BIOCHEMISTRY DEPARTMENT
INTRODUCTION TO CLINICAL BIOCHEMISTRY
TASKS ASSIGNED
·
To
arrange the patient worksheets according to the reference number
·
To
centrifuge samples
·
To
perform urine protein tests
·
To
load samples to the machine.
·
To
enter repeat samples
·
To
check for the test results and issue reports.
SPECIMENS TESTED IN BIOCHEMISTRY
SECTION
Serum
Serum is the most common specimen tested - it is
obtained by centrifugation of coagulated blood. Serum contains no blood cells
or clotting factors but has electrolytes, hormones, antigens, antibodies, and
other substances such as drugs, microbes, and proteins not used in coagulation.
Plasma
Plasma is obtained by centrifugation of uncoagulated
blood. It contains blood cells, clotting factors, glucose, electrolytes (such
as sodium, magnesium, calcium, and chloride), hormones, and proteins (such as
albumins, fibrinogen, and globulins).
Urine
Clinical tests usually require a 24-hour urine
collection. The collection container usually contains a preservative.
Cerebrospinal
spinal fluid (CSF)
CSF is a clear fluid present in the brain and spine
which is largely similar to blood plasma though it differs by usually analyzed
in clinical chemistry to identify or rule out meningitis.
Cobas C 311 Fully Automated Clinical chemistry Analyzer
The tests that are conducted in the biochemistry
section are all performed through a chemistry analyzer. The samples are
centrifuged and loaded into this machine which is called the Cobas C311. This
machine is used to calculate
the concentration of certain substances within samples of serum, plasma, urine
and/or other body fluids. Substances analyzed through these instruments include
certain metabolites, electrolytes, proteins, and/or drugs. Beckman Coulter offers a variety of scalable
clinical chemistry analyzers, all of which can help optimize your laboratory’s
uptime, reliability and performance. The machine consists of the following;
·
Intuitive
graphical user interface, standardized with entire AU series
- Sample
tracking
- Patient
statistics
- User
customized menu
- Color alerts
to highlight system operating conditions
PURPOSE
·
The Cobas C 311 analyzer
is on automated, discrete. Clinical chemistry analyzer intended for the
·
Vitro
quantitative/ qualitative determination of analytic in body fluids.
PRINCIPLE
·
The Cobas C 311 Analyses
is on automated software control analyzer for clinical chemistry analysis.
·
It is designed
for both qualitative, qualitative in vitro determination test for analysis. The
Cobas C 311 Analyzer performs photometric assess and iron selective Electrode
measurement and uses serum, plasma, urine, CSF and supernatant sample type.
SPECIMEN TYPE
·
Serum
·
Plasma
·
Urine
·
CSF
·
Supernatant
TEST SELECTION
·
Choose workplace
> Test selection
• Select the stat or routine option from the
sample area on the top left of the test selection screen
• When requesting routine samples, type in the
sequence number for the sample in the sequence no text box and press Enter. The
cursor moves to the disk position text box.
• Type in the position for the sample in the disk
pos, text box and press Enter. The cursor moves to the sample ID text box.
• Select the pre-dilution check box if the sample
has already been diluted and press Enter
·
The cursor moves
to the sample cup box.
·
Select the
sample container type and press enter. Select the necessary dilution.
TYPES OF TESTS AND
THERE REFERENCE RANGES
|
TEST |
REFERENCE RANGE |
|
Fasting Plasma Glucose (FBS) |
70 – 200 mg / dL |
|
Post Prandial Blood Sugar (PPBS) |
70 – 300 mg / dL |
|
Random Blood Sugar (RBS) |
70 – 300 mg / dL |
|
Total Iron |
37.0 – 145 µg
/ dl |
|
Ionized Calcium |
1.12 – 1.32
mmol / L |
|
Serum Magnesium |
1.58 – 2.55 mg/ dL |
|
Creatinine Phosphokinase (CPK) |
26.0 – 180 U / L |
|
Lactate dehydrogenase (LDH) |
225 – 450.0 U / L |
|
C Reactive Protein |
0.1 – 75.0 mg
/ L |
|
Rheumatoid Factor |
< 30 IU /
mL |
|
Anti Streptolysin “O” Titer (ASOT) |
< 200 IU / mL (adults) < 150 IU / ml (children) |
|
Creatinine |
Female 0.5 – 0.9
mg / dL Male 0.7 –
1.2 mg / Dl |
|
Serum Iron &
T.I.B.C Serum Iron U/I.B.C T.I.B.C Transferrin Saturation |
37. 0 – 145.0
µg / dL 259.2 – 388.2 µg / Dl 20.0 – 50.0 |
|
Blood Urea Blood Urea Blood Urea Nitrogen |
15.0 – 39.0 mg / dL 7.0 – 18.0 mg / dL |
|
Bilirubin – Total and Direct Bilirubin – Total Bilirubin Direct Bilirubin Indirect |
0.1 – 1.2 mg / dL 0.1 - 0.5 mg / dL |
|
Serum Electrolytes Sodium Potassium Chloride |
134 – 146
mmol / L 3.5 – 5.1
mmol / L 101.9 – 109
mmol / L |
|
Plasma protein Total protein Albumin Globulin A/G Ratio |
60.0 – 83.0 g
/ L 35.0 – 50.0 g
/ L 25.0 – 33.0 g
/ L 0.8 – 2.3 |
|
Profile Liver Total Protein Albumin Globulin A/G Ratio Bilirubin- Total ALK. Phosphatase ALT (S.G.P.T) AST (S.G.O.T) Gamma –GT |
60.0 – 83.0 g
/ L 35.0 – 50.0 g
/ L 25.0 – 33.0
g / L 0.8 – 2.3 0.1 – 1.2 mg
/ Dl 98.0 – 270 U
/ L 0.1 – 40.0 U / L 0.1 – 40.0 U / L 0.1 – 49.0 U / L |
|
Profile Renal Blood Urea Creatinine (Enzymatic) Serum Sodium Serum Potassium Serum Chloride Total Calcium Inorganic Phosphorous Uric Acid Blood Urea Nitrogen Bicarbonate (CO2) |
15.0 – 44.0 mg / dL 0.5 – 0.9 mg / dL 134 – 146
mmol / L 3.5 – 5.1
mmol / L 101.9 – 109
mmol / L 2.20 – 2.65 mmol / L 2.7 – 4.5 mg
/ dL 2.6 – 6.0 mg / dL 7.0 – 18.0 mg / Dl 23.0 – 29.0 mmol / L |
|
Lipid Profile Cholesterol Triglycerides Cholesterol –
HDL Cholesterol –
Non- HDL Cholesterol LDL Cholesterol VLDL Chol / HDL LDL / HDL |
140 .0 –
270 mg / dL 10.0 – 250 mg / dL 35.0 – 85 mg /
dL 55.0 –
189.0 mg / dL 75.0 -159.0 mg / dL 10.0 – 41.0 mg / dL 2.0 – 5.0 mg / dL 0.01 – 3.30 mg / dL |
- 1. 1. Urine Test
The types of urine tests that are conducted are as
follows;
·
Urine for Micro
albumin
This test looks for the
presence of protein in the urine. If there is higher amount of protein present
in the urine, this may result in a disease known as Micro albuminuria. This
test is performed by adding sulphosalysilic acid. If there is a colour change
it indicates the presence of protein. The level of protein is measured as
follows;
¨
Nil :- 1-100 mg / L
¨
Star mark (*) :- 150 – 160 mg/L
¨
Trace :- 150 -299 mg / L
¨
+ , + +, + + +, + + + + :- > 300
Sample testing procedure
- ·
Initially the
patient’s worksheets are arranged to an order of the reference number.
- ·
The blood samples
are centrifuged for 10 minutes at a speed of 2500 rpm in order to obtain the
blood serum.
- ·
After
centrifugation the lid of the blood sample is removed and arranged the tubes to
the plain racks according to the patient’s reference numbers.
- ·
The racks are then
loaded to the cobas C311 machine for analysis.
- ·
After the samples
are being read the results are checked over a computer if there are any samples
to be repeated and confirm the results and set ready to issue them.
- ·
If there are
repeated samples, they are taken and inserted to a red rack and the tests are
manually entered and again sent via the machine.
·
The repeated tests
are issued as “repeated and confirmed” in the reports.
PATIENT PREPARTION FOR BLOOD
TESTS
LIPID PROFILE
o
Fasting (12-14
hrs.) preferred prior to the test
o
Water is permitted
during fasting
o
Maintain regular
dietary habits and activity for three days before the test and abstinence from
alcohol for one day before the test
o
if the test is
done at non fasting specimen only the total cholesterol and HDL cholesterol
results are valid
o
12 hrs. fasting
time is required for both Lipid profile and FBS
FASTING VENOUS PLASMA GLUCOSE
·
Fast overnight
(08-10 hrs.)
·
Fasting should be
no food or drink except water
·
Avoid high effort
exercise on the previous day and the sample day prior to the test
·
Withhold morning
insulin or oral hypoglycemic agent until after fasting blood sample has been
drawn
RANDOM VENOUS PLASMA GLUCOSE
·
No Special
preparation is required
POSTPRANDIAL VENOUS PLASMA
GLUCOSE
·
For the 2hr PPBS,
patient should have a balance diet and then not to eat anything else until the
blood is drawn
·
Should not smoke
during the testing as smoking may increase glucose level
·
Should rest during
the 2-hr interval
- 2 Aspartate Amino-Transferase
(AST) / Serum glutamic oxaloacetic transaminase (SGOT)
INTRODUCTION
Aspartate transaminase (AST),
also called aspartate aminotransferase or (SGOT), is a pyridoxal phosphate
(PLP)-dependent transaminase enzyme. AST catalyzes the reversible transfer of
an a-amino group between aspartate and glutamate and, as such, is an important
enzyme in amino acid metabolism. AST is found in the liver, heart, skeletal muscle,
kidneys, brain, and red blood cells, and it is commonly measured clinically as
a marker for liver health.
SIGNIFICANCE
·
An increase in AST
levels may be due to:
- ·
Acute kidney
failure
- ·
Cirrhosis
- ·
Heart attack
- ·
Hepatitis
- ·
Liver tumor
- ·
Medicines that are
toxic to the liver
- ·
Mononucleosis
("mono")
SPECIMEN TYPE, COLLECTION AND
STORAGE
·
Serum is
preferred.
·
Serum without
preservative should be separated from cells or clot within half an hour of being
drawn.
- 3Haemoglobin A1C
Program (HbA1C)
INTENDED USE
The D-10" Hemoglobin
A1c Program is intended for the
quantitative determination of hemoglobin A1c (IFCCmmol/mol and NGSP%) in human
whole blood using ion-exchange high-performance liquid chromatography (HPLC) on
the D-10 Hemoglobin Testing System.
Hemoglobin A, measurements
are used as an aid in diagnosis of diabetes mellitus, as an aid to identify
patients who may be at risk for developing diabetes mellitus, and for the
monitoring of long-term blood glucose control in individuals with diabetes
mellitus.
The D-10 Hemoglobin A.
Program is for professional in vitro diagnostic use only.
SUMMARY AND EXPLANATION OF THE
TEST
Diabetes mellitus is a
condition characterized by hyperglycemia resulting from the body's inability
to use blood glucose for energy. In Type 1 diabetes, the pancreas no longer
makes insulin and therefore, blood glucose cannot enter the cells to be used
for energy. In Type 2 diabetes, either the pancreas does not make enough
insulin or the body is unable to use insulin correctly. The direct and indirect
effects of hyperglycemia on the human vascular system are the major source of
morbidity and mortality in both Type 1 and Type 2 diabetes.
These effects include macro
vascular complications (coronary artery disease, peripheral arterial disease,
and stroke) and micro vascular complications (diabetic nephropathy, neuropathy,
and retinopathy). Diabetes mellitus affects >8% of the world population.
HbA,, testing has been
recommended for the diagnosis of Type 2 diabetes by the International Expert Committee
(IEC), the American Diabetes Association (ADA), and the World Health
Organization (WHO), which recommend a diagnostic threshold of 26.5% (248
mmol/mol) HbA, HbA, testing has also been recommended for the identification of
individuals at increased risk for developing diabetes (pre-diabetic). The ADA
has defined the HbA range for pre-diabetes as 5.7-6.4% (39-47 mmol/mol).
Detection and treatment of pre-diabetes may reduce or eliminate the risk of
developing Type 2 diabetes and related complications.
Therapy for diabetes requires the long-term maintenance of a blood glucose level as close as possible to a normal level, minimizing the risk of long-term vascular consequences. A single fasting blood glucose measurement is an indication of the patient's immediate past condition (hours), but may not represent the true status of blood glucose regulation. The measurement of hemoglobin A. (HbA) every two to three months has been accepted as a measure of glycemic control in the care and treatment of patients with diabetes mellitus.
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