INTRODUCTION TO CHEMPATH

INTRO:

CHEMICAL PATHOLOGY/CLINICAL
CHEMISTRY/CLINICAL BIOCHEMISTRY

INCORPORATES ASPECTS OF:

PHYSIOLOGY
CHEMISTRY
BIOCHEMISTRY
 COURSE ACTIVITIES
LECTURES

WET PRACTICALS

TUTORIALS
 CA AND PROFFESSIONAL EXAMS
CA
COMBINED MCQs

PROFFESSIONAL EXAMS
MCQs 20 + 20
ESSAYS 4+ 4 (ANSWER ANY 4)
PRACTICAL PAPER (NORMALLY 2 + 2)
 CHEMPATH
ANALYSIS OF INDIVIDUAL CONSTITUENTS IN
BODY FLUIDS THAT PROVIDES INFORMATION
REGARDING THE FUNCTION OR INTEGRITY OF
A TISSUE, ORGAN OR ORGAN SYSTEM

EFFICACY OF A TEST DEPENDS SPECIFICITY

AND SENSITIVITY TO DETECT PATHOLOGICAL
CHANGE
 PURPOSE OF CHEM PATH TESTS
TO MEASURE/DETECT

LEVELS OF SUBSTANCES THAT HAVE BIOLOGICAL FUNCTION

(GLUCOSE, CALCIUM)

NON-FUNCTIONAL METABOLITES/WASTE PRODUCTS

(UREA/CREATININE)

SUBSTANCES THAT INDICATE CELL DAMAGE OR DISEASE (ALT,

CKMB)

DRUGS OR TOXIC SUBSTANCES (DIGOXIN/ CARBON MONOXIDE)

 Steps in the Investigation of a Patient
PATIENT HISTORY
PHYSICAL EXAMINATION
LABORATORY TESTS
IMAGING TECHNIQUES
DIAGNOSIS
THERAPY
EVALUATION
 Clinical Chemistry Laboratory
Organization
CORE LAB FACILITY

FOUND AT VIRTUALLY ALL HOSPITALS

OPERATES 24/7 TO PROVIDE THE ESSENTIAL MOST REQUESTED TESTS

HIGHLY AUTOMATED ENVIRONMENT

INSTRUMENTS WITH MULTI-ANALYTE CAPABILITIES

 Clinical Chemistry Laboratory
Organization
SPECIAL CHEMISTRY

LESS FREQUENTLY ORDERED TESTS

LABOUR INTENSIVE AND OFTEN MANUAL METHODS

GENERALLY NON-STAT TESTS (RESULT NOT REQUIRED

IMMEDIATELY)
 Clinical Chemistry Laboratory
Organization
POINT OF CARE TESTING (POCT)

INSTRUMENTS LOCATED OUTSIDE OF CHEMISTRY

LABORATORY SUCH AS CCU, ER, ICU OR SATELLITE CENTRE
(CLINIC)
Core Lab Instrumentation
Special Chemistry Instrumentation and
Analytical Methods
ELECTROPHORESIS
SEPARATION OF SERUM PROTEINS INTO 5 DISTINCT BANDS
SEPARATION OF LIPOPROTEINS INTO 4 DISTINCT BANDS
SEPARATION OF ISOFORMS OF ENZYMES
HPLC
ANALYSIS OF VITAMINS AND HEMOGLOBIN VARIANTS
INFRARED SPECTROSCOPY
ANALYSIS OF KIDNEY STONES
RADIOIMMUNOASSAY (RIA)/ELISAS
USED LESS AND LESS BUT STILL EMPLOYED FOR THOSE ANALYTES PRESENT IN MINUTE
AMOUNTS (PMOL) IN THE BLOOD (IE. TESTOSTERONE)
GC-MS (GAS CHROMATOGRAPHY-MASS SPECTROSCOPY) AND/OR LC-MS (LIQUID
CHROMATOGRAPHY- MASS SPECTROSCOPY.
QUANTITATION OF DRUG MEASUREMENT
 POC Instrumentation

Cardiac Markers Drug Screen Urinalysis

Qualitative, pseudo-quantitative
Visual qualitative tests and/or quantitative
Results must be recorded Hard copy of result generated
and reported manually Possible LIS interface
 POC instrumentation
VISUAL QUALITATIVE TESTS

RESULTS RECORDED AND REPORTED

MANUALLY
 The Test
IDEAL MARKER

SPECIFIC FOR A SPECIFIC DISEASE

EASILY MEASURABLE
QUANTITY CORRELATES WITH DISEASE SEVERITY
EARLY DETECTION FOLLOWING ONSET OF
DISEASE
NOT AFFECTED BY OTHER BIOLOGICAL
DISTURBANCES
 The Test
HIGHLY SPECIFIC MARKER:

TROPONIN I. MARKER OF MYOCARDIAL

INFARCTION

PREDOMINATES IN CARDIAC TISSUE

RELEASED INTO THE BLOOD STREAM FOLLOWING

CELL DEATH
 The Test
Non specific marker: low blood pH (acidosis)

Very important to know but can be caused by

a hosts of events

Drugs
Respiratory problems
Renal problems
 Biological Samples
BLOOD
URINE
CEREBROSPINAL FLUID
AMNIOTIC FLUID
DUODENAL ASPIRATE
GASTRIC JUICE
GALL STONE
KIDNEY STONE
STOOLS
SALIVA
SYNOVIAL FLUID
TISSUE SPECIMEN
SWEAT
 The Test
Choice of specimen type depends on

Analyte to be measured

Ease of collection
Steps in obtaining a laboratory test
TEST ORDERED BY CLINICIAN
SPECIMEN IS COLLECTED
SPECIMEN AND ORDER ARE TRANSPORTED TO
THE LAB
THE SPECIMEN IS ACCESSIONED IN THE LAB
PRETEST PROCESSING
TEST EXECUTION
RESULTS REVIEWED AND VERIFIED BY A LAB
SCIENTIST
RESULTS RELEASED TO THE PATIENTS RECORD
 Analytical Procedures/Methods
TOO NUMEROUS TO COVER!
PHOTOMETRY
FLUOROMETRY
NEPHELOMETRY
ELECTROPHORESIS
ISOTOPIC IMMUNOASSAY
CHROMATOGRAPHY
SPECTROMETRY