INTRODUCTION TO CHEMICAL PATHOLOGY

INTRODUCTION
Chemical Pathology (Clinical Biochemistry) is the study of biochemical changes in the body due
to diseases. It focuses on analyzing various biological fluids to understand chemical imbalances
or abnormal metabolic processes, which help in diagnosing and managing diseases. Chemical
pathologists use sophisticated techniques to measure concentrations of enzymes, hormones,
electrolytes, lipids, and other metabolites, providing critical data for patient care.
○ Biochemical Changes: Disease often causes chemical changes in the blood or other
body fluids, like an increase in liver enzymes or glucose in diabetes.
○ Metabolic Processes: Conditions such as metabolic disorders (e.g., inborn errors of
metabolism) affect how the body processes carbohydrates, fats, and proteins.
● PURPOSE:
1. Diagnosis: Helps in identifying diseases by measuring abnormal levels of substances like
enzymes, electrolytes, or hormones (e.g., elevated blood glucose in diabetes).
2. Monitoring Treatment: Periodic testing helps clinicians evaluate how well a treatment is
working. For example, measuring HbA1c levels in diabetes helps monitor long-term blood
sugar control.
3. Prognosis: Chemical pathology can help predict the outcome or progression of a disease.
For example, persistent elevation in liver enzymes in a patient with hepatitis may indicate
worsening liver function.
4. Screening: Preventive screening tests, such as cholesterol levels for cardiovascular
disease risk or blood glucose levels for diabetes, identify individuals at risk before they
develop symptoms.

REQUEST FOR LABORATORY INVESTIGATIONS

A Laboratory Investigation Request is a formal order from a healthcare professional for
specific tests, aimed at assisting in diagnosis, monitoring, or screening. This request
serves as a communication tool between the healthcare provider and the laboratory to
ensure that appropriate and relevant tests are performed.
● COMPONENTS OF A LAB REQUEST
1. Patient Information: Full patient details, including name, age, gender, and medical
record number
2. Clinical Information: The presenting symptoms, previous medical history, and
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provisional diagnosis, which help the laboratory prioritize and interpret test results.
3. Test Requested: A specific list of tests, such as liver function tests, blood glucose,
or electrolyte levels, tailored to the patient’s condition.
4. Reason for Test: Whether for diagnosis, treatment monitoring, or screening.
● IMPORTANCE:
1. Clear Communication: A clear and detailed request minimizes the chance of errors
and ensures appropriate tests are performed.
2. Correct Test Selection: A properly filled request ensures that the right tests are
chosen for the patient’s condition.

QUALITY CONTROL, PRECISION and ACCURACY

In the laboratory, ensuring the accuracy and precision of test results is critical. Quality
control (QC) processes are put in place to guarantee that results are reliable and
consistent over time.
○ Accuracy is defined as how close the laboratory result is to the true value. For
instance, if a test shows a blood glucose level of 90 mg/dL and the true level is 90
mg/dL, the test is accurate.
○ Precision refers to the ability of the laboratory to consistently reproduce the same
result when testing the same sample multiple times.
● IMPORTANCE OF QUALITY CONTROL
1. Accurate Diagnoses: Accurate test results help in making correct diagnoses. For
example, incorrectly high blood sugar levels could lead to unnecessary treatment
for diabetes.
2. Patient Safety: Ensuring precision and accuracy prevents misdiagnosis and
inappropriate treatment.
3. Regulatory Compliance: Laboratories must adhere to quality standards set by
regulatory bodies to maintain accreditation and ensure high standards of patient
care.
● ELEMENTS OF QUALITY CONTROL
○ Control Samples: These are samples with known values tested alongside patient
samples. The results are compared to expected values to check accuracy.
○ Calibration: Instruments are regularly calibrated using standards to ensure their
accuracy.
○ Reagent Monitoring: Chemicals and reagents used in tests are checked regularly for
quality and consistency.
NOTE
There are two essential components of quality control in clinical laboratories:
 1. Internal Quality Control (IQC):
○ Daily Monitoring: IQC involves testing control samples with known concentrations of
analytes daily. These control samples check the performance of laboratory
equipment.
○ Troubleshooting: If control sample results fall outside acceptable ranges, it triggers
an investigation into potential errors, such as instrument malfunction or reagent
issues.
○ Ensures Consistency: IQC ensures that results obtained on different days and by
different operators are consistent.
2. External Quality Assessment (EQA):
○ Inter-laboratory Comparisons: EQA involves comparing the results of samples tested
by multiple laboratories. It helps ensure consistency and accuracy across different
labs.
○ Benchmarking Performance: EQA schemes provide a performance benchmark,
highlighting laboratories that need to improve their procedures.
● QUALITY CONTROL PROCEDURES
1. Levey-Jennings Charts: These are used to track control results over time and detect
trends or shifts that indicate potential issues in the testing process.
2. Westgard Rules: A set of statistical rules applied to control data to detect any
outliers or trends that might suggest an error in the analytical process.

COLLECTION/PRESERVATION OF SPECIMENS: BLOOD, URINE AND STOOL

The proper collection and preservation of biological specimens are essential to obtain
valid test results. Any errors in collection, handling, or storage can lead to incorrect
results, which could misguide treatment decisions.
● BLOOD COLLECTION
1. Venipuncture: Blood is usually drawn from a vein in the arm using a sterile needle
and syringe or a vacuum tube system (e.g., Vacutainer).
– Anticoagulants: Blood samples may need preservatives like EDTA (for full blood
counts) or heparin (for blood gases).
– Handling: Some tests, like potassium or glucose, require immediate processing to
avoid changes in the sample.
2. Capillary Sampling: In some cases, like for glucose testing in diabetics, a small
blood sample from a finger prick may suffice.
● URINE COLLECTION
1. Random Urine Sample: Collected anytime for general screening (e.g., dipstick
analysis for glucose or protein).
 2. Midstream Urine Sample: Reduces contamination from the skin or genitals and is
commonly used for bacterial culture tests.
3. 24-hour Urine Collection: Used for tests measuring substances that fluctuate
throughout the day (e.g., creatinine clearance or protein levels).
Preservation: Samples may be refrigerated to prevent bacterial growth and chemical
changes.
● STOOL COLLECTION
1. Stool for Microbiology: Collected in sterile containers for bacterial, parasitic, or viral
cultures.
2. Stool for Occult Blood: Used to detect hidden blood in the stool, often used in
screening for gastrointestinal bleeding or colorectal cancer.
3. Handling: Stool samples may be mixed with preservatives for specific tests, like
fecal fat tests.

TESTS OF GASTROINTESTINAL FUNCTION: PANCREATIC EXOCRINE FUNCTION TEST

The pancreas plays a key role in digestion by secreting digestive enzymes (amylase,
lipase, protease) into the small intestine. Pancreatic exocrine function tests assess
whether the pancreas is producing enough of these enzymes to aid in digestion.
● COMMON TEST
1. Fecal Elastase Test:
– This measures elastase, a pancreatic enzyme, in the stool. Low levels indicate
exocrine pancreatic insufficiency, commonly seen in chronic pancreatitis or cystic
fibrosis.
2. Secretin Stimulation Test:
– Secretin is a hormone that stimulates the pancreas to release enzymes and
bicarbonate. After administering secretin, pancreatic fluid is collected, and its
enzyme and bicarbonate levels are measured.
3. 72-hour Fecal Fat Test:
– Measures the amount of fat in the stool over a three-day period. Excessive fat
suggests malabsorption, often due to pancreatic insufficiency.

MALABSORPTION SYNDROME
Malabsorption syndrome occurs when the small intestine cannot absorb nutrients
effectively, leading to deficiencies and malnutrition. Causes include pancreatic diseases,
liver diseases, and intestinal disorders that damage the absorptive surface of the gut.
● COMMON CAUSES
1. Pancreatic Insufficiency: Conditions like chronic pancreatitis or cystic fibrosis result
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in inadequate production of digestive enzymes, leading to malabsorption of fats,
proteins, and carbohydrates.
2. Liver Disease: Bile, produced by the liver, is necessary for fat digestion. Diseases
like cirrhosis can impair bile production and result in fat malabsorption.
3. Celiac Disease: An autoimmune disorder where gluten consumption leads to
damage in the small intestine’s villi, reducing nutrient absorption.
4. Infections and Inflammation: Conditions like Crohn’s disease, tuberculosis, or
intestinal infections can damage the intestinal lining, impairing absorption.
● TEST FOR MALABSORPTION
1. Fecal Fat Test: Measures the fat content in stool. High levels of fat indicate fat
malabsorption, often linked to pancreatic or liver dysfunction.
2. D-xylose Absorption Test: Measures the ability of the intestines to absorb a simple
sugar (D-xylose). Impaired absorption may indicate intestinal mucosal disease.
3. Endoscopy and Biopsy: Direct visualization and tissue sampling from the small
intestine can reveal structural abnormalities, such as villous atrophy in celiac
disease.
4. Blood Tests: Nutrient deficiencies (e.g., iron, vitamin D, folate) can indicate
malabsorption, as these nutrients are normally absorbed in the small intestine.
By thoroughly investigating these aspects, clinicians can diagnose and