Global requirements of clinical biochemistry lab

Prepared by:
mazen fahad mazen musaid

Introduction :

Clinical biochemistry lab :

It is a discipline of medical lab and also known as (Clinical chemistry ,chemical pathology, medical biochemistry or pure blood chemistry) is the area of pathology that is generally concerned with analysis of body fluids.

this large array of tests can be further subcategories into sub specialties: - general or routine chemistry . - endocrinology : the study of hormone . - enzymology : the study of the enzymes. - pharmacology or toxicology : the study of drugs.

Clinical Biochemistry Test compromise over one third of all hospital investigation . Clinical biochemistry is that branch of laboratory medicine in which chemical and biochemical method are applied to study of disease .

Most studies are confined to blood and urine because the relative ease in obtaining such specimen , although analysis are made on other body fluid such CSF and gastric aspirate . Most current laboratories are now highly automated and use assays that are closely monitored and quality controlled. Some techniques that applied including the use and measurement of enzyme activity , spectrophotometry , electrophoresis and immunoassay.

Clinical biochemistry laboratory organization

Core lab : - found virtually in all hospital - operates 24h 7 days a week - highly automated environment - instrument with multi-analytes capabilities - high volume test , many test you can do in this type of lab .

Core lab instruments:

In this lab we use auto analyzer, based on the procedure which is called automation ,self regulation , where the specimen is accurately pipetted by a mechanical probe and mixed with a particular volume of the reagent and results are displayed in digital forms and also printed by a printer.

The automated instruments not only save the labour and time but allow reliable quality control, reduce subjective crrors and work economically by using smaller quantities of samples and reagents.

there are many type of auto analyzer : A- continuous flow analyzer: In these systems, the samples and reagents are passed sequentially through the same analytical pathway and separated by means of air bubbles. B- discrete analyzer: 1-Batch analysers 2- stat analyzer. 1- batch analyzer: These are convenient to analyse specimen in batches such as of sugar, urea creatinine etc. can be automated and semiautomated.

Semi automated batch analyzer: the initial step you will do by your self ,pipitting ,mixing , incupation . ADV: 1- cheap &compact. 2- cheap sample analysis since the amount of reagent 0.5 ml. 3- Enzyme determinations by kinetic methods are performed accurately in 1 to 3 minutes. 4-The enzymatic reagents are not corrosive and involve monostep testing. 2- stat analyzer(random access analyzer) 'Stat' (means immediate reporting or emergency determination analysers.

Electrolytes analyzer:
Atomic absorption spectroscopy: It is a modification of the flame photometer in that it measures the amount of light absorbed by the nebulized sample while moving from ground state to excited state. Ion selective electrodes:measure the potential difference between two electrodes. Specific electrodes are used for the determination of sodium, potassium and chlorides.The requirement is for an ion selective membrane to separate the solution of known activity from the detecting system.

Special lab :

- less frequently ordered test - labor intensive and often manual method - general not-stat tests - lower volume test This type of lab not available in on auto analyzer because: - the demand is not there. - the test is not easily automated (extraction step).

Instruments are usually batch analyzers. Either research instruments or diagnostic instruments that perform 1 specific test on multiple samples.

More training involved with test protocols and instrumentation than Core Lab instrumentation. Longer time required to reach competency.

Special Chemistry Instrumentation and Analytical Methods

Electrophoresis:

Used to separate serum proteins into 5 distinct bands Used to separate Lipoproteins into 4 distinct bands Often used to separate isoforms of enzymes

HPLC :
Used to measure vitamins and hemoglobin variants

Infrared

Spectroscopy :

Used to analyze components of Kidney stones

Radioimmunoassay (RIA)

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.

Used for quantitative drug measurement

Point of Care Testing (POCT):

Instruments located outside of chemistry laboratory such as CCU, ER, ICU or satellite centre (clinic).

Why we use like these instruments?

Tests are of urgent importance, and results will affect the immediate management of the patient
Instruments are available that can perform certain tests at remote locations, such as at the bedside on in a clinical care unit.

Some of test that can performed :

Blood test ,electrolyte, urinalysis, blood gases,cardiac marker (troponin,t), drug screen.

POC are nearly always more expensive, than the same tests performed in the central laboratory. Many are immunoassay based. Can be qualitative or quantitative

POCT INSTRUMENTATION

Cardiac Markers

Drug Screen

Urinalysis

Visual qualitative tests Results must be recorded and reported manually

Can be qualitative, semiquantitative and/or quantitative.Hard copy of result generated Possible to interface hospital LIS

Lab Safety

The lab is an exciting place but it can be a dangerous place if the safe procedure is not followed. KNOW YOUR SURROUNDING ! Should be aware of potential harms that can be caused by any object in the surrounding Hazard in lab: Any object or material in a lab that can cause injury to human or harm the environment is called hazard.

Depending upon the nature of hazardous substance the hazards are of 3 types: 1. Physical hazard 2. Chemical hazard 3. Biological hazard Physical hazard

Flammable Combustible Compressed Gas High voltage equipments Sharp

Chemical hazard

Corrosives Oxidative Toxic Poisonous

Corrosive : A chemical that causes visible destruction of or irreversible alterations of living tissue by chemical action at the site of contact. ex: amines , acids

Oxidizers

Reactive chemical that releases oxygen and accelerates combustion. They may be corrosives, irritants, toxins, sensitizers, etc. ex: Oxygen, peroxides. Toxic : A chemical capable of adversely affecting a body. Capable of adversely affecting one or multiple organs of the body. ex: Xylene - Kidney, Liver, Central nervous system. Isocyanates - Lungs.

Poisons: Poisons are likely to cause death or serious injury if they are swallowed, inhaled, or come in contact with the skin. May interfere with oxygen distribution in the bloodstream. Can enter the body through inhalation, absorption, or ingestion. ex: Methanol, carbon monoxide

Carcinogens
A substance capable of causing or producing cancer in humans or animals.

Exposure to a carcinogen can, over time, cause changes in cell division within the body that leads to uncontrolled cell growth.

ex: Formaldehyde, silica, benzene

Personnel protection:

After knowing about the nature of substances around the primary mean of safety is protecting your self For this personal protective equipment (PPE) is desired The basic concept of PPE lies in

how the hazard contact our body?

Ingestion swallowing Inhalation breathing Absorption skin contact

To secure the contacts with our body

We should have following as Personal Protective Equipment

A-Safety Glasses B -Gloves C -Apron D -Face Shield E - Respirator

Still require Safe Practice!

Despite having all PPE we are still require to practice safely in lab
since PPE never protects us completely from hazards

Instruction for using chemical safety:

Never touch, taste, or smell any chemical that you do not know is harmless. If you are instructed to smell fumes, do so by gently waving your hand over the container so that the fumes are brought to you. Do not bring the container to your nose. Do not inhale the fumes directly from the container.

Labels

Name of material Suppliers Name/address

Health hazard Physical hazard

Importance of Labeling

To identify hazards in your work area. Labels must be on every bag, barrel, bottle, box, can, cylinder, drum, storage tank, etc. Notify your supervisor or safety representative if there are no labels on a container.

Material Safety Data Sheets

Data sheet containing information about the hazards associated with a chemical. All manufacturers, distributors, and consumers must have MSDS. All hazardous materials MUST have a corresponding MSDS.

Electrical Equipment Safety

Be careful not to shock yourself or another person. Turn off all power sources when setting up circuits or repairing equipment. Do not use metal articles such as rulers, metal pencils or pens; do not wear rings, metal watchbands, or bracelets when working with electrical equipment.

General Lab Rules

Read all directions for doing an investigation before beginning. Be alert and listen for directions. Ask questions if you are unsure of anything. Never perform activities that are not authorized by the teacher. Do not handle equipment without permission.

First aid

Be aware of the locations of the first-aid kit, but allow the teacher to administer first aid to an injured student Report all accidents to your teacher immediately.

Thank you &all the best