the hormone insulin.  Laboratory tests of body fluids of individuals with this disease show increased concentrations of glucose.  The laboratory tests for ketones, acids, and glycosylated proteins provide measures of disease severity.

1/28/2016Dr Atef Masad19 Lipids as Biochemical Markers of Disease  Clinical chemistry laboratories offer many tests for lipid disorders. One of the most common tests is the lipid profile.  This panel of tests includes measures of  triglycerides  cholesterol  Low density lipoprotein cholesterol (LDL-C)  and high-density lipoprotein cholesterol (HDL- C).  The results of testing for these lipids provide measures of risk for coronary artery disease.

1/28/2016Dr Atef Masad20 Total Serum/Plasma Proteins and Plasma Albumin as Biochemical Markers of Disease  Plasma proteins have functions in many organs and tissue systems.  carrier molecules,  receptor chemicals,  immune response agents,  and enzymes or catalytic proteins.  Total plasma protein is a measure of nutrition, the status of many organs and tissues that are involved in protein metabolism, and the process of breakdown and excretion of protein metabolites.

1/28/2016Dr Atef Masad21  The measurement of plasma protein fractions provides more specific evidence for diagnosis and assessment of disorders.  Because of its importance in maintaining osmotic pressure, the measure of albumin concentration is a reflection of this pressure.  As a transport protein, the measurement of albumin monitors the ability of the body to transport such diverse substances as bilirubin, fatty acids, and calcium through the blood.

1/28/2016Dr Atef Masad22 Enzymes as Biochemical Markers of Disease  Damage to tissue can release different types of enzymes based on their location.  For example, mild inflammation of the liver reversibly increases the permeability of the cell membrane and releases cytoplasmic enzymes  such as lactate dehydrogenase (LD),  alkaline phosphatase (ALP),  and aspartate transaminase (AST).

1/28/2016Dr Atef Masad23 The clinical chemistry laboratory and organ systems Cardiovascular Circulatory System  The clinical chemistry laboratory offers analysis of biochemicals for the assessment of  acute myocardial infarction,  congestive heart failure  and coronary artery disease.

1/28/2016Dr Atef Masad24  The laboratory offers measurement of lipids as predictive factors for the development of heart disease.  Measurement of arterial blood gases helps assess the acid-base and oxygenation status of the patient.

1/28/2016Dr Atef Masad25 Respiratory Tract  The function of the respiratory tract is to transfer gases from the environment to tissue cells and from tissues cells to the environment.  The respiratory system also helps maintain the acid-base balance in the body.  Measurement of arterial blood gases helps assess the function of the respiratory system, as well as the circulatory system

1/28/2016Dr Atef Masad26 Respiratory Tract  Blood oxygenation and pH are dependent upon the uptake of oxygen by hemoglobin and removal of carbon dioxide from red blood cells.  The assessment of diseases such as chronic obstructive pulmonary disease is dependent upon the measurement of partial pressures of oxygen and carbon dioxide in arterial blood to monitor the function of the lungs.

1/28/2016Dr Atef Masad27 Liver  The clinical chemistry laboratory offers a lot of tests that provide information about specific diseases of the liver.  Measurement of the concentration of the enzyme alanine transaminase (ALT) provides information about hepatitis.  Measurement of the enzyme alkaline phosphatase (ALP) provides information about biliary tract disorders.  Analysis of the concentrations of proteins that are made in the liver provides information about the ability of the liver to perform this function.

1/28/2016Dr Atef Masad28 Renal System  The clinical chemistry laboratory offers many tests for different biochemical markers of renal function, including electrolytes, minerals, and protein metabolic waste products.  These biochemical markers are measured in serum, urine, and other body fluids.

1/28/2016Dr Atef Masad29 Digestive System  The clinical chemistry laboratory provides information about nutritional status, intestinal absorption, and function of the pancreas and other organs of the digestive tract.  Analysis of gastric fluid assesses the ability of the stomach to secrete acid.  Measurement of serum concentrations of lipase and amylase monitors the exocrine function of the pancreas.

1/28/2016Dr Atef Masad30 Therapeutic drug monitoring  Involves the analysis, assessment and evaluation of circulating concentrations of drugs in serum, plasma, or whole blood.  Purpose is to ensure the medication dose is at therapeutic range and not toxic.

1/28/2016Dr Atef Masad31 Toxicology  Study of poisons. The study of interrelationships between toxin exposure and disease states. (diagnosis & therapeutic intervention)

1/28/2016Dr Atef Masad32 Tumour Markers  A tumour marker is a biological substance synthesized and released by cancer cells or substances produced by the host in response to cancerous tissue.  It may be used to: Detect the presence of a tumour Monitor the progress of disease Monitor the response to treatment