CC1 COMPILED NOTES

• Clinical Chemistry


  Systematic study of the biochemical process associated with health and disease & the measurement of constituents in body fluids or tissues to facilitate diagnosis of disease
• Two pathologies


  • Clinical Pathology
  • Anatomical Pathology
• Clinical Pathology


  General, concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids, such as blood, urine, and tissue homogenates or extracts using the tools of chemistry, microbiology, hematology, molecular pathology, and Immunohaematology
• Anatomical Pathology


  Only reads tissue results, Pap smears, etc. - the study of organs and tissues to determine the causes and effects of particular diseases
• Purpose & function of clinical chemistry

  • Confirming or rejecting a diagnosis
  • Providing guidelines in patient management
  • Establishing a prognosis
  • Detecting disease through case finding or screening
  • Monitoring follow-up therapy
• Scope of clinical chemistry

  • Bio: life
  • Pharma: drugs/tambal
  • Toxi: abuse of drugs/tambal
  • Immuno: function & components of immune system
  • Analytical chem: structure of any matter
  • Endocrinology: hormones
• Point of Care Testing (POCT)


  A.k.a near-patient testing, alternate-site testing or patient-focused testing.
• Substances measured in serum

  • Substances normally present with a function in the circulation: Glucose, TAG, cholesterol, Total protein & albumin, Hormones, Electrolytes, Vitamins
  • Metabolites-nonfunctioning waste products in the process of being cleared: Urea, Bilirubin, Ammonia, Uric Acid, Creatinine
  • Substances released from cells as a result of cell damage & abnormal permeability or abnormal cellular proliferation: Enzymes (LD, ALT, AST, CK, AMS, GGT, ALP, ACP), Ferritin
• Disease


  A pathological condition of the body that is manifested by a group of clinical signs & symptoms
• Laboratory testing


  • Diagnose
  • Prognosis
  • Referral
• Medical Technologist


  • A.k.a clinical laboratory scientist. • Usually has baccalaureate degree & formal training in an accredited medical technology /medical laboratory science program that meets the criteria by national standard. Passed the PRC licensure examination. Appropriate international certification: MT-ASCP, CLS-NCA, AMT, RMT-ISCLT
• Medical Laboratory Technician


  A.k.a clinical laboratory technician. Person who not being a graduate of BSMT/BS in Hygiene, but having passed the corresponding civil service examination, performs the work of medical technology under the supervision of a registered medical technologist and/or qualified pathologist
• Medical Assistant


  Multi-skilled allied health professional, dedicated to assisting in all aspects of a medical practice under the supervision of a physician. Medical Assistants help with patient care management, execute administrative and clinical procedures and often perform managerial and supervisory functions
• Reagents


  Mix according to number order and needed volume.
• Chemicals


  • Analytical Reagent Grade Chemicals (Spectrograde, Nanograde, High Performance Liquid Chromatography (HPLC) grade)
  • United States Pharmacopeia and the National Formulary grade chemicals (USP & NF)
  • Technical or Commercial Grade
• Primary Standard (PS)

  A chemical that is the highest purity and can be measured directly to produce a substance of exact known concentration.
• IUPAC grades for standard reference materials

  • Grade A - Atomic weight standards
  • Grade B - Ultimate standard
  • Grade C - Primary standards with >0.002% impurity
  • Grade D - Working standard with >0.5% impurity
  • Grade E - Secondary standards derived from using Grade C standards
• Water specifications


  • Type I Reagent Grade Water
  • Type II Reagent Grade Water
  • Type III Reagent Grade Water
• Thermometers


  Liquid in-glass, Electronic thermometer or thermistor probe, and Digital thermometer. All temp reading devices must be CALIBRATED to ascertain accuracy
• Calibration


  The accuracy of the thermometer used to monitor the incubation temperature of an instrument should be verified every 6 to 12 months. Thermometers used for monitoring should agree within 0.1°C or 1.0°C with the NIST reference thermometer
• Preventive Maintenance


  It is imperative that preventive maintenance procedures be performed, and the results recorded for all laboratory instrumentation. This includes maintenance of analytical balances, refrigerators, freezers, centrifuges, ovens, water baths, automated analyzers, and all other laboratory equipment used for analyzing specimens
• Temperature scales


  • Celsius (°C) or centigrade
  • Fahrenheit (°F)
  • Kelvin (°K) - SI Designation
• Temperature conversions


  Celsius to Fahrenheit: °C(9/5) + 32

  Fahrenheit to Celsius: (°F - 32)5/9
• Glassware and plasticware


  • Glassware: Breakable, Reuseable, Ideal for acidic solutions, High thermal and corrosion resistance, Good Optical properties

  Plasticware: Highly shockproof/shatterproof, Disposable, Ideal for alkaline solutions, Relatively inert, Flexible, Suitable for Cryogenic (Freezing) experiments
• Types of glass


  • High Thermal Resistant Glass (Borosilicate, Corex, Vycor)

  High Silica Glass

  Glass with High Resistance to Alkalies

  Low Actinic Glass

  Standard Flint Glass
• Class A


  Should be
• HIGH SILICA GLASS


  • 96% silica content comparable to fused quartz in its thermal endurance, chemical stability and electrical characteristics
  • Radiation resistant, good optical qualities and temperature capabilities
  • Ideal for high precision analytical work and can also be used for optical reflectors and mirrors
• GLASS WITH HIGH RESISTANCE TO ALKALIES

  • Boron-free glassware for strong alkali solutions and digestion with strong alkalies
  • Less thermal than borosilicate glass
• LOW ACTINIC GLASS


  • Amber, red colored to reduce the amount of light passing through the substance within the glassware
  • Highly protective laboratory glassware for handling heat-labile substances in the 300-500 nm range (bilirubin, carotene and vitamin A)
• STANDARD FLINT GLASS


  • Soda lime glass which is composed of a mixture of oxides of Si, Ca and Na
  • Lowest in cost and readily fabricated
  • Poorly resistant to high temperatures and sudden changes in temperature
  • Easy to melt and shape thus used as reagent bottle and disposable laboratory glassware
  • Release alkali into the pipetted liquid
• POLYOLEFINS (POLYETHYLENES, POLYPROPYLENES)


  • Unique group of resins with relatively inert chemical properties
  • Usually unaffected by acids (however, concentrated sulfuric acid slowly attacks polyethylene at RT), alkalies, salt solutions and most aqueous solutions
  • Aromatic, aliphatic, and chlorinated hydrocarbons cause moderate swelling at RT
  • Organic acids, essential oils and halogens slowly penetrate these plastics
  • Strong oxidizing agents attack this group at elevated temperatures only
  • Polypropylene is more expensive than polyethylene therefore the latter is used in most disposable plasticwares
  • Polypropylene is sterilizable however it absorbs pigment and tends to become discolored
• POLYCARBONATE RESIN


  • Twice as strong as polypropylene (from -100 °C to 160 °C)
  • Chemical resistance is NOT as wide as the polyolefins
  • UNSUITABLE for use with bases as amines, ammonia and alkalies as well as oxidizing agents
  • Glass-clear and shatterproof
  • Ideal for centrifuge tubes and graduated cylinders
• TYGON


  • Nontoxic, clear plastic of modified PVC (polyvinylchloride)
  • Used extensively for the manufacture of ACA tubings
  • Flexible and used to handle most chemicals
  • Can be steam-autoclaved or chemically sterilized
  • Tubing is soft and flexible and quickly slips over tubulatures but gripping tightly on glass or metals
• TEFLON FLUOROCARBON RESINS


  • Almost chemically inert with high corrosion resistance at extreme temperatures
  • For cryogenic experiments and work at high temperatures over extended periods (-270 to 255 degC)
  • Pure translucent white and inert
  • Easy to clean and fast drying but it can be scratched and misshaped
• VOLUMETRIC OR TRANSFER PIPETTE


  • Designed to deliver a fixed volume of liquid
  • Consists of a cylindrical bulb joined at both ends to narrower glass tubing
  • Calibration mark is etched around the upper suction tube
  • Lower delivery tube is drawn out to a fine tip
  • Used for accurate measurements of aliquots of nonviscous samples, filtrates, controls, and standard solutions
• OSTWALD-FOLIN PIPET


  • Similar to volumetric pipet, but has their bulb closer to the delivery tip
  • Used for measuring viscous fluids as blood or serum
  • Has an etched ring near the mouth piece
  • Blown out only when the fluid has drained to the last drop in the delivery tip
• GRADUATED OR MEASURING PIPETTE


  • Plain, narrow tube drawn out to a tip
  • Graduated uniformly along its length
  • Mohr pipet - Calibrated between two marks on the stem
  • Serological Pipet - Intended for the delivery of predetermined volumes, principally used for the measurements of reagents and are not generally considered accurate enough for measuring viscous samples and standards, has larger orifice than the Mohr pipet, thus drains faster
• Micropipets


  • Sahli (TC)
  • Kirk (TC)
  • Lang-levy (TD/TC)
  • Overflow (TC)
  • Capillary (TC)
  • Sanz pipet (TC)
  • Unopette (TC)
  • Semiautomatic Eppendorf (TD/TC)
• Cleaning Glasswares and Plastic Wares

  1. Routine washing may be done by soaking in dilute bleach followed by drying in an oven, soaking in 20% nitric acid solution for 12-24 hours and soaking in acid-dichromate solution

  2. BLOOD CLOTS - soak in 10% NaOH

  3. NEW PIPETS - soak in 5% HCl or 5% HNO3

  4. METAL ION Determination - soak in 20% nitric acid

  5. GREASE - soak in any organic solvent or 50% KOH

  6. PERMANGANATE STAINS - soak in 50% HCl or mixture of 1% ferrous sulfate in 25% sulfuric acid

  7. BACTERIOLOGIC GLASSWARE - soak in 2% to 4% cresol solution followed by autoclaving and thorough washing

  8. IRON Determination - soak in 1:2 dilution of conc. HCl solution or 1:3 dilution of conc. HNO3
• Analytic Balances


  • Used for the preparation of any primary standard. Weight range of 0.01mg to 160g
  • Mechanical analytic balance aka substitution balance