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What is Clinical Chemistry?
It is also known as chemical
pathology, clinical
biochemistry, or medical
biochemistry.
Blood and urine are the most
utilized specimens in clinical
chemistry.
Is the branch of medical science involved in the analysis of biological materials,
usually bodily fluids to provide diagnostic results on the state of the human.
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What is Blood glucose?
This is a test performed that screens the
measurement of the amount of blood glucose the
patient has.
Storage of Glucose: Liver, muscle system and
adipose tissues
Glucose can also be found in urine
Stored in the form
of Glycogen
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Tests to measure Blood Glucose
Fasting blood sugar (FBS)
Random blood sugar (RBS)
Oral glucose tolerance test (OGTT)
Two-hour post-prandial blood sugar (PPBS).
Glycosylated hemoglobin
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Blood Glucose Chart
Level Mg/dL Indication
Dangerously High 315+ Hyperglycemia
High 215 - 280 Hyperglycemia
Borderline 120-180 Prediabetes
Normal 72 - 110 Normoglycemia
Low 70 Hypoglycemia
Dangerously Low 50 Hypoglycemia
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What is Blood Lipid Profile?
Lipids are organic substances characterized
by their general insolubility in water and
solubility in organic solvents. The term lipid is
sometimes regarded as “fat”. Per gram, it may
provide 9 kcal of heat.
Functions: Act as a primary energy source; an
important constituent of cellular membrane.
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FattyAcids
Simplest form of lipids but not routinely measured
Forms: saturated (solid at room temperature) and unsaturated
(liquid at room temperature)
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Triglycerides (triacylglycerols)
Considered neutral fats consisting of fatty acids and glycerol
Act as the storage form of lipids in the human body
When serum samples turned turbid from blood collected after a
meal, it is due to the presence of triglycerides.
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Cholesterol
An example of a steroid alcohol
Necessary for the production of various hormones, vitamin D,
and even bile salt which is necessary for fat digestion
Measurement is usually requested in conjunctions with the
diagnosis of cardiovascular diseases.
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Phospholipids
Most abundant form of lipids, but not routinely measured.
Include lecithin (70%), sphingomyelin (20%), and cephalin (10%).
Lipoproteins are lipid transporters which are classified based on their
density or through electrophoresis.
Generally, as the protein content increases, the lipid content decreases,
making its size smaller but denser.
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What is Renal Function Test?
The kidneys are paired organs considered as the body's major
ways sweeper they are responsible for the removal of waste
products of metabolism does if these are badly damaged waste
accumulate in the body.
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Creatine
is a waste product of muscle metabolism derived from certain phosphate which is
a substance stored in the muscle and is used for energy
Increased level of creatinine is due to the impairment of urine formation or are
excretion which occurs in renal disease, shock, water imbalance or ureter
blockage
When renal function is impaired (about 50%), blood creatinine levels increase
Doctor may request measurement of creatinine clearance to evaluate renal
functionality. This test requires the use of 24-hour urine specimen
Determination is based on Jaffe reaction that use freshly prepared alkaline picrate
solution
Normal value: 0.6 - 1.2 mg/dl
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90% on BUN is excreted in the urine
Azotemia is an elevation of blood urea nitrogen. If such elevation
is accompanied by renal failure, it is termed uremia
Low BUN levels - during starvation, pregnancy, and low-protein
diet
High BUN levels - a high protein diet; after administration of
steroids; and kidney diseases
Methods of detection
Urease converts urea into CO2 and NH3. NH3 is measured
through Nessler’s or Berthelot reaction
Normal value 8-23 mg/dl
Blood urea nitrogen (BUN)
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Used to check how will the kidneys are working estimates how
much blood passes through the glomeruli (tiny filters in the
kidneys) each minute.
Measures how will the kidney are filtering the blood and sees
how far a kidney disease has progressed.
Recommended for people diagnosed with the chronic kidney
disease that is caused by diabetes, family history of kidney
disease, frequent here urinary tract infection, heart disease, high
blood pressure and unary blockage.
Glomerular filtration rate (GFR)
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Liver is the organ responsible for the synthesis of many organic
substances. It also detoxifies the body against noxious
substances.
What is Liver Function?
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• . Bilirubin
- A brownish yellow substance found in the bile. It is produced
when the liver breaks down old red blood cells. Bilirubin is then
removed from the body through the stool (feces) and gives stool
its normal color.
- Bilirubin circulates in the bloodstream in two forms:
• B1 or indirect (or unconjugated) bilirubin
• Water-insoluble bilirubin
• Toxic bilirubin and its accumulation in the brain may lead to
kernicterus
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• B2 or direct (or conjugated) bilirubin
• Water-soluble bilirubin
• Eliminated in the urine and makes it appear dark yellow
• Total bilirubin and direct bilirubin levels are measured directly in
the blood, whereas indirect bilirubin levels are derived from the
total and direct bilirubin measurements. (Total serum bilirubin =
direct bilirubin + indirect bilirubin)
• - Van den Bergh reaction is the color reaction for bilirubin
• - Methods: Malloy-Evelyn and Jendrassik-Grof
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. a. Aspartate aminotransferase (AST)
- Formerly called SGOT or serum glutamic oxaloacetic transaminase
-Tissue sources: liver, heart, skeletal muscle, kidney, pancreas, brain,
spleen, and lungs.
b. Alanine aminotransferase (ALT)
- Formerly called SGPT or serum glutamic pyvuric transaminase
- Tissue sources: liver, heart, skeletal muscle, kidney, and pancreas
- Considered as a liver-specific enzyme and is increased in cases of
hepatic disorders.
If ALT and AST are found together in elevated amounts in the blood,
liver damage is most likely present.
c. De Ritis Ratio (AST/ALT ratio)
- Helps identify the cause of hepatic disorders
- > 1: non-viral in origin
- < 1: viral in origin
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d. Alkaline phosphatase (ALP)
- Useful in the diagnosis of bone and liver diseases
e. Gamma-glutamyl transferase (GGT)
- Useful in the diagnosis of chronic alcoholism resulting in liver
damage
f. Cholinesterase
- Useful in the assessment of insecticide and pesticide poisoning
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- Hypoproteinemia refers to the low total protein level in blood
suggestive of a liver disorder, a kidney disorder, or a disorder in
which protein is not digested or absorbed properly
- Hyperproteinemia refers to the high total protein level in blood
and may be seen with chronic inflammation or infections such as
viral hepatitis or HIV
- Albumin is made mainly in the liver. It helps keep the blood
from leaking out of the blood vessels. It also helps carry some
medicines and other substances through the blood and is
important for tissue growth and healing
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- Globulins are a group of proteins in the bloodstream that help
regulate the function of the circulatory system.
- A low albunium/globulin (A/G) ratio may reflect an
overproduction of globulins, as may be seen in multiple or
autoimmune diseases
- - A high A/G ratio suggests the underproduction of
immunoglobulins
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- Cardiac markers are usually requested to evaluate and
reflects the evaluate whether one’s heart is health or not.
Doctors consider this test if their have experience
episodes of myocardial infarction as manifested by
chest pain.
What is Cardiac Function Test?
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1. Troponin test
- Considered the most sensitive and specific test for
myocardial damage.
-Expected to peak 12 hours after infarction.
2. Myoglobin
- Along with troponin, myoglobin is ordered as a
cardiac biomarker to help diagnose or rule out a heart
attack.
- An increase in myoglobin is detectable later than
troponin, but is not as specific for heart damage and will
not stay elevated for as long as troponin.
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●
3. Cardiac Enzymes
Point of
Differenc
e
CK-MB
(Creati
ne
Kinase)
AST
(Aspartate
Aminotransfer
ase)
LDH
(Lactate
dehydrigena
se)
Appearan
ce
4-8
hours
12 hours 24 hours
Peak 12-24
hours
48 hours 72 hours
Length of
time
staying
elevated
3 days 5 days 10-14 days
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• A tumor marker is a biomarker indicative of an
inherent cancerous condition. Oncology, the science
of cancer, emphasizes the importance of early of
tumors through laboratory tests to address the
associated condition early and to provide proper
intervention appropriately.
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Among the different tumor markers that are used nowadays
include:
1. AFP (Alpha-fetoprotein) – hepatocellular carcinoma
2. CEA (Carcinoembryonic antigen –gastrointestinal cancer
3. PSA (Prostate-specific antigen) – prostate cancer
4. hCG (Human chorionic gonadotropin) –gestational
trophoblastic disease
5. NSE (Neuron specific enolase) –neuroendocrine tumor
6. CA 125 – ovarian cancer
7. CA 19-9 – pancreatic cancer
8. CA 15-3 – breast cancer
9. Calcitonin – medullary thyroid carcinoma
10. Desmin – smooth muscle sarcoma
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References:
Introduction to Medical Technology Practice in the Philippine Setting
Carmelita C. Cardona RMT, MSMT
Ruby SP. Garcia-Meim, RMT, MSMT
Gregorio L. Martin I, RMT, MSMT, MPH
Authors
Sheila Grace Alarilla-Martin, MS
Contributor
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Justine Claire Aniag- Information, PPT, Reporter
Jiecel Rae Francine P. Echevarria- PPT, Reporter
Abigail Espinosa- Reporter
Christian Estrella- Reporter
Trisha Andrea Muga- Information, Reporter
Jenn Matthew Tolentino- Reporter
BSMT 1
Members:
