MLS 043 (Clinical Chemistry 1 - Lecture)

STUDENT ACTIVITY SHEET BS MEDICAL TECHNOLOGY / THIRD YEAR

Session # 1

LESSON TITLE:
Scope of Clinical Chemistry Materials:

LEARNING OUTCOMES: pen and notepad

Upon completion of this lesson, the student can: References:

Bishop et.al. (2010). Clinical Chemistry:
1. Identify the nature of the study of clinical chemistry.
Techniques, Principles, Correlations (6th ed.).
2. Identify the scope of clinical chemistry testing, including Lippincott Williams & Wilkins.
the types of biologic samples that are typically analyzed
and panels of tests. Ridley, J. (2011). Essentials of Clinical Laboratory
Science. Cengage Learning.
Roberta, R. (2017). Clinical Chemistry Learning
Guide Series. Abbott Diagnostics.

Dear students,

I am glad to welcome you all to Clinical Chemistry 1. Indeed, this course will contribute to your personal advancement
as future medical technologists as it will instill knowledge on the fundamental principles and applications in one of the
major areas of a clinical laboratory, the clinical chemistry section.

Theories on analytic techniques, instrumentation, automation, specimen handling, quality assurance, carbohydrates,
lipids, and non-protein nitrogen are the main concepts in this course. It is recommended that you consult the
suggested references to supplement your knowledge.

While it is unfortunate that face-to-face classes are still prohibited due to the pandemic, don’t let this dampen your
spirits. Let us adjust to the “new normal” by maximizing the opportunity to learn through printed modules.

All the best!

PREVIEW
Today’s session will cover:
I. Nature of the study of Clinical Chemistry
II. Common Analytes tested in Clinical Chemistry laboratory
III. Biologic Samples
IV. Panels of Clinical Chemistry tests

MAIN LESSON

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 I. Nature of the course

Clinical chemistry is a quantitative science that is concerned with measurement of amounts of biologically
important substances (called analytes) in body fluids. The methods to measure these substances are carefully
designed to provide accurate assessments of their concentration. The results of clinical chemistry tests are
compared to reference intervals to provide diagnostic and clinical meaning for the values.

II. COMMON ANALYTES

Clinical chemistry is the branch of laboratory medicine that focuses primarily on molecules. The tests in a clinical
chemistry laboratory measure concentrations of biologically important ions (salts and minerals), small organic
molecules and large macromolecules (primarily proteins).

III. BIOLOGIC SAMPLES

Blood is the most common biologic fluid collected for clinical laboratory testing. It is usually drawn from a vein (in
the arm) directly into an evacuated tube. Typically a tube will hold about 5 mL of blood – enough to perform many

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 clinical chemistry tests, since automated analyzers require only small amounts (usually from 2 to 100 μL) for a
single test. Occasionally, when collection of blood from a vein is difficult, a sample of capillary blood may be
collected by pricking the skin and collecting several drops of blood from the puncture site. An example is the use
of heel stick blood for testing of newborns.

Other biologic fluids (matrices) often used for testing include urine, saliva, cerebrospinal fluid (CSF), amniotic
fluid, synovial fluid, pleural fluid, peritoneal fluid and pericardial fluid. These fluids often contain the same biologic
analytes of interest – such as glucose and protein – but differ greatly from each other in physical and chemical
properties. These differences in fluid characteristics are termed matrix differences. Test methods that are
designed for determination of an analyte in blood plasma may not be suitable for determination of that same
analyte in other fluids (other matrices). When using a test method for analysis of a fluid other than blood plasma
or serum, it is important to validate that the method is acceptable for the type of fluid sample being used.

A. BLOOD

Blood is the most commonly used specimen for testing in the clinical laboratory. Blood consists of two
main parts – a fluid portion (called plasma, which contains the dissolved ions and molecules) and a
cellular portion (the red blood cells, white blood cells and platelets). Most clinical chemistry analytes are
found in the plasma. Part of the preparation of blood for testing these analytes involves removing the
cells. This is done by centrifugation of the sample to pack the blood cells in the bottom of the collectio
tube and allow removal of the liquid portion for testing.

If a blood sample is collected in a tube containing an additive that prevents the blood from clotting (called
an anticoagulant), the fluid portion of the blood is called plasma. If the blood is collected in a tube with no
anticoagulant, the blood will form a clot. A clot is a gelatinous semisolid composed of cross-linked protein
that is formed in a multistep process referred to as the clotting cascade. Upon centrifugation, the clot
descends to the bottom of the tube along with the cells. The resultant liquid above the cells and clot is called
serum. Serum contains all the components of plasma except the clotting proteins, which are consumed in
the cascade of reactions that form the blood clot.
Some clinical chemistry tests are best performed using plasma, others are best performed using serum,
and still others can be performed using either plasma or serum.

Tubes used to collect blood have color-coded caps that signal what, if any, additives are present in the tube.
Additives may be anticoagulants to allow preparation of plasma or may be substances included to protect
analytes from chemical or metabolic breakdown.

Note: Certain types of anticoagulants may be incompatible with some kinds of tests. For example, EDTA
is an anticoagulant that inhibits the clotting of blood by sequestering calcium ions that are necessary
components of clotting reactions. However, samples of plasma collected using EDTA tubes are generally

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unsuitable for measurement of calcium and for any test method that involves a reaction step depending
on availability of calcium.

B. URINE

Urine is another fluid commonly used for testing in clinical chemistry laboratories. It is especially suitable for
tests that evaluate kidney functions, tests that look at waste products that are excreted by the kidneys, and for
metabolites that are cleared quickly from the bloodstream and accumulate in the urine, such as drugs of
abuse. Sometimes both serum and urine concentrations of a substance are useful to know in order to evaluate
how well the analyte is being excreted – either to ensure that expected excretion is taking place or to
determine if unexpected leakage is occurring.

Urine samples can be concentrated or dilute depending on the hydration status and kidney function of the
patient. These differences in urine can affect the amount of a substance found in a sample at different times.
Since creatinine is excreted at fairly constant rates over time, urine analytes are sometimes normalized to the
amount of creatinine in the sample in order to correct for the differences in the hydration state of the patient
and concentrated versus dilute samples.

Urine is relatively easy to collect from most people, although special techniques may be needed for infants
and small children. Different types of urine samples, representing collection at different times of day and for

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different durations of time, are used for laboratory analyses. You can know more about the different urine types
in your Clinical Microscopy course.

C. OTHER FLUIDS

Fluids other than blood and urine, like amniotic fluid, synovial fluid, peritoneal fluid, pleural fluid and
pericardial fluid, are used in limited clinical settings and are tested for only a few special analytes.
Amniotic fluid is typically used for tests of fetal health. Spinal fluid is used primarily for assessment of
patients with symptoms of diseases such as meningitis or multiple sclerosis or patients who may have
suffered a cerebrovascular accident. Chemical testing of fluids such as peritoneal fluid, pericardial fluid or
pleural fluid is typically done to assess the origin of the fluid – to determine whether it has leaked from blood
vessels because of pressure differences (called a transudate, which is relatively low in protein) or because of
inflammation or injury (called an exudate, which is relatively high in protein). Saliva is rarely used in clinical
laboratory testing, but is recognized as a specimen whose composition reflects the blood plasma levels of
many low molecular weight substances such as drugs or alcohol.Saliva can be collected without the privacy
concerns of observed urine collection for drugs of abuse testing — in order to witness the specimen collection
and prevent sample adulteration or substitution by the patient. Saliva also has an advantage for hormones like
cortisol for pediatric patients, when blood collection is too painful or stressful.

IV. PANELS OF TESTS

When an individual test alone is not sufficient to assess a medical condition, a combination of several tests may
be used. The pattern of results from the combination of tests may provide better insight into the status of the
patient than any single test result. Such tests, done on the same sample, are often ordered as a group called a
panel or profile. The types of panels and the specific tests included in panels reflect local, regional or national
practices. Even for panels with the same name, the individual tests included may differ from institution to
institution.

Examples of common chemistry panels include:

● Basic Metabolic Panel (BMP) – It provides information about the current health of your kidneys and respiratory
system as well as electrolyte and acid/base balance and level of blood glucose
● Comprehensive Metabolic Panel (CMP) –It provides the same information as the BMP with the addition of the
health of your liver and important blood proteins
● Electrolyte Panel – helpful for detecting a problem with the body's fluid and electrolyte balance
● Lipid Panel – used to assess a person's risk of developing cardiovascular disease
● Liver Panel (also called Hepatic Function Panel) – used to screen for, detect, evaluate, and monitor acute and
chronic liver inflammation (hepatitis), liver disease and/or damage
● Renal Panel (also called Kidney Function Panel) – contains tests such as albumin, creatinine, BUN, eGFR to
evaluate kidney function
● Thyroid Function Panel – to help evaluate thyroid gland function and to help diagnose thyroid disorders
CHECK FOR UNDERSTANDING
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the correct
answer and another one (1) point for the correct rationalization. Superimpositions or erasures in your answer/ratio is not
allowed. You are given 25 minutes for this activity:

Multiple Choice

1. Which of the following is NOT measured in a Basic Metabolic Panel?

A. Chloride
B. Creatinine
C. Glucose
D. None of the above

ANSWER: ________

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RATIO:___________________________________________________________________________________________
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2. Which portion of an anticoagulated blood sample contains most clinical chemistry analytes?
A. in the blood thinner
B. in the clear, straw-colored liquid portion of blood that remains after red blood cells, white blood cells, platelets and
other cellular components are removed
C. in the cellular portion of the blood
D. B and C

ANSWER: ________
RATIO:___________________________________________________________________________________________

3. What comprises a Lipid Panel?

A. Total Cholesterol, TAG
B. LDL, HDL, TAG
C. Total Cholesterol, TAG, LDL, HDL
D. Total Cholesterol, TAG, LDL

ANSWER: ________
RATIO:___________________________________________________________________________________________

4. What type of anticoagulant is in a blood collection tube with a red cap?

A. No anticoagulant
B. Lithium or sodium heparin
C. Potassium EDTA
D. Thrombin

ANSWER: ________
RATIO:___________________________________________________________________________________________

5. Which of the following refer/s to “reference intervals”?

A. a range that has been documented to reflect the results expected for healthy people
B. consensus values that reflect medical decision levels
C. values are agreed upon by healthcare professionals as good indicators for medical decision making
D. All of the above

ANSWER: ________
RATIO:___________________________________________________________________________________________

6. Tests in a clinical chemistry laboratory primarily measures ____________of biologically important ions
A. volume
B. concentration
C. viability
D. solution

ANSWER: ________
RATIO:___________________________________________________________________________________________

7. Which of the following is NOT found in serum?

A. Calcium
B. IgM
C. fibrinogen
D. thyrotropin

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ANSWER: ________
RATIO:___________________________________________________________________________________________

8. Which of the following is/are analytic techniques in clinical chemistry?

A. spectrophotometry
B. immunoassays
C. electrophoresis
D. all of the above

ANSWER: ________
RATIO:___________________________________________________________________________________________

9. When can the use of an EDTA tube be unsuitable in clinical chemistry?

A. calcium determination
B. potassium determination
C. both A and B
D. complete blood count

ANSWER: ________
RATIO:___________________________________________________________________________________________

10. . Which of the following is unlikely sent to the clinical chemistry laboratory?
A. throat swab
B. blood bag
C. biopsy specimen
D. all of the above

ANSWER: ________
RATIO:___________________________________________________________________________________________

RATIONALIZATION ACTIVITY
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
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4. ANSWER: ________
RATIO:_______________________________________________________________________________________
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5. ANSWER: ________
RATIO:_______________________________________________________________________________________
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RATIO:_______________________________________________________________________________________
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RATIO:_______________________________________________________________________________________
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LESSON WRAP-UP (10 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

Enumerate three important concepts that you have learned today:

1. ________________________________________________________________

2. ________________________________________________________________

3. ________________________________________________________________

List two concepts that you find difficult:

1. ________________________________________________________________

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 2. ________________________________________________________________

Write your most important question about the topics covered in this module:

1. ________________________________________________________________

(For next session, please study Specimen Collection and Processing)

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