Clinical Chemistry

prepared byprepared by

Dr. Akaber TarekDr. Akaber TarekBiochemistry DepartmentBiochemistry Department

Clinical Chemistry

prepared byprepared by

Dr. Akaber TarekDr. Akaber TarekBiochemistry DepartmentBiochemistry Department

Plasma & SerumPlasma & Serum

PlasmaPlasma Blood + clotting Blood + clotting

factorfactor Formed elements.Formed elements. Contain fibrinogen Contain fibrinogen

& pr-othrombin.& pr-othrombin. No thrombin is No thrombin is

formed.formed.

SerumSerum Blood – clotting Blood – clotting

factor.factor. Formed elements.Formed elements. No fibrinogen& pr-No fibrinogen& pr-

othrombin.othrombin. Thrombin formed Thrombin formed

during clotting during clotting processprocess..

Preparation of samplesPreparation of samples

SerumSerum:: Blood is taken in clean tube. Blood is taken in clean tube. Put at 37Put at 3700 c for clotting. c for clotting. Centrifuge the sample. Centrifuge the sample.

Use the supernatant that is “serum”.Use the supernatant that is “serum”.

Plasma:Plasma:

Blood is taken on anticoagulant. Blood is taken on anticoagulant.

Mix well blood with anticoagulant. Mix well blood with anticoagulant.

Use the sample that is “plasma”.Use the sample that is “plasma”.

To prevent hemolysis To prevent hemolysis during vein punctureduring vein puncture::

Never draw blood through a Never draw blood through a hematomahematoma ..

Remove the tourniquet as early Remove the tourniquet as early as possible to decrease flow as possible to decrease flow velocity and turbulence.velocity and turbulence.

Do not remove the collection tube Do not remove the collection tube until full.until full.

When mixing is required, gentle When mixing is required, gentle inversion is adequate.inversion is adequate.

Procedures of testsProcedures of tests

Take blood sample from patient in suitable Take blood sample from patient in suitable tube.tube.

Put the sample in water bath 37Put the sample in water bath 3700c for c for coagulation.coagulation.

Centrifuge the sample for 10 min. to obtain Centrifuge the sample for 10 min. to obtain clear serum.clear serum.

Carry out the procedures according kits.Carry out the procedures according kits. Then make the calculation.Then make the calculation.

Liver Function TestsLiver Function Tests

LFT used to detect, evaluated and LFT used to detect, evaluated and monitor liver monitor liver diseases or damage.diseases or damage.

These include:These include: Total protein (albumin & globulins)Total protein (albumin & globulins) Albumin (main protein made by liver)Albumin (main protein made by liver) ALT or SGPTALT or SGPT “alanine aminotranferase” “alanine aminotranferase” AST or SGOT “ aspartate aminotranferase”AST or SGOT “ aspartate aminotranferase” ALP “alkaline phosphatase”ALP “alkaline phosphatase” Bilirubin (total & direct)Bilirubin (total & direct) GGT, LDH, PT (pro-thrombin time)GGT, LDH, PT (pro-thrombin time)

ALT is an enzyme found ALT is an enzyme found mostly in the liver; smaller mostly in the liver; smaller amounts of it are also in the amounts of it are also in the kidneys, heart, and muscles.kidneys, heart, and muscles.

ALT test detects liver injury ALT test detects liver injury “More Specific”.“More Specific”.

Very high levels of ALT due Very high levels of ALT due to acute hepatitis.to acute hepatitis.

AST is an enzyme found AST is an enzyme found mostly in the heart and mostly in the heart and liver, and to a lesser liver, and to a lesser extent in other muscles. extent in other muscles.

AST not specific.AST not specific. Very high levels of AST Very high levels of AST

due to acute hepatitis.due to acute hepatitis.

ALT AST

ALP is an enzyme found in ALP is an enzyme found in high concentrations in bone high concentrations in bone and in the liver. Smaller and in the liver. Smaller amounts of ALP are found amounts of ALP are found in the placenta.in the placenta.

ALP is not specific for liver ALP is not specific for liver diseases.diseases.

GGT is an enzyme found GGT is an enzyme found mainly in the liver.mainly in the liver.

It is the most sensitive It is the most sensitive liver enzyme in detecting liver enzyme in detecting bile duct problems. bile duct problems.

A rise in GGT can occur A rise in GGT can occur even when there is no even when there is no identifiable cause that is identifiable cause that is related to liver diseases.related to liver diseases.

ALP GGT

The total protein test is a The total protein test is a rough measure of all of the rough measure of all of the protein in the plasma portion protein in the plasma portion of your blood.of your blood.

Total protein measures the Total protein measures the combined amount of two combined amount of two classes of proteins, albumin classes of proteins, albumin and globulin. and globulin.

Low total protein levels Low total protein levels suggest liver disease.suggest liver disease.

A/G ratio is normally slightly A/G ratio is normally slightly over 1 over 1

A low A/G ratio may reflect A low A/G ratio may reflect overproduction of globulinsoverproduction of globulins underproduction of albuminunderproduction of albumin..

Albumin is the most Albumin is the most abundant protein in the abundant protein in the blood plasma. blood plasma.

Low albumin levels can Low albumin levels can suggest liver diseases, suggest liver diseases, inflammation, shock, inflammation, shock, malnutrition & kidney malnutrition & kidney diseases.diseases.

High albumin levels High albumin levels usually reflect dehydration. usually reflect dehydration.

Total Protein Albumin

BilirubinBilirubin

Bilirubin is an orange-yellow pigment found in bile. Bilirubin is an orange-yellow pigment found in bile. RBCs normally degrade after 120 days in the RBCs normally degrade after 120 days in the

circulation. At this time, hemoglobin (the red-colored circulation. At this time, hemoglobin (the red-colored pigment of red blood) breaks down into bilirubin.pigment of red blood) breaks down into bilirubin.

Unconjugated bilirubin is carried to the liver, where Unconjugated bilirubin is carried to the liver, where sugars are attached to it, producing conjugated sugars are attached to it, producing conjugated bilirubin. bilirubin.

When bilirubin levels are high, a condition called When bilirubin levels are high, a condition called Jaundice.Jaundice.

Kidney Function TestsKidney Function Tests::

KFT used to evaluate and KFT used to evaluate and monitor kidney monitor kidney diseases or damage & the effectiveness of diseases or damage & the effectiveness of the treatment.the treatment.

These include:These include:

Urea & BUN “blood urea nitrogen”Urea & BUN “blood urea nitrogen”

Creatinine and creatinine clearance.Creatinine and creatinine clearance.

Uric acid.Uric acid.

Lipid profileLipid profile

Lipid profile includes:Lipid profile includes:

1)Total lipids1)Total lipids 2) 2)TriglyceridesTriglycerides

3) Cholesterol 3) Cholesterol 4) 4) HDLHDL

5) LDL5) LDL These tests must be carried out after These tests must be carried out after 12-1512-15

fasting due the high molecular weight of lipid fasting due the high molecular weight of lipid molecules and the prolonged digestion and molecules and the prolonged digestion and metabolism. metabolism.

Blood GlucoseBlood Glucose

Blood glucose level is one of the most Blood glucose level is one of the most important test in the lab.important test in the lab.

Glucose is very essential for all body Glucose is very essential for all body activities.activities.

This includes:This includes:

1)1) RBSRBS “random blood sugar” “random blood sugar”

2)2) FBSFBS “fasting blood sugar”“fasting blood sugar”

3)3) PPSPPS “post-prondial blood sugar” “post-prondial blood sugar”