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  1. 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 3BMSCC1lec1IntroductionPmoyo18th March2015 1
  2. 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 3BMSCC1lec1IntroductionPmoyo18th March2015 2
  3. 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. 3BMSCC1lec1IntroductionPmoyo18th March2015 3
  4. 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 3BMSCC1lec1IntroductionPmoyo18th March2015 4
  5. 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 3BMSCC1lec1IntroductionPmoyo18th March2015 5
  6. Areas of interest-1 3BMSCC1lec1IntroductionPmoyo18th March2015 6 Biochemistry Endocrinology Analytical chemistry Immunology Instrumentation Pharmacology Toxicology other Computers Clinical Chemistry employs
  7. 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 3BMSCC1lec1IntroductionPmoyo18th March2015 7
  8. 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 3BMSCC1lec1IntroductionPmoyo18th March2015 8
  9. 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) 3BMSCC1lec1IntroductionPmoyo18th March2015 9
  10. 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 3BMSCC1lec1IntroductionPmoyo18th March2015 10
  11. 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 3BMSCC1lec1IntroductionPmoyo18th March2015 11
  12. 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 chemistry 3BMSCC1lec1IntroductionPmoyo18th March2015 12
  13. 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 3BMSCC1lec1IntroductionPmoyo18th March2015 13
  14. 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 3BMSCC1lec1IntroductionPmoyo18th March2015 14
  15. 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 3BMSCC1lec1IntroductionPmoyo18th March2015 15