CLINICAL CHEMISTRY 1
LECTURE 1: Introduction to Clinical
chemistry and the clinical chemistry
laboratory
P.B.B. Moyo, Msc(BMS)
Department of Biomedical Science
Malamulo College of Health Sciences
Makwasa, March 23rd , 2015
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COURSE OVERVIEW
• AIM: This course aims at providing students with
knowledge, attitude and skills required to perform
clinical chemistry investigations correctly,
supervise technicians and provide sound advice to
clinicians about the same wherever necessary.
• GENERAL OBJECTIVES: By the end of this course
you should be able to:
1. Describe the scope of clinical chemistry
2. Apply the principles of measurement indicated
for CCL
3. Describe structure and metabolism of CHON,
CHO, Lipids, Hormones, Electrolytes,
Elements, and Organic bio-compounds
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Course overview continued
4. Describe specimen requirement specifications on
patient preparation, specimen collection and handling
appropriately
5. Perform investigations and analyses of the
parameters in 3, above
6. Apply quality assurance principles and measures in
the CCL
7. Provide information, education and communication
(IEC) to the public regarding CCL roles
8.Provide required supervision for biomedical
tecnnicians
9. Provide technical support to management and other
hospital sub-systems.
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Lesson Overview
• Define related terms
• List the factors that led to the development of
clinical chemistry
• State the rationale of laboratory medicine and
clinical chemistry in particular
• Point out the areas of interests or benefits of
clinical chemistry
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The scope of clinical chemistry
• Introduction
1) what it is
2) why study it
3) How it is studied
4) Requirements:
- equipment
- personnel
- reagents and test kits
- consumable supplies
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Areas of interest-1
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Biochemistry
Endocrinology
Analytical
chemistry
Immunology
Instrumentation
Pharmacology
Toxicology
other
Computers
Clinical
Chemistry
employs

history
• Synthesis of urea by Friedrich Wohler in 1800
- exploration of life phenomenon to replace the
misconception that ‘life was but a series of chemical
reactions’
- Crude techniques but advances to understand the living
material were made despite limitations, in the 19th
century. Viz;
1) discovery of starch, fats and some blood proteins were
isolated and characterised
2) Cholesterol in gall stones
3) chemical composition of urine
• 1815 urine test for diabetes and CHO metabolism
investigations started
• 1836 The first clinical chemistry book was published
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history
• Further developments in the 1900s
- Ph meter-initially for citrus acidity testing but
adapted to ph in assays, its effect on RR and
later test blood pH to identify and
monitor ABB treatment
- Colorimeters-electronic measurement replaced
visual comparison reacted tests with
standard solutions i.e. objectivity replaced
subjectivityESULTED IN INCREASED ACCURACY
AND PRODUCTIVITY
Provided the basis for the discovery of automated
analysers in use today
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History – Advanced testing
• 2. Dr. L. Skeggs discovered the Technicon
Autoanalyser
• 3. 1970 Radioisotopes were used in assays
Scintillation counting devices
Immunoassays
• 4. Incorporation or linkage of computers to
laboratory equipment
- ability for data processing
- monitoring of data produced
- ensured accuracy
- correlations and relationships with previous
information (eg. Delta checks)
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Explosion of biochemical knowledge
• 1. Deep probing into mysteries resulted from
increased knowledge and use of instrumentation
• More details could be revealed using a very small
sample and in a very short time (test turn around
time was greatly reduced)
• 2. Hormone studies, enzyme activities, and
electrophoresis, plus pharmacological
investigations on drug levels became the order of
the day
• Therefore, clinical chemistry has become and
indispensable necessity in modern, evidence
based medicine
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Current Interests
• 1. Indicators of a healthy life style – regular
check ups e.g. Cholesterol, blood sugar
• 2. Predictors of heart disease eg. Lipoproteins
• 3. Markers of mental ilnes or cancer eg. Cortisol
or Alfa Feto Protein (AFP)
• 4. Disease specific protein markers eg. C-reactive
protein and Ceruloplasmin
• 5. Nutritional assessment- the healing process
and mineral status
• 6. Treatment monitoring eg. LFTs in ARV therapy
• 7. General maintenance of health
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The Future of Clinical chemistry
• 1. Certainty-more areas to explore: genetic studies, DNA
probes consequently, may permit rapid and accurate
detection of metabolic disorders and inborn errors of
metabolism
• 2. Forensic chemistry- use of DNA in partenity testing,
identification of criminals and drug screaning for
substance abuse eg. Athlets
• 3. Development potential evidenced by:
-Ion Selective Electrodes-pHM? Mbfconst.acc
- Bedside (lab)testing
-Paediatric patients versus adult values
4. Contributions through research discovery and
ellaboration of new and existing functions and roles of
certain molecules
• Politics and economics will drive the future of clinical
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The clinical chemistry laboratory
1. Personnel
2. SOPs
3. Specimens-patient preparation,
collection, transport and storage
4. Methods - choice criteria
5. Equipment – choice and proper use
•Results and Records
6. Quality assurance
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Prerequisites of clinical chemistry work
• The scientific notation of use of (systeme
internationale )SI units
• Ability to make bake basic computations
applicable to the clinical chemistry laboratory
• Availability and use of quality water: one that
meets specific requirements
• Availability and use of quality chemicals,
reagents and consumable supplies
• Adherence to collection, transport, handling and
processing or testing of specimens
• Application of safety and quality assurance
measure in clinical chemistry laboratory work
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Summary
1. Clinical chemistry scope covers several branches
2. CC developed rapidly with the synthesis of urea
due to its relation to life
3. Instrumentation made laboratory testing more
efficient and productive with reduced turn around
time
4. CC provides the bases for diagnostic, prognostic,
forensic and drug monitoring
5. CC has pointed out special areas of interest in
human health and indicators of impending
diseases
6. Despite the important roles, CC success is
dependent on government policies and the
economy of a country
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