CLINICAL CHEMISTRY 1 – INTRODUCTION TO BASICS & QC IN CC1

PURPOSE & FUNCTION OF LABORATORIANS Point-of-care testing (POCT)

through clinical pathology & laboratory medicine  aka near-patient testing, alternate-site
are to assist clinicians in: testing or patient-focused testing
 used in emergency dept., operating suites,
1. Confirming or rejecting a diagnosis
clinics, health maintenance organization
2. Providing guidelines in patient management
(HMO), physicians, offices, & nursing
3. Establishing a prognosis
homes
4. Detecting disease through case finding or
 addresses acute patient needs
screening
5. Monitoring follow-up therapy  instrumentation includes portable chemistry
analyzers, glucometers, BG analyzers,
Goals of a Clinical Laboratory hemoglobin meters, & coagulation testing
 Facilitate the correct performance of
analytic procedures that yield accurate and  Specimens or samples are analyzed while
precise information substances in them are measured or
 Aiding patient diagnosis and treatment quantitated.
Substances measured in serum fall generally into
Requirements for reliable results the following categories:
 Correct use of basic supplies and 1. Substances normally present with a function
equipment in the circulation
 Possess an understanding of fundamental  Glucose, TP, albumin,
concepts critical to an analytic procedure individual poteins,
electrolytes, TAG,
CLINICAL CHEMISTRY – systematic study of cholesterol, hormones,
biochemical processes associated with health & vitamins
disease & the measurement of constituents in body 2. Metabolites – nonfunctioning waste
fluids or tissues to facilitate diagnosis of disease products in the process of being cleared
Scope: biochemistry, instrumentation, computers,  Urea, creatinine, uric acid,
pharmacology, endocrinology, immunology, ammonia, bilirubin
analytical chemistry, toxicology 3. Substances released from cells as a result
 It is much easier to detect a malfunction of cell damage & abnormal permeability or
than to elucidate or document the cause abnormal cellular proliferation
 Malfunction of a cell maybe caused by a  Enzymes such as LD, ALT,
variety of factors: AST, CK, AMS, GGT, ALP &
1. Destruction by trauma or by invasive ACP
agents  ferritin
2. Genetic deficiency of a vital enzyme 4. Drugs & toxic substances
3. Insufficient supply of one or more
 Antibodies, substances of
essential nutrients
abuse, therapeutic drugs,
4. Insufficient blood supply
poisons
5. Insufficient oxygen supply
Laboratory tests
6. Malignancy
 Chemical tests – direct/indirect, colorimetric,
7. Accumulation of waste products
redox, condensation
8. Failure of a control system
 Degrative tests (Enzymatic) – one-step or
9. Defect in the cellular recognition of
multi-step, NADH Consumption
certain signals
 Measurement of Activity (not concentration)
 Multi-method
 Titrimetric

MONTEMAR, T.M. 1
 CLINICAL CHEMISTRY 1 – INTRODUCTION TO BASICS & QC IN CC1

 Electrochemical 3. Glass with high resistance to alkalies

LAB REQUESTS - boron-free glassware for strong alkali solutions
 “STAT” – immediate; urgent requests; and digestion with strong alkalies
usually less than 1 hour TAT - less thermal resistant than borosilicate glass
 PRIORITY – important for clinical decisions; - known as soft glass
less than 2 hours TAT 4. Low actinic glass
 ROUTINE – non urgent; standard or special - amber or red-colored to reduce the amount of light
tests; generally, 4-6 hours passing through the substance within the glassware
- highly protective laboratory glassware for handling
heat-labile substances in the 300-500nm range
GLASSWARES PLASTICWARES (bilirubin, carotene and vitamin A)
breakable Highly shock proof; shatterproof 5. Standard flint glass
Reusable disposable - soda-lime glass which is composed of a mixture of
Ideal for acidic sol’ns Ideal for alkaline solutions oxides of Si, Ca and Na
High thermal & Relatively inert - lowest in cost and readily fabricated
corrosion resistance - poorly resistant to high temperature and sudden
Good optical Flexible changes in temperature
properties
- easy to melt and shape thus used as reagent
Low cost For cryogenic experiments
bottles and disposable laboratory glasswares
- releases alkali into the pipetted liquid
GLASS: 5 GENERAL TYPES
1. High thermal resistant glass
PLASTICWARES
- Borosilicate glass with low alkali content
1. Polyolefins (polyethylenes,
- Resists heat, corrosion and thermal shock
polypropylenes)
- Most common are Pyrex, Kimax and Exax
 Unique group of resins with relatively
 Corex
inert chemical properties
- 6x stronger than borosilicate glass
 Unaffected by acids (however, conc.
- Alumina-silicate glass
sulfuric acid slowly attacks
- Better able to resist clouding due to alkali or
polyethylene at RT), alkalies, salt
scratching
solutions and most aqueous
- Ideal for higher temperature thermometers,
solutions
graduated cylinders and centrifuge tubes.
 Aromatic, aliphatic and chlorinated
 Vycor
hydrocarbons cause moderate
- recommended for use in application involving high
swelling at RT
temperature and drastic heat shock and extreme
chemical treatment with acids and dilute alkalies  Organic acids, essential oils and
- heatable to 900°C and withstand down shock from halogens slowly penetrate these
900°C to ice water plastics
- ideal for ashing and ignition techniques  Strong oxidizing agents attack this
2. High silica glass group at elevated temperatures only
- 96% silica content comparable to fused quartz in  Polypropylene is more expensive
its thermal endurance, chemical stability and than polyethylene therefore the latter
electrical characteristics is used in most disposable plastic
- radiation resistant, good optical qualities and wares
temperature capabilities  Polypropylene is sterilizable
- ideal for high precision analytical work and can however it absorbs pigment and
also be used for optical reflectors and mirrors tends to become discolored
2. Polycarbonate resin

MONTEMAR, T.M. 2
 CLINICAL CHEMISTRY 1 – INTRODUCTION TO BASICS & QC IN CC1

 twice as strong as polypropylene - Similar to volumetric pipet but have their

(from -100°C to +160°C) bulb closer to the delivery tip
 Chemical resistance is not as wide - Used for measuring viscous fluids as
as the polyolefins blood or serum
 Unsuitable for use with bases as - Has an etched ring near the mouthpiece
amines, ammonia and alkalies as (blowout pipet)
well as oxidizing agents - Blown out only when the fluid has
 Glass clear and shatterproof drained to the last drop in the delivery tip
 Ideal for centrifuge tubes and 2. Graduated or Measuring Pipets
graduated cylinders  Plain, narrow tube drawn out to a tip
3. Tygon  Graduated uniformly along its length
 Nontoxic, clear plastic of modified  Two types which are calibrated for delivery
PVC (polyvinylchloride) are available
 Used extensively for the MOHR PIPET
manufacture of ACA tubings - calibrated between two marks on the
 Flexible and used to handle most stem
chemicals SEROLOGICAL PIPET
 Can be steam-autoclaved or - has graduation marks down on the tip
chemically sterilized and blown out to deliver the entire
volume of the pipet if etched ring or
 Tubing is soft and flexible and
double rings are evident near the mouth
quickly slips over tubulatures but
of the pipet
gripping tightly on glass or metals
- Intended for the delivery of
4. Teflon fluorocarbon resins
predetermined volumes
 Almost chemically inert with high
- Principally used for the measurements
corrosion resistance at extreme
of
temperatures
reagents and are not generally
 For cryogenic experiments and work
considered accurate enough for
at high temperatures over extended
measuring viscous samples and
periods (-270°C to +255°C)
standards
 Pure translucent white and inert - Serological pipets have larger orifice
 Easy to clean and fast drying but it than
can be scratched and misshaped the Mohr pipet and thus drain faster
MICROPIPETS
PIPETS - Two General Types - Sahli (TC)
1. Volumetric or Transfer pipet - Kirk (TC)
 Designed to deliver (TD) a fixed volume of - Lang Levy (TD/TC)
liquid - Overflow (TC)
 Consists of a cylindrical bulb joined at both - Capillary (TC)
ends to narrower glass tubing - Sanz Pipet (TD=TC)
 Calibration mark is etched around the upper - Unopette (TC)
suction tube - Semiautomatic pipet Eppendorf (TD/TC)
 Lower delivery tube is drawn out to a fine tip
 used for accurate measurements of aliquots CHEMICALS
of non-viscous samples, filtrates, controls, The American Chemical Society (ACS)
and standard solutions established the specifications of chemicals in the
analytical grade category.
OSTWALD FOLIN PIPET
MONTEMAR, T.M. 3
 CLINICAL CHEMISTRY 1 – INTRODUCTION TO BASICS & QC IN CC1

The analytical reagent grade chemicals are A primary standard (PS) is a chemical that is the
of very high purity. They are labeled Analytical highest purity and can be measured directly to
Reagent (AR) or ACS which state the actual purity produce a substance of exact known concentration.
of each lot. These include chemicals such as: The International Union of Pure and Applied
 spectrograde, nanograde, and 2High Chemistry (IUPAC) requires that PS be at least
Performance Liquid Chromatography (HPLC) 99.98% pure and that the working standards be
grade. 99.95% pure
The AR grade chemical are used in: Grade A - atomic weight standards
a. most analytical laboratory procedures Grade B - ultimate standards
b. making up reagents for spectrophotometry, Grade C* - primary standards with >0.002%
chromatography, trace metal analysis, atomic impurity
absorption spectrophotometry, fluorometry and Grade D* - working standards with >0.5% impurity
standardization procedures. Grade E - secondary standards derived from using
United States Pharmacopoeia (USP) and Grade C standards
the National Formulary (NF) grade chemicals are *Commercially available
not injurious to humans and are used to produced
drugs. They are not pure enough for use in most REFERENCE MATERIALS
chemical procedures.  Primary standard – highly purified chemical
Less pure grade chemicals are referred to that can be measured directly to produce a
as purified and technical. The chemically pure (CP) substance of exact known concentration
or pure grade chemicals do not recommend for and purity
reagent preparations.  Secondary standard – lower purity with
Technical or commercial grade reagents are concentration determined by comparison
primarily used in manufacturing and should not be with primary standard
used in the clinical laboratory. The technical grade
is the lowest quality and should not be used for The National Bureau of Standards (NBS)
analytical work. now National Institute of Science and
CHEMICAL REAGENTS Technology (NIST) purified materials known as
 Analytic reagent (AR) – meets or exceeds Standard Reference Materials (SRM) are used as
the established specifications of American primary standard materials in the clinical laboratory.
Chemical Society (ACS) They are relatively expensive and should be used
 Ultrapure – put through additional as a reference for the comparison of commercially
purification steps for use in specific obtained standards and reagents.
purposes (chromatography, atomic A secondary standard is a substance of
absorption, immunoassays, etc.) lower purity whose concentration is determined by
 United States Pharmacopeia (USP) & comparison to a primary standard.
National Formulary (NF) – used to
manufacture drugs WATER
 Chemically pure (CP) – impurity limitations  Reagent grade water (RGW) is water
are not stated and that preparation of these suitable for reagent and standard
chemical are not uniform; not recommended preparation. Most procedures use distilled
for use by clinical labs water or deionized water.
 Technical/commercial grade – used for  Distilled water is purified to remove almost
manufacturing and never used in clinical all organic materials. Water may be distilled
labs more than once and each distillation cycle
will remove impurities.
STANDARDS  Deionized water is produced from distilled
water using either an anion or cation
MONTEMAR, T.M. 4
 CLINICAL CHEMISTRY 1 – INTRODUCTION TO BASICS & QC IN CC1

exchange resin followed by replacement of Resistivity 10 1.0 0.1

the removed particles with hydroxyl or (megaohm.cm
hydrogen ions respectively. )
WATER SPECIFICATIONS pH NS NS 5.0-8.0
 Distilled Water – purified by distillation; Use For min. Analytic Glassware
ref., (e.g., process washing
remove almost all organic materials
Trace
 Deionized water – purified by ion exchange; metal,
all ions are removed iron and
 RO water – purified by reverse osmosis; enzyme
uses pressure to force water through a analyses)
semipermeable membrane
 Ultrafiltration and nanofiltration – removing Tests to determine the grade of water
particulate water, microorganisms, and any  pH
pyrogens or endotoxins  Colony count
 Ultraviolet oxidation/sterilization w/ ozone  Resistivity – pure water is devoid of ions is
treatment – destroy bacteria but may leave poor conductor, relationship of resistance
behind residual products and purity is linear. As purity increases, so
does resistance
The College of American Pathologists  Detection of coliforms
(CAP) and the National Committee for Clinical  Chemical Oxygen Demand
Laboratory Standards (NCCLS) issued minimum  Elements (Cl, ammonia, nitrate, nitrite, iron,
specifications for RGW. The NCCLS requirements hardness, phosphate, sodium, silica, carbon
for each type are tabulated below: dioxide)
Specifications Type I Type II Type III
Bacterial content <10 10² NA  Type I RGW - used for procedures that
(max. colony require maximum water purity such as:
forming unit/mL) - preparations of standard solutions,
pH NA NA NA - ultra-micro chemical analysis,
Resistivity 1.0 (in- 1.0 0.1 - measurement of nanogram or sub
(megaohms/cm at line) nanogram concentration
25°C) - and tissue or cell culture (or both).
Silicates, mg/L 0.05 0.1 1.0  Type II RGW - used in most laboratory
SiO₂ max. determination in chemistry, hematology,
Particulate matter 0.22 µm NA NA microbiology, immunology and other
(filter in system) chemical laboratory areas.
Organic Activated NA NA  Type III RGW - used in most qualitative
contaminants carbon measurement / examinations, most
filter in procedures in urinalysis, parasitology and
system histology, washing glassware, and
procedures not requiring Type I or Type II
Reagent water categories (from SAS)
water.
Parameters Type I Type II Type III Carbon dioxide free water is
Max. colony ≤10 1000 NS obtained by boiling Type II water. This is used
count when carbon dioxide, ammonia and oxygen may
(CFU/mL) affect analysis.
Silicate (mg/L 0.05 0.1 1.0
SiO₂)

MONTEMAR, T.M. 5
 CLINICAL CHEMISTRY 1 – INTRODUCTION TO BASICS & QC IN CC1

CLEANING GLASSWARES AND PLASTIC three months. The speed of the centrifuge is
WARES checked using the tachometer or strobe light.
 Routine washing may be done by soaking in
dilute bleach followed by drying in an oven,  All laboratories are required to have safety
soaking in 20% nitric acid solution for 12-24 showers, eyewash stations and fire
hours and soaking in acid dichromate extinguishers and to periodically test and
solution. inspect the equipment of proper operation.
 For blood clots, soak in 10% NaOH Other items that must be available for
 For new pipets, soak in 5% HCI or 5% personnel include fire blankets, spill kits and
HNO₃ first aid supplies.
 For metal ion determination, soak in 20%  Mechanical pipetting devices must be used
nitric acid for manipulating all types of liquids in the
 For grease, soak in any organic solvent or laboratory, including water. Mouth pipetting
50% KOH is strictly prohibited.
 For permanganate stains, soak in 50% HCI
or a mixture of 1% ferrous sulfate in 25% BIOLOGIC SAFETY
sulfuric acid  All samples and other body fluids should be
 For bacteriologic glassware, soak in 2% to collected, transported, handled and
4% cresol solution followed by autoclaving processed using strict precautions.
and thorough washing  Gloves, gowns and face protection must be
 For iron determination, soak in 1:2 dilution used if splash or splattering is likely to
of conc. HCI solution or 1:3 dilution of conc. occur.
HNO₃  Specimen should remain capped during
Chemical Hazards centrifugation because biologic specimens
 Caustic - can cause burns could produce finely dispersed aerosols that
are a high-risk source of infection.
 Flammable - also combustible, that is, can
easily catch fire
Any blood, body fluid or other potentially
 Corrosive - harmful to mucous membranes,
infectious material spill must be cleaned up and the
skin, eyes or tissues
area of equipment disinfected immediately.
 Carcinogen - can produce or incite cancer
 Mutagen - cause changes in RNA or DNA Recommended clean up includes the following:
 Teratogen - cause birth defects A. Wear appropriate protective equipment
B. Use mechanical devices to pick up broken glass
CENTRIFUGE or other sharp objects.
The relative centrifugal force (RCF) is obtained C. Absorb the spill with paper towels, gauze pads
by or
using a nomogram or by using this formula: tissue, etc.
RCF = 1.118 x 10⁻⁵ x r x rpm² D. Clean the spill site using common aqueous
Where: detergent.
r = radius in cm. between the axis of rotation and E. The spill site using approved disinfectant or 10
the %
center of the centrifuge tube bleach using appropriate contact time.
rpm = speed in revolutions per minute F. Rinse the spill site with water.
G. Dispose all materials in appropriate biohazard
The CAP recommends cleaning of any spills or containers.
debris such as blood, glass and others daily;
checking of the timer, brushes and speed every
MONTEMAR, T.M. 6
 CLINICAL CHEMISTRY 1 – INTRODUCTION TO BASICS & QC IN CC1

Occupational Safety and Health Organization - carcinogenic potential;

Administration (OSHA) “Blood Borne Pathogens” - safe handling procedures;
standard requires written “Exposure Control Plan” - spill cleanup procedures; and
- emergency first aid.
Categories of exposure are the following: MSDSs contain information on the nature of the
 Category I - daily exposure to blood and chemical, precautions if spilled and disposal
body fluids recommendations.
 Category II - regular exposure to blood and
body fluids
 Category III - no exposure to blood and Material Safety Data Sheet (MSDS)
body fluid  A document that contains information on
potential hazards (health, fire, reactivity and
Employers must offer Hepatitis B vaccine at environmental) and how to work safely with
no cost to all personnel in Category I and II. the chemical product
Biological safety cabinets should be  An essential starting point for the
installed in strategic places to facilitate development of a complete health and
manipulations of infectious material. It reduces risk safety program
of exposure of laboratory personnel and patients.  Contains information on the use, storage,
handling and emergency procedures all
SAFETY AGAINST EXPOSURE TO TOXIC related to the hazards of the material
CHEMICALS  MSDSs are prepared by the supplier or
OSHA published its Hazard Communication manufacturer of the material
Standard in 1983 to minimize the incidence of  Intended to tell what the hazards of the
chemically related occupational illnesses and product are, how to use the product safely,
injuries in the workplaces. OSHA requires the what to expect if the recommendations are
following: not followed, what to do if accidents occur,
a. Manufacturers of chemicals should evaluate the how to recognize symptoms of
hazards of the chemicals they produce and develop overexposure, and what to do if such
hazard communication programs for employees incidents occur
exposed to hazardous chemicals. What information is on the MSDS?
b. Clinical laboratories should develop and institute  Product Information: product identifier
a chemical hygiene plan. (name), manufacturer and suppliers’ names,
c. Hospitals and laboratories are obliged to addresses, and emergency phone numbers
maintain an inventory of all hazardous substances  Hazardous ingredients
used in the  Physical Data
workplace.  Fire or Explosion Hazard Data
 Reactivity Data: information on the chemical
OSHA requires that material safety data sheets
instability of a product and the substances it
(MSDS) be provide for each chemical by
may react with
manufacturers and suppliers and must be made
 Toxicological Properties: health effects
available on site for laboratory personnel.
 Preventive measures
MSDS will specifically include
- the chemical identity;  First aid measures
- chemical and common name;  Preparation information: who is responsible
- physical and chemical characteristics; for preparation and date of preparation of
- signs and symptoms of exposure; MSDS
- routes of entry;
- exposure limits;
MONTEMAR, T.M. 7
 CLINICAL CHEMISTRY 1 – INTRODUCTION TO BASICS & QC IN CC1

well as the quantity that is disposed.

Records must be maintained for the length
of employment plus 30 years
 Radiation monitoring utilizes film badge or
survey meter. The exposure limit (maximum
permissible dose equivalents is 5000
mrem/year whole body)
The National Fire Protection Association  The Wipe test (Leak test) involves wiping
(NFPA) has developed the Hazards Identification laboratory surfaces with moistened
system to provide common, recognizable warning absorbent material and the radiation
signs for chemical hazards. The system consists of contained in each wipe is counted.
four color-coded, diamond shaped symbols FIRE SAFETY
arranged to form a larger diamond shape. Fires have been divided into four classes on the
- Red (top) designates flammability nature of the combustible material and
- Blue (left) indicates health hazards requirements for extinguishments.
- Yellow (right) indicates reactivity stability  Class A - ordinary combustible solid
- White (bottom) indicates special materials such as paper, wood, plastic and
consideration rubber
Contained within each color-coded diamond is a  Class B - flammable liquids/ gases and
number ranging from 0 to 4, indicating the severity combustible petroleum products
of the respective hazard (0 = none/minimal, 1 =  Class C - energized electrical equipment
slight, 2 = moderate, 3 = serious and 4 = extreme)  Class D - combustible/reactive metals such
Special Considerations: as Mg, Na and K
Water Reactive -  Class E - nuclear reaction
Oxidizing Agent - Ox  Class K - cooking media
Radioactive -
 (Type A) - Pressurized water extinguishers
Poison -
(foam and multipurpose dry chemical types)
are for Class A fires.
ELECTRICAL SAFETY
 (Type ABC) – Multi-purpose dry chemical
 Lockout/tag out malfunctioning electrical or
and carbon dioxide extinguishers are used
mechanical equipment until services.
for Class B and C fires.
 Report any small shocks, unplug and tag
 (Type C) - Halogenated hydrocarbon
equipment until serviced.
extinguishers are recommended particularly
 If a severely shocked person cannot let go of
for use with computer equipment.
instrument, unplug it without touching the
 (Type D) - Class D fires present special
person or knock person loose with
problems and extinguishments is left to
nonconductive material such as wood.
trained fire fighters using special dry
chemical extinguishers
RADIATION SAFETY
Personnel should know the location and type of
 A radiation safety policy should include
portable fire extinguisher near the work area and
environmental and personnel protection. know how to use an extinguisher before a fire
 All areas where radioactive materials are occurs.
used or stored must be posted with caution
signs and traffic in these areas should be SAFETY AWARENESS FOR CLINICAL
restricted to essential personnel only LABORATORY PERSONNEL
 Records must be maintained as to the  Health Care Organizations focus their
quantity of radioactive material on hand as responsibility in protecting their employees

MONTEMAR, T.M. 8
 CLINICAL CHEMISTRY 1 – INTRODUCTION TO BASICS & QC IN CC1

from infection especially against hepatitis B  Other liquid wastes, including flammable
virus (HBV), human immunodeficiency virus solvents, must be collected in approved
(HIV) & TB bacilli. containers and segregated into compatible
 The Centers for Disease Control (CDC) classes
updated the 1983 Guidelines for Isolation  flammable material can be burned in
Precautions in hospitals with the release of specially designed incinerators with after
its Universal Precautions in 1987 because burners and scrubbers to remove toxic
of the growing concern about HIV. products of combustion.
 The CDC recommends that blood and body  solid chemicals wastes that are unsuitable
fluid precautions should be consistently for incineration must be buried in a landfill.
used for all patients regardless of their
blood-borne infection status.
Potentially infectious materials include: BIOHAZARDOUS WASTES
a. body fluids (semen, vaginal secretions,  Medical waste is defined as a special
pericardial fluid, peritoneal fluid, synovial waste from health care facilities and is
fluid, pleural fluid, amniotic fluid, saliva, further defined as solid waste that, if
tears, CSF, urine and breast milk) improperly treated or handled may transmit
b. unfixed tissues, organs or blood slides infectious diseases
Infective agents may be inactivated by  it comprises of animal waste, bilk blood and
= heat sterilization (250°C for 15 minutes), blood products, microbiologic wastes,
= ethylene oxide (450-500 mg/L at 55- pathologic wastes and sharps.
60°C),  The approved methods for treatment and
= 2 % glutaraldehyde, disposition of medical wastes are
= 10 % hydrogen peroxide, incineration, steam sterilization, burial,
= 10 % formaldehyde, thermal inactivation, chemical disinfection,
= 5-25 % hypochlorite, or encapsulation in a solid matrix.
=10 % v/v with tap water of a common
household bleach makes a very effective UNITS OF MEASUREMENT
and System Internationale d’ Unites (SI) is
economical disinfectant inactivating HBV in preferred in scientific literature and clinical
10 minutes and HIV in 2 minutes. laboratories and is the only system employed in
many countries. The SI system units (referred as SI
DISPOSAL OF HAZARDOUS MATERIALS units) are based on the metric system. Several sub-
There are four basic waste disposal techniques. classifications exist within the SI system, one of
These include: which is the basic unit.
- flushing down the drain to the sewer The Systeme Internationale (SI) defines seven
system base units as shown.
- Incineration Quantity Basic Unit Symbol
- landfill burial Length meter m
- recycling Mass kilogram kg
 It is permissible to flush water-soluble Time second s
substances down the drain with large Electric current ampere A
quantities of water. Temperature Kelvin K
 Strong acids and bases should be Luminous intensity Candela cd
neutralized before disposal Amount of substance mole mol/M
 Foul smelling chemicals should never be Catalytic amount katal
disposed of down the drain

MONTEMAR, T.M. 9
 CLINICAL CHEMISTRY 1 – INTRODUCTION TO BASICS & QC IN CC1

Another set of SI-recognized units is termed discarded if they differ by more than 1°C
derived units. A derived unit is a derivative or a from the reference.
mathematical function describing one of the basic  On a daily basis, the temperature of the
units. An example of derived unit is meters per incubation area should be checked, and the
second (m/s), used to express velocity. The SI uses thermometer itself should be
standard prefixes that, when added to a basic unit,  It is imperative that preventive maintenance
can indicate decimal fractions or multiples of that procedures be performed and the results
unit. recorded for all laboratory instrumentation.
SI Derived Units are obtained by  This includes maintenance of analytical
combining two or more basic units by multiplication balances, refrigerators, freezers,
or division. centrifuges, ovens, water baths, heating
blocks, thermometers, pipettors, dilutors,
Derived Derived Unit Symbol
Quantity automated analyzers, and all other
Substance Moles per Mol/m³ or mol laboratory equipment used for analyzing
concentration cubic meter m⁻³ specimens.
Conductance Siemens S  Preventive maintenance is performed at
Resistance Ω scheduled times such as per shift, daily,
Activity Becquerel Bq weekly, monthly, or yearly.
(radionuclide)
Volume Cubic meter m³ QUICK QUIZ:
Tissue injury Is greatly associated with elevated
The National Institute of Standards and levels of blood
Technology (NIST) recognizes the use of five a. Electrolytes b. hormones c. enzymes d. albumin
specific types of calibrating weights. b.
 Class S weights - for monthly calibration of Electrochemical methods are ideal for the
analytical balances measurement of serum/plasma
 Class M weights - to calibrate the weights a. Glucose b. enzymes c. proteins & amino acids
themselves since their quality is that of d. metal ions
primary standards.
 Class S-1 - used for routine analytical work. Identify the analyte measured using the following
 Class P weights - are allowed greater tests and the type of each test:
tolerance levels than Class S-1 1. Jaffe reaction
 Class J weights - used for microanalytical 2. Hantzsch test
work. 3. GOD-PAP
4. Clark-Collip
The accuracy of the thermometer used to 5. Schales and Schales
monitor the incubation temperature of an 6. Evelyn-Malloy
instrument should be verified every 6 to 12 months. Which of the following is an aluminum silicate glass
 Reference thermometers must be certified that is at least six times stronger than borosilicate
by the NIST. and is resistant to alkaline etching and scratching?
a. Kimax b. Pyrex
 For the monitoring of enzymatic reactions,
c. Corning boron free d. Corex
thermometers should agree within 0.1°C
The tinted glass which is ideal for delayed testing
with the NIST reference thermometer
of light sensitive substances is
 Thermometers used to check refrigerator
a. standard flint b. soda lime c. actinic d. boron free
and freezer temperatures should agree
within 0.1°C with the reference
The internal tubings of clinical analyzers should be
thermometer. Thermometers should be
made of
MONTEMAR, T.M. 10
 CLINICAL CHEMISTRY 1 – INTRODUCTION TO BASICS & QC IN CC1

a. Teflon fluorocarbon b. polycarbonate d. distillation and deionization

c. Tygon d. polyvinylchloride
Xylene, ethanol, methanol, and acetone would be
The advantages of this plastic is that it can be in which hazard class?
made into very thin sheets and can withstand a. corrosive b. flammable c. oxidizer d. all of the
extreme temperatures. above
a. Polyolefins b. Polycarbonate
Precautions such as using a fume hood, wearing
The College of American Pathologists (CAP) rubber gloves, donning a respirator, and cleaning
requires that volumetric pipets and flasks be glassware with a strong acid or organic solvent are
certified as: a. Class A b. Class B c. Class C d. consistent with working with
Class D a. corrosives b. carcinogens c. azides d. all
reagents
“To deliver” (TD) pipettes are identified by
a. two etched bands near the mouthpiece Which of the following may be safely pipetted by
b. self-draining capacity c. dual purpose pipet mouth?
labels a. serum b. urine c. saline solution d. none of the
d. blue graduation levels above

Regarded as the ultimate standard by IUPAC is The speed of the centrifuge should be checked at
a. Grade A b. Grade B c. Grade C d. Grade D least once every three (3) months with a /an
a. tachometer b. wiper c. potentiometer d.
What is the most common use of a standard in the ergometer
clinical laboratory?
a. to verify accuracy of results A corrosive material was spilled onto the hand of a
b. to standardize the testing laboratorian. After diluting the material under
c. to compare its value with the results obtained running
d. to obtain the concentration of the cold water, what should be done next?
What is the most appropriate term to describe a. consult the MSDS
water that is used as a solvent in the clinical b. wipe up spills with paper towels
laboratory? c. dilute spills and remove it in a biohazard bag
a. distilled water b. deionized water c. reagent d. go to the emergency room
grade water d. tap water
Which of the following information is found in the
The type of water desired for use in test methods MSDS?
requiring maximum accuracy and precision is a. Health hazard data b. Fire & explosion hazard
a. distilled b. pure grade c. type I d. type II data
c. First Aid measures d. All of the above
What is effectively removed by activated charcoal
adsorption in water purification? A fire extinguisher used in the event of an electrical
a. charged chemicals b. microbes and pyrogens fire should include which of the following
c. toxic gases d. organic compounds classifications?
a. type A b. type B c. type C d. type D
What purification method is ideal for the removal of
pyrogens and microorganisms? In the Hazards Identification System, what hazard
a. activated charcoal adsorption does the blue diamond positioned to the left
b. semipermeable membrane filtration identify?
c. reverse osmosis a. flammable b. health c. reactivity d. contact

MONTEMAR, T.M. 11
 CLINICAL CHEMISTRY 1 – INTRODUCTION TO BASICS & QC IN CC1

The major job-related hazard in clinical laboratories

produces symptoms of malaise, anorexia, nausea,
vomiting, fatigue, diarrhea, and abdominal
tenderness is
a. AIDS b. salmonellosis c. tuberculosis d. hepatitis

A laboratory professional was asked to send a

blood specimen from an HIV positive patient to a
laboratory for special tests. The specimen must be
properly labeled and shipped as
a. infectious substance b. diagnostic specimen
c. biological product d. clinical specimen

SI units are designated units employed by the

International System of Units. The unit class that
encompasses the seven fundamental quantities of
measurement is
a. base b. primary c. derived d. elemental

Which of the following is most commonly

represented by a derived unit?
a. amount of substance b. electric current
c. mass d. substance concentration

References:
PPT – MLS 043 Introduction to Basics & QC in
CC1 Slides 1 – 72
MLS 043 CC1 SAS Module 1

MONTEMAR, T.M. 12