BIOCHEMISTRY I

Lesson 2
Automation in Clinical Chemistry
Part II

Introduction to Clinical Chemistry

Blood chemistry test: routine or scheduled
Routine - frequently ordered (e.g. glucose test,
chemistry profiles such as renal, lipid and liver
profile).
Scheduled - performed only 2 or 3 times / week
(e.g. hormone, certain drugs levels). These tests
are requested when a particular diagnosis is
suspected or treatment must be monitored.

Types of Specimen for Chemical Analysis

Specimens include:
Blood
Urine
Cerebrospinal fluid
Synovial fluid
Pleural fluid
Ascites fluid
Pericardial fluids

Less common,
collected by
physician only

Units of Measurement
Usually reported in metric units or SI units.
Commonly used:
Milligrams (mg) or micrograms (g) per
deciliter (dL).
Millimoles per liter (mmol/L)
Enzymes activity units per liter (U/L)

Analytes Commonly Tested in Chemistry

Profile
1. Protein
Essential components of cells and body fluids
2 major groups of serum protein: albumins
and globulins
Albumins: made in liver, serve as transport
proteins and help maintain fluid balance in
body (by maintaining colloid osmotic
pressure).
Globulins: antibodies, blood coagulation
proteins, enzymes and proteins that
transports irons

Analytes Commonly Tested in

Chemistry Profile
a. Total Serum Protein
Normal concentration: 6.0 - 8.0 g/dL (60 - 80
g/L)
Provides information about the state of
hydration, nutrition and liver function (as
most serum proteins are made in the liver).
Proteins are most commonly measured in
serum, but can also be found in urine and CSF
(concentration is normally low).
Can be measured clinically using a
refractometer.

Analytes Commonly Tested in

Chemistry Profile
b. Albumin
Normal concentration: 3.8 - 5.0 g/dL
Hypoalbuminemia (decreased level of
albumin) cause by liver disease, starvation,
impaired amino acid absorption, increased
protein catabolism and protein loss
through skin, kidneys or gastrointestinal
tract.

Analytes Commonly Tested in

Chemistry Profile
c. Albumin to Globulin Ratio
Total serum protein and albumin are
usually measured in a sample together.
Globulins is computed from the difference
(total protein - albumin = globulin).
Ratio of albumin to globulin (A/G ratio) computed and reported.

Analytes Commonly Tested in

Chemistry Profile
2. Electrolytes
Refers to the major ions: cations (Na+ & K+) and
anions (Cl- & HCO3-).
All those affect hydration and pH balance, heart
and muscle formation.
Sodium: 135 - 148 mmol/L
Potassium: 3.5 - 5.4 mmol/L
Chloride: 98 - 108 mmol/L
Bicarbonate: 22 - 28 mmol/L

Analytes Commonly Tested in

Chemistry Profile
3. Mineral metabolism
Commonly measured minerals are calcium,
phosphorus (phosphate) and iron.
Calcium: for bone and teeth formation, blood
coagulation.
Phosphorus: development of teeth and bones.
Iron: haemoglobin production.

Analytes Commonly Tested in

Chemistry Profile
a. Calcium
Serum calcium reference range: 8.7 - 10.5 mg/dL.
99% of body calcium is bound in calcium
complexes in the skeleton and are not
metabolically active.
Calcium assay: measure only unbound Ca2+ ions,
which are metabolically active.
Hypercalcemia cause Ca deposition in soft organs
(e.g. kidney stones).
Hypocalcemia can be life threatening.

Analytes Commonly Tested in

Chemistry Profile
b. Phosphorus
Normal serum phosphorus: 3.0 - 4.5 mg/dL
Mostly found in the form of inorganic phosphate.
80% is in the bone, the rest in high energy
compound (e.g. ATP).
Level influenced by calcium and certain
hormones.

Analytes Commonly Tested in

Chemistry Profile
c. Iron
Normal serum iron concentration: 65 - 165 g/dL
Iron is transported by transferrin (serum protein)
in blood.
Anemia is caused by iron deficiency.

Analytes Commonly Tested in

Chemistry Profile
4. Kidney Function
Kidneys: eliminate waste products, maintains
water and pH balance, produce certain
hormones (from adrenal glands e.g.
aldosterone).
Substances are excreted and reabsorbed from
urine to maintain homeostasis.

Analytes Commonly Tested in

Chemistry Profile
a. Creatinine
Normal serum creatinine: 0.7 - 1.4 mg/dL
Creatinine is the waste product of creatine
phosphate.
Their levels are not affected by diet or hormone
levels.
Increases when there is impairment of urine
formation or excretion.

Analytes Commonly Tested in

Chemistry Profile
b. Blood Urea Nitrogen (BUN)
Normal BUN concentration: 8 - 18 mg/dL
BUN is a measure of surplus amino acids.
Concentration influenced by diet, hormones, and
kidney function. Therefore, it is not a good
indicator of kidney disease as creatinine.

Analytes Commonly Tested in

Chemistry Profile
c. Uric Acid
Normal serum uric acid: 3.5 - 7.5 mg/dL
Formed from breakdown of nucleic acids and is
secreted by kidneys.
Has low solubility - tends to precipitate as uric
acid crystals (urates).
Use to diagnose and treat gout (precipitation of
uric acid in tissues and joints).
Levels can also increase after massive
radiation/chemotherapy - due to increased cell
destruction

Analytes Commonly Tested in

Chemistry Profile
5. Liver Function
Role of liver:

Carbohydrate metabolism - glycogen and glucose

Produce plasma proteins, transport proteins and
blood coagulation proteins
Important in lipid metabolism - source of
cholesterol
Storage site for iron, glycogen and vitamins
Destruction of old cells (phagocytosis) and
detoxification

Analytes Commonly Tested in

Chemistry Profile
a. Bilirubin
Total serum bilirubin: 0.1 - 1.2 mg/dL
Bilirubin is waste product from breakdown of
haemoglobin (formed in liver, excreted in bile)
In liver, most bilirubin binds to glucuronide and is
excreted into bile (called conjugated or direct
bilirubin)
Non-conjugated bilirubin (indirect bilirubin)

Analytes Commonly Tested in

Chemistry Profile
Total serum bilirubin = direct bilirubin +
indirect bilirubin
Bilirubin assays measures both total and direct
bilirubin
Indirect bilirubin is obtained by subtraction
Bilirubin assay is done to screen for or monitor
gall bladder or liver dysfunction
Since bilirubin levels are normally low, only
high values are significant

Analytes Commonly Tested in

Chemistry Profile
b. Liver enzymes
Enzymes used to assess liver function are:

Alkaline phosphatase (ALP)

Aspartate aminotransferase (AST aka SGOT)
Alanine aminotransferase (ALT aka SGPT)
Gamma glutamyl transferase (GGT)
Lactate dehydrogenase (LDH)

Analytes Commonly Tested in

Chemistry Profile
i. Alkaline phosphatase (ALP)

Also known as AP
Widely distributed in body especially in bone
and liver ducts
Reference range: 20 - 130 U/L

Analytes Commonly Tested in

Chemistry Profile
ii. Aspartate aminotransferases

Aspartate aminotransferase (AST) or formerly

called serum glutamic oxaloacetic transaminase
(GOT or SGOT)
Present in tissues such as cardiac, muscle and
liver
Elevated after myocardial infarction (heart
attack) and liver disease
Reference range: 10 - 37 U/L

Analytes Commonly Tested in

Chemistry Profile
iii. Alanine aminotransferases

Alanine aminotransferase (ALT), formerly called

serum glutamic-pyruvic transaminase (GPT or
SGPT)
Low levels in cardiac tissue; high in liver tissue
Level usually rise higher than AST in liver disease
Reference range: 3 - 30 U/L

Analytes Commonly Tested in

Chemistry Profile
iv. Gamma glutamyl transferase (GGT)

Found in kidney, pancreas, liver and prostate

tissue
More helpful than AP in determining liver
damage because GGT remains normal in bone
disease
More useful than AST because it remains normal
in muscle disorders
GGT values are used to monitor recovery from
hepatitis
Reference range: 3 - 40 U/L

Analytes Commonly Tested in

Chemistry Profile
v. Lactate dehydrogenase (LDH)

Also called LD
Level increase in blood during liver disease and
after myocardial infarction
Reference range: 110 - 230 U/L

Analytes Commonly Tested in

Chemistry Profile
6. Cardiac Function
Creatinine kinase (CK), is an enzyme used to
diagnose myocardial infarction
Following myocardial infarction, CK is released
from the damaged heart muscle
Serum CK peaks in about 24 hrs; fall back to
normal range within 3 - 4 days
Reference range: 30 - 170 U/L

Analytes Commonly Tested in

Chemistry Profile
7. Lipid Metabolism
a. Cholesterol & Cholesterol fractions
Serum cholesterol concentration tend to increase
with age
Reference: 140 - 250 mg/dL (best to maintain below
200 mg/dL)
LDL (low density lipoprotein)
Measured
HDL (high density lipoprotein)

Remove cholesterol from bloodstream and carry it to liver

VLDL (very low density lipoprotein)

Analytes Commonly Tested in

Chemistry Profile
b. Triglycerides (TG)
Reference range: 10 - 190 mg/dL
Triglycerides are transported in the plasma
bound to lipoproteins
Blood to be tested for triglycerides should be
collected when the patient has been fasting for
12 - 14 hrs

Analytes Commonly Tested in

Chemistry Profile
8. Carbohydrate Metabolism
Glucose
Reference range: 70 - 110 mg/dL
Carbohydrate metabolism influenced by insulin
produced by pancreas
Also affected by growth hormone, glucagon and
cortisol

Analytes Commonly Tested in

Chemistry Profile
9. Thyroid Function
In blood, more than 99% of thyroid hormones
are bound to serum proteins and are
metabolically inactive
2 major hormones: Thyroxine (T4) & Triiodothyronine (T3)
Thyroid profiles include measurements of free or
total T4, free or total T3 and thyroid stimulating
hormone (TSH) levels

Analytes Commonly Tested in

Chemistry Profile
Reference range for TSH: 0.35 - 5.0 IU/L (mIU/L)
Levels may vary according to age
Reference ranges can be different depending on
the assay method

Less Commonly Ordered Clinical

Chemistry Tests
Special tests that measure:
Insulin
Growth hormone
Adenocorticotrophic hormone (ACTH)
Follicle stimulating hormone (FSH)

Less Commonly Ordered Clinical

Chemistry Tests
Other tests measure:
Vitamins
Trace minerals
Isoenzymes
Metabolic products

These tests need special specimen collection

and specialised instrumentation
A clinical chemistry test should be consulted
for more information