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Clinical Chemistry PDF

This document provides an overview of the clinical chemistry section of a medical laboratory. It discusses the areas and tests performed in clinical chemistry, including general chemistry, electrophoresis, toxicology, and immunochemistry. It describes sample collection and handling procedures. It also outlines the priorities for collecting routine, stat, and timed samples. It provides details on fasting samples and glucose tolerance tests used to diagnose diabetes and gestational diabetes.

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Gab Bravo
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224 views23 pages

Clinical Chemistry PDF

This document provides an overview of the clinical chemistry section of a medical laboratory. It discusses the areas and tests performed in clinical chemistry, including general chemistry, electrophoresis, toxicology, and immunochemistry. It describes sample collection and handling procedures. It also outlines the priorities for collecting routine, stat, and timed samples. It provides details on fasting samples and glucose tolerance tests used to diagnose diabetes and gestational diabetes.

Uploaded by

Gab Bravo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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THE CLINICAL CHEMISTRY

SECTION
UNIT OUTCOMES
At the end of this unit, the student is able to:
1. Define the areas in clinical chemistry
2. Explain the sample collection in clinical chemistry
3. Know the different tests performed in clinical chemistry section
4. Define the various test collection priorities.
5. Define a fasting sample, and name three tests affected by not fasting.
6. Describe the phlebotomist’s duties when administering an oral glucose tolerance
test for diabetes mellitus and gestational diabetes.

OUR LADY OF FATIMA UNIVERSITY / COLLEGE OF MEDICAL LABORATORY SCIENCE – VALENZUELA CAMPUS / JOSHUA LUIGI D. RAMEL, RMT ([email protected])
I. OVERVIEW
CLINICAL CHEMISTRY SECTION
• Most automated area of the laboratory
• Instruments are computerized and designed to perform single and
multiple tests from small amounts of specimen
II. AREAS IN CLINICAL CHEMISTRY:
• General or automated chemistry
• Electrophoresis
• Toxicology
• Immunochemistry
III. SAMPLE COLLECTION AND HANDLING
• Tests are performed primarily on SERUM collected in gel barrier
tubes, but the serum may also be collected in tubes with red, green,
gray, or royal blue stoppers.

• Also performed on plasma, urine, and other body fluids


III. SAMPLE COLLECTION AND HANDLING
• Serum and plasma are obtained by centrifugation,
which should be performed within 1 to 2 hours of
collection

• Because many tests are performed on instruments


that take photometric readings, differences in the
appearance or color of a specimen may adversely
affect the test results
III. SAMPLE COLLECTION AND HANDLING
• Specimens of concern include:
• Hemolyzed specimens- appear red because of
the release of hemoglobin from rbcs
• Icteric specimens – appear yellow because of
the presence of excess bilirubin
• Lipemic specimens- are cloudy because of
increased lipids
III. SAMPLE COLLECTION AND HANDLING
• Fasting samples drawn from patients who have not eaten for 8 to 12
hours are preferred.

• Serum separator tubes contain an inert gel that prevents contamination


of the specimen by RBCs or their metabolites.

• Samples must be allowed to clot fully before centrifugation to ensure


complete separation of the cells and serum.

• Many chemistry tests require special collection and handling


procedures, such as chilling and protection from light
IV. TESTS PERFORMED IN THE CHEMISTRY SECTION
IV. TESTS PERFORMED IN THE CHEMISTRY SECTION
IV. TESTS PERFORMED IN THE CHEMISTRY SECTION
V. COLLECTION PRIORITIES
1. Routine Samples
• tests that are ordered by the health-care provider to diagnose and monitor a patient’s
condition.
• usually collected early in the morning but can be collected throughout the day during
scheduled “sweeps” (collection times) on the floors or from outpatients.

2. ASAP Samples
• “as soon as possible.”
• The response time for the collection of this test sample is determined by each hospital or
clinic and may vary by laboratory tests.
V. COLLECTION PRIORITIES
3. Stat Samples
• Stat means the sample is to be collected, analyzed, and results reported immediately.
• highest priority and are usually ordered from the emergency department or for a critically ill
patient whose treatment will be determined by the laboratory result.
• The sample must be delivered to the laboratory promptly and the laboratory personnel
notified.
VI. FASTING SAMPLES
• The patient must only have refrained from eating and drinking (except water) for
12 hours

• Drinking water is encouraged to avoid dehydration in the patient, which can affect
laboratory results.

• Test results most critically affected in a nonfasting patient are those for glucose,
cholesterol, triglycerides, or lipid profiles.

• Prolonged fasting increases bilirubin and triglyceride values and markedly


decreases glucose levels.
VI. FASTING SAMPLES
• When a fasting sample is requested, it is the responsibility of the phlebotomist to
determine whether the patient has been fasting for the required length of time.

• If the patient has not, this must be reported to a supervisor or the nurse and noted
on the requisition form if the decision is made to collect the sample nonfasting.
VII. TIMED SAMPLES
• Requisitions are frequently received requesting that blood be drawn at a specific
time.

• Phlebotomists should arrange their schedules to be available at the specified time


and should record the actual time of collection on the requisition and sample tube.
VIII.GLUCOSE TOLERANCE TESTS
• For the diagnosis of diabetes mellitus and gestational diabetes.
• Included the 2-hour postprandial (pp) glucose test and the classic glucose
tolerance test (gtt).
GTT Preparation
• Before the test, patients should be instructed to eat a balanced diet that includes
150 g per day of carbohydrates for 3 days and to fast for 12 hours but not more
than 16 hours.
• Certain medications can interfere with the test results:
• Alcohol
• Anticonvulsants
• Aspirin
• Birth control pills
• Blood pressure medications
• Corticosteroids
• Diuretics
• Estrogen-replacement pills
GTT Preparation
• For glucose tolerance tests, the fasting patient should be instructed to abstain from
food and drinks including coffee and unsweetened tea, except water, for 12 hours
but not more than 16 hours before and during the test.

• Smoking, chewing tobacco, alcohol, sugarless gum, and vigorous exercise should
be avoided before and during the test because they stimulate digestion and may
cause inaccurate test results.

• Note on the requisition form if the patient is chewing gum


2-Hour Oral Glucose Tolerance Test
• Recommended method for the diagnosis of diabetes mellitus.
• Requires the collection of a fasting glucose sample, having the patient drink a 75-g
glucose solution within 5 minutes and return for an additional glucose test in 2
hours.
• Diabetes mellitus= ≥200 mg/dl
One- and Two-Step Method for Gestational Diabetes
1. One-step method
• Utilizes the same procedure as the diagnostic OGTT used to diagnose diabetes
mellitus
• Normal value: ≤ 140 mg/dl

2. Two-step method
• Requires the patient to receive two tests.
• First a 50-g glucose challenge load is administered to the fasting patient and blood collected
and tested at 1-hour postingestion.
• The second test is administered on a different day and consists of either a 75-g OGTT or a
100-g 3-hour OGTT based on institutional protocol and health-care provider preferences.
Normal Values:
2-hour 75-g test: 155mg/dL
3-hour 100-g test: 140 mg’dL
IX. LACTOSE TOLERANCE TEST
• Evaluates a patient’s ability to digest lactose, a milk sugar.
• The enzyme mucosal lactase converts lactose into glucose and galactose.
• Patients without this enzyme are unable to break down lactose from milk and milk
products, which may result in gastrointestinal discomfort and diarrhea.
• Avoiding milk can reduce the symptoms.

• The patient is asked to drink a standardized amount of lactose solution based on


body weight in place of the glucose.
• A blood collection schedule is similar to a 2-hour GTT.
• Glucose levels will raise no more than 20 mg/dL from the fasting sample result if
the patient is lactose intolerant.
X. REFERENCES
Textbooks

1. Di Lorenzo, M.S., Strasinger, S.K. (2011). The Phlebotomy Textbook (3rd Edition)

Lecture Notes

1. Darlucio, Rochelle (RMT), Pagdanganan, John Kenneth (RMT), (2018), Ramel, Joshua Luigi (RMT), (2018)

OUR LADY OF FATIMA UNIVERSITY / COLLEGE OF MEDICAL LABORATORY SCIENCE – VALENZUELA CAMPUS / JOSHUA LUIGI D. RAMEL, RMT ([email protected])

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