INTRODUCTION TO

CLINICAL LAB
OUTLINES:
 Use of tests
 Professional staff
 Emergency and specialized laboratory
 Samples & analytes
 Core biochemistry
 Types of laboratory test
 Biologic specimens
 Care when collection blood specimen
OUTLINES:

 Collection and preservation of blood specimen

 Care of blood specimen after collection

 Types of blood specimen

 Hospital information system

 Laboratory information system

 USE OF BIOCHEMICAL TESTS

• Diagnosis and in the monitoring of

treatment.
• Screening for disease or in assessing the
prognosis.
• Research into the biochemical basis of
disease
• Clinical trials of new drugs
• Biochemical investigations hold the key for
 Modern clinical biochemistry laboratories
are designed to provide results 24 hours
per day and 7 days a week.

 Over 70% of patients require an analytical

test to aid their diagnosis.

 Clinical biochemical tests comprise over ⅓

of all hospital laboratory investigations.
 There are over 400 different tests which may
be carried out in clinical biochemistry
laboratories.

 They vary from the very simple, such as the

measurement of sodium, to the highly
complex, such as DNA analysis, screening for
drugs, or differentiation of lipoprotein
variants.
 Many high volume tests are done on large
automated machines.

 Less frequently performed tests may be

conveniently carried out by using
commercially prepared reagents packaged in
"kit" form. Some analyses are carried out
manually.
PROFESSIONAL STAFF:

 Biomedical scientists,

 Clinical scientists,

 medical staff.
SAMPLES:

 Clinical
samples or specimens are
materials collected from patients and
used in the investigation of their diseases
ANALYTES:

 Analytesare substances that are

tested for in the sample, using
appropriate analytical methods or
chemical tests.
EMERGENCY LABORATORY

 The emergency laboratory is likely to have an

analyser which is the same as that used in the
core laboratory and provides a similar 24
hours, 7 days a week rapid turnaround service

 It is not unreasonable to expect results to be

available 30 minutes after the laboratory
receives the sample
CORE BIOCHEMISTRY:

• Most biochemistry laboratories provide the

"core analyses", commonly requested tests

which are of value in many patients, on a

frequent basis.
CORE BIOCHEMICAL TESTS:

• Sodium, potassium, chloride and bicarbonate

• Urea and creatinine
• Calcium and phosphate
• Total protein and albumin
• Bilirubin and alkaline phosphatase
• Alanine aminotransferase (ALT) and Aspartate
aminotransferase (AST)
• Glucose
• Amylase…….
SPECIALIZED TESTS:

• Not every laboratory is equipped to carry out

all possible biochemistry requests.

• Large departments may act as reference

centers where less commonly asked for tests
are performed.
SPECIALIZED TESTS:

• Hormones
• Specific proteins
• Trace elements
• Vitamins
• Drugs
• Lipids and lipoproteins
• DNA analyses
SPECIALIST LABORATORY

 Outside of the core and emergency areas,

most laboratories also perform other tests
depending on the volumes of work requested
locally.

 This is likely to require specialist equipment

and expertise.
TYPES OF LABORATORY
TESTS:
1. Discretionary or on-off tests

2. Biochemical profiles

3. Dynamic function tests

4. Screening tests

5. Metabolic work-up tests

DISCRETIONARY OR ON-OFF TESTS

 Most common clinical biochemistry tests that

are designed to answer specific questions,

e.g., does the patient have increased blood

urea/glucose concentration?

 Normally, these tests are useful to support the

BIOCHEMICAL PROFILES
 These tests are based on the fact that more
useful information on the patients disease
status can be obtained by analysing more
constituents rather than one.

 e.g., plasma electrolytes (Na+, K+, Cl-,

bicarbonate, urea); liver function tests
(serum bilirubin, ALT, AST).
DYNAMIC FUNCTION TESTS
 These tests are designed to measure the
body's response to external stimulus
 e.g., oral glucose tolerance test (to assess
glucose homeostasis) : bromosulphthfein test
(to assess liver function).
SCREENING TESTS

 These tests are commonly employed to

identify the inborn errors of metabolism, and
to check the entry of toxic agents (pesticides,
lead, mercury) into the body.
METABOLIC WORK-UP TESTS

 The programmed intensive investigations

carried out to identify the endocrinological

disorders come under this category.

BIOLOGIC SPECIMEN:
IDENTIFICATION OF PATIENTS AND SPECIMENS

• The correct patient must be appropriately iden­

tified on the specimen and request form, as
follows:

1. Patient identification data (PID):This

usually comprises name plus unique number.

2. Test request information: This includes

relevant clinical details (including any risk of
infection hazard), the tests to be performed and
where the report is to be sent.
3. Collection of specimens. In the correct
tube and the appropriate preservative.

4. Matching of specimens to requests. Each

specimen must be easily and unequivocally
matched to the corresponding request for
investigations.
REQUEST FORM

 The nature of the sample, it must be

accompanied by a request form, which
must be completed in full to allow the sample
to be positively identified and linked to any
previous reports.

 Request forms come in many shapes and

sizes, although they are commonly in an A5
format
SPECIMEN COLLECTION:

 Tube will hold about 5 ml of blood – enough to

perform many clinical chemistry tests, since
automated analyzers require only small
amounts (usually from 2 to 100 μl) for a single
test.

 Among these, blood (directly or in the form of

plasma or serum) is frequently used for the
investigations in the clinical biochemistry
laboratory.
COLLECTION OF BLOOD:

• Venous blood is most commonly used for a

majority of biochemical investigations. It can
be drawn from any prominent vein (usually
from a vein on the front of the elbow).

• Capillary blood (<0.2 ml) obtained from a

finger or thumb, is less frequently employed.

• Arterial blood (usually drawn under local

anesthesia) is used for blood gas
determinations.
Introduction to Clinical
biochemistry
CARE WHEN COLLECTION BLOOD SPECIMENS

• Posture of the patient,

• The choice of skin-cleansing agent
• The selection of a suitable vein

1. The skin must be clean over the site for

collect­ing the blood specimen with alconol
and methylated spirits.
2. Limbs into which intravenous infusions are being
given must not be selected as the site of
venepuncture unless particular care is taken.

3. Venepuncture technique should be standardised

as far as possible to enable closer comparison of
successive results on patients.

4. Venous blood specimens should be obtained

with minimal stasis Prolonged stasis can markedly
raise the concentrations of plasma proteins and other
non-diffusible substances (e.g. protein-bound
substances). It is advisable to release the tourniquet
before withdrawing the sample of blood
5. Posture should be standardised if
possible When a patient's posture changes
from lying to standing, there may be an
increase of as much as 13% in the
concentration of plasma proteins or protein-
bound constituents, due to redistribution of
fluid in the extracellular space.
• 6. Haemolysis should be avoided, since it
renders specimens unsuitable for plasma K+,
magne­sium and many protein and enzyme
activity mea­surements.

• 7. Infection hazard High-risk specimens

require special care in collection, and this
danger must be clearly indicated on the
request form.
COLLECTION AND PRESERVATION OF BLOOD SPECIMENS
• 1. Diet Dietary constituents may alter the
concentrations of analytes in blood
significantly (e.g. plasma [glucose] and
[triglyceride] are affected by carbohydrate
and fat-containing meals, respectively).

• 2. Drugs Many drugs influence the chemical

composition of blood. Such effects of drug
treatment, for example, antiepileptic drugs,
have to be taken into account when
interpreting test results.
 3. Diurnal variation. The concentrations of
many substances in blood vary considerably
at different times of day (e.g. cortisol).

 Specimens for these analyses must be

collected at the times specified by the
laboratory, as there may be no reference
ranges relating to their concentrations in
blood at other times
CARE OF BLOOD SPECIMENS AFTER COLLECTION
• Blood specimens should be transported to the
lab­oratory as soon as possible after collection.

• Special arrangements are needed for some

specimens (e.g. for acid-base measurements,
or unstable hormones) because of their lack of
stability.

• Most other analytes are stable for at least 3 h in

whole blood, or longer if plasma or serum is
first sepa­rated from the cells.
• As a rule, whole blood specimens for chemical
analysis must not be stored in a refrigerator,
since ionic pumps that maintain electrolyte
gradients across the cell membrane are
inactive at low temperatures.

• Conversely, separated serum or plasma is

best refrigerated, to minimize chemical
changes or bacterial growth.
Biochemical investigations can
be performed on 4 types of
blood specimens
 The selection of the specimen depends on the
parameter to be estimated.

 1. Whole blood (usually mixed with an

anticoagulant) is used for the estimation of
hemoglobin, carboxyhemoglobin, pH, glucose,
urea, non-protein nitrogen, pyruvate, lactate,
ammonia etc.

 (Note : for glucose determination, plasma is

preferred in recent years).
 2. Plasma, obtained by centrifuging the
whole blood collected with an anticoagulant,
is employed for the parameters

• fibrinogen,
• glucose,
• bicarbonate,
• chloride,
• ascorbic acid etc.
 3. Serum is the supernatant fluid that can be
collected after centrifuging the clotted blood.

 It is the most frequently used specimen in the

clinical biochemistry laboratory.

 The parameters estimated in serum include

proteins (albumin/globulins), creatinine,
bilirubin, cholesterol, uric acid, electroylets
(Na+, K+, Cl-), enzymes (ALT, AST, LDH, CK,
ALP, ACP, amylase, lipase) and vitamins.
 4. Red blood cells are employed for the
determination of abnormal hemoglobins,
glucose 6-phosphate dehydrogenase,
pyruvate kinase etc.
HOSPITAL INFORMATION SYSTEM

 Hospital information system (HIS) is the

central patient database for a hospital and
its patients.

 It is used to generate requests for diagnostic

procedures, and is also a repository for the
results from diagnostic tests.
LABORATORY INFORMATION SYSTEM

 A laboratory information system (LIS) is

also a database that contains all the
laboratory diagnostic information.

 It is interfaced to the laboratory analyzers and

to the Hospital Information System.
QUESTION # 1:
 HIS stands for:

a) Hospital information system

b) Hospital instruction system
c) High hospital information system
d) All of the above
QUESTION # 1:
 HIS stands for:

a) Hospital information system

b) Hospital instruction system
c) High hospital information system
d) All of the above
QUESTION # 2:
 The maximum time for the stability of any
analyte is

a) 4h
b) 3h
c) 5h
d) 6h
QUESTION # 2:
 The maximum time for the stability of any
analyte is

a) 4h
b) 3h
c) 5h
d) 6h
QUESTION # 3:
 Request forms commonly in ------------- format?

a) A5 format
b) A4 format
c) Letter
QUESTION # 3:
 Request forms commonly in ------------- format?

a) A5 format
b) A4 format
c) Letter
THANK YOU