General Laboratory: Clinical Chemistry Basic Overview Online Training

Continue Continue Untitled Scene Clinical Chemistry Basic Overview Online Training This course will provide a basic understanding of the principles involved in diagnostic testing and review common test groups performed in the clinical chemistry laboratory. Identify the purpose of the clinical chemistry laboratory 1 4 Identify the components of chemical reactions 3 2 Identify common disease states Identify common test groups performed in the clinical chemistry laboratory Master Template HOOD05162003052540 | Effective Date: 26-Nov-2019 5 Identify the principles of immunochemistry and potentiometry Welcome Welcome to the Clinical Chemistry Basic Overview Online Training course. The chemistry section of the clinical lab typically processes more samples and reports more test results than any other section of the lab. Many of these tests are ordered by the physician for immediate processing, so it is important that people and instruments are performing optimally. Knowledge of the tests performed and procedures used will give you an insight into the day-to-day functioning of this busy laboratory. Clinical Chemistry Functions The Clinical Chemistry Laboratory applies the principles of analytical chemistry, organic chemistry and biochemistry, as well as: Performs qualitative and quantitative analysis on chemical analytes Analyses serum, plasma, urine, spinal fluid and other body fluids Helps verify general patient health or diagnose, monitor and treat disease Clinical Chemistry Functions The clinical chemistry laboratory applies the principles of analytical chemistry, organic chemistry, and biochemistry to perform qualitative and quantitative analyses on a variety of chemical substances called analytes. These analytes are found in serum, plasma, urine, and other body fluids to help verify a patient’s health as well as diagnose, monitor, or treat disease. Chemistry Automation Clinical chemistry tests are often run on automated instruments or analyzers. Automated analyzers can process hundreds of tests per hour Analyzers must be verified, maintained and monitored to produce accurate and precise results With total laboratory automation, preanalytic, analytic and postanalytic phases of laboratory testing can be combined into an integrated system1 Chemistry Automation Clinical chemistry tests can be performed manually, but the majority of chemistry tests are run using automated instruments operated by technologists and technicians. These instruments, also called analyzers, can process hundreds of tests per hour and must be verified, maintained, and monitored in order to produce accurate and precise test results. In some laboratories, preanalytic, analytic, and postanalytic phases of laboratory testing can be combined into an integrated system to create a total laboratory automation system. Measurement Types Measurement types used depend on the analyte and the chemical reaction characteristics. Endpoint measurement occurs after the analytical reaction is complete Rate measurements are taken while the reaction is still occurring Select the tab arrows to see an example of each measurement type. Endpoint Rate Measurement Types Depending on the type of analyte being measured and the characteristics of the chemical reaction, either endpoint or rate measurement can be performed. Endpoint measurement consists of a measurement that occurs after the analytical reaction is complete. Rate measurement, on the other hand, consists of readings being taken while the reaction is still occurring. Select the tab arrows to see an example of each type of measurement. Endpoint Measurements This graph shows a plot of time (1) versus amount of end-product (2). Reagent and sample are mixed at (3) and begin to react. Measurement (4) is made after all the end-product has been completely formed. 2 1 3 4 Rate Measurements This graph shows a plot of time (1) versus amount of end-product (2). Reagent and sample are mixed at (3) and begin to react. Measurements (4) are made during the reaction while the end-product is being formed. 2 1 3 4 Chemical Reactions Analyte + Reagent = End-Product Step 1: Sample and reagent are mixed in a reagent container Step 2: Analyte in the sample reacts with reagent to form an end-product Step 3: End-product is measured to determine the amount of analyte in the sample Analyte End-Product Reagent Chemical Reactions Chemical analysis methods take advantage of the fact that each analyte has a unique chemical formula that can react with another specific chemical called a reagent. During analysis a specific amount of patient sample is mixed with reagent in a test tube or other reaction container. If the analyte is present in the sample, a chemical reaction occurs between the analyte and the reagent producing an end-product. The amount of end-product produced by the chemical reaction can then be measured. The higher the amount of analyte present, the more end-product is produced. Select the underlined words to find a complete definition. End-Product – The final material or substance left at the completion of a series of reactions, either chemical or physical Reagent – A substance or compound added to a system to cause a chemical reaction, or added to test if a reaction occurs Analyte – A solute dispersed in a solution that is identified and measured in laboratory practice Chemistry Tests Chemistry tests ordered in routine panels or profiles: Provide an overview of a patient’s condition Focus on a particular organ system such as the heart, liver or kidneys Select the tab arrows to learn more about different chemistry profiles. General Metabolic Tests Lipids Enzymes Electrolytes Did You Know? The expected level of test analytes in healthy people fall within a certain range of values called the normal range or the reference range. These ranges can vary based upon age or sex. Levels outside of this range are flagged for further investigation. Chemistry Tests Chemistry tests can be ordered by the physician either individually or in groups, called routine panels or profiles. Profiles provide an overview of a patient’s condition or focus on a particular organ system such as the heart, liver or kidneys. Select the tab arrows to learn more about different chemistry profiles. Electrolytes Electrolyte balance plays a vital role in maintaining body fluid, pH and water balance, and controlling nerve conduction and muscle contractions. Electrolyte values can be abnormal in cases of dehydration, vomiting, diarrhea, kidney failure, respiratory problems and heart failure. These electrolyte values are: Sodium Potassium Chloride Carbon Dioxide Enzymes Enzymes are proteins that shorten the time of a chemical reaction while not changing themselves. For example, an enzyme in saliva starts the process of breaking down food Enzymes are also part of important reactions that occur within the cells of the body. Body organs contain different levels of specific enzymes and, as a result, enzyme levels can increase in blood when organ inflammation, disease or damage occurs. Enzymes that are commonly tested when injury or disease to specific organs is suspected are: Liver: ALT AST Heart: AST CK LDH Pancreas: Amylase Lipase Prostate: Acid Phosphatase Lipids are a group of molecules that includes fats and oils. Lipids in the body store energy, form parts of cell structures such as cell membranes, and are used to produce certain hormones and bile acids. Lipids are particularly associated with cardiovascular health. Some type of lipids are: Total Cholesterol HDL Cholesterol LDL Cholesterol Triglycerides Lipids These tests are often run as a panel for screening purposes. They check overall metabolism of several organs including the pancreas, liver, bones and kidneys. Some general metabolic tests are: Albumin Blood Urea Nitrogen Calcium Creatinine Glucose General Metabolic Tests Magnesium Phosphorous Total Bilirubin Total Protein Uric Acid Immunochemical Reactions Antigen + Antibody = Immune Complex Antigen Immune complex Antibody Did You Know? Antibodies are Y-shaped proteins called immunoglobulins (Ig) produced by the body’s white blood cells in response to a foreign substance or antigen. Immunoglobulins are also called gamma globulins. There are five different classes of immunoglobulins in humans, each having a different structure and purpose. They are: IgG, IgM, IgA, IgD, and IgE. Immunochemical Reactions Immunoassay methods give us the ability to measure analytes that are present in very small quantities. An immunochemical reaction involves the binding of an antibody to an antigen to form the measurable end-product called an immune complex. Select the underlined words to find a complete definition. Immune complex (AgAb) – The immune complex end-product can be measured by turbidimetry or nephelometry, or can be linked to other chemicals to be measured colorimetrically, fluorometrically or by chemiluminescence Antibody (Ab) – The antibody is in the reagent. This antibody was produced in the body of a mammal (usually a rabbit or a mouse) by injecting it with a small amount of the antigen. The immune system of the animal recognized the antigen as foreign and produced antibodies against it. The specific antibody needed was then isolated from the animal’s blood to manufacture the reagent Antigen (Ag) – The antigen is the analyte (for example, a therapeutic drug) that is being measured in the patient sample Immunoassay Tests Immunoassay testing uses antibody to isolate, bind and detect specific analytes or antigens. Can measure analytes that are present in very small quantities Can be incorporated into routine chemistry testing analyzers Immunoassay Tests The use of antibodies to isolate and detect analytes has expanded the field of analytical chemistry tremendously. So much so, that an entire category of testing within the clinical lab called “Immunochemistry” or “Immunoassay” has developed. Because specific antibodies are used, immunoassay gives us the ability to measure analytes that are present in much smaller quantities than routine analytes. Some chemistry analyzers incorporate immunoassay testing methods in their assay menu. Specific Proteins Specific Proteins are blood proteins that increase or decrease in response to disease conditions. Some disease conditions that affect specific proteins are: Infection/Inflammatory disease: Alpha-1 Antitrypsin C3 and C4 CRP Risk for Heart Attack: Apolipoprotein A1 Apolipoprotein B HsCRP Anemia: Haptoglobin Transferrin Specific Proteins Specific proteins are individual blood proteins that increase or decrease in response to disease conditions. Measurement of these different proteins by immunoassay can be used to confirm a suspected diagnosis or to monitor treatment. Therapeutic Drugs The therapeutic range of a drug is the blood level within which the desired effect occurs. Not every patient will react to a drug in a predictable manner and the typical drug dose may be either ineffective or toxic. Therapeutic drug monitoring is done to ensure effective dosage, to determine a patient’s medication compliance, and to prevent toxicity. The drug categories are: Antibiotics Antiarrythmic drugs Anticonvulsant drugs Antiasthmatic drugs Therapeutic Drugs The therapeutic range of a drug is the blood level within which the desired effect occurs. Unfortunately, not every patient will react to a drug in a predictable manner and the typical drug dose may be either ineffective or toxic. Additionally, some drugs have a narrow margin between therapeutic and toxic levels. Therapeutic drug monitoring is done to ensure effective dosage, to determine a patient’s medication compliance, and to prevent toxicity. Toxicology/Drugs of Abuse Analysis for drugs can also be performed to obtain drug levels in forensic and legal situations, and to monitor employees in certain workplace programs for exposure to industrial hazards or evidence of substance abuse. The toxicology tests for drugs of abuse are: Ethanol Salicylate Acetaminophen Urine Drugs of Abuse screen Amphetamine and methamphetamine Anabolic steroids Cannabinoids Cocaine Opiates Phencyclidine (PCP) Barbiturates Benzodiazepines Toxicology/Drugs of Abuse Analysis for drugs can also be performed to obtain drug levels in forensic and legal situations, and to monitor employees in certain workplace programs for exposure to industrial hazards or evidence of substance abuse. Potentiometry Potentiometry is used when the analyte produces an electrical potential in solution. Compares potentials of the reference electrode (1) in an electrolyte solution (2) to the indicator electrode (3) in contact with sample (4) The indicator electrode can be an Ion Selective Electrode or ISE The difference between the potentials (5) depends on sample analyte concentration Examples of tests that use this measurement technique include: Sodium (Na+), Potassium (K+), and Chloride (Cl-), and blood gas measurements such as pO2, pCO2, and pH. 1 3 5 4 2 Potentiometry Some analytes can be measured without using a chemical or immunochemical reaction because they are able to produce an electrical potential in solution. Potentiometry compares the potential of a stable reference electrode surrounded by an electrolyte solution to the potential of an indicator electrode in contact with the sample. An indicator electrode made selective for the desired analyte by use of internal design or a selective membrane is called an Ion Selective Electrode or ISE. The potential difference between the reference and indicator electrode depends upon the activity or concentration of the specific analyte in the sample. Analytes & Disease States Analyte testing in chemistry is used to help diagnose, monitor or treat diease. Select the tab arrows to learn more about some of the specific disease states and the chemistry analytes that aid in their diagnosis and treatment. Diabetes Liver Disease Atherosclerosis Heart Attacks Analytes & Disease States Analyte testing in chemistry is used to help diagnose, monitor, or treat disease. Select the tab arrows to learn more about different disease states and common chemistry analytes that aid in their diagnosis and treatment. Heart Attacks Heart attacks occur when a clot in the coronary artery blocks the supply of blood and oxygen to the heart. A blockage that is not treated within a few hours causes the affected heart muscle to die (Myocardial Infarction). Cardiac markers are used to determine the extent of heart muscle damage and include: CK CK-MB LDH Troponin (I or T) Atherosclerosis Atherosclerosis is the progressive buildup of plaque in the walls of the arteries. Clogged arteries cut off the flow of blood to the brain and heart and can lead to a heart attack or stroke. Common chemistry tests related to the diagnosis and treatment of atherosclerosis are: Total Cholesterol HDL Cholesterol LDL Cholesterol Triglycerides The liver is a large and important organ that functions to store excess carbohydrate, filter toxins and waste products, and make bile to aid in digestion. Liver diease can be cause by viral infections, toxins, drugs and alcohol, cancer or hereditary conditions. Common chemistry tests related to the diagnosis and treatment of liver disease are: Total Bilirubin Direct Bilirubin Liver enzymes: AST ALT ALP GGT Liver Disease Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The most common chemistry tests used to diagnose and monitor diabetes are: Blood Glucose Urine Glucose Diabetes Identify common disease states Identify the principles of immunochemistry and potentiometry Identify the components of chemical reactions Identify the purpose of the clinical chemistry laboratory Course Review Congratulations. You have completed the Clinical Chemistry Overview Online Training course. Select the objectives listed below to review the material before proceeding to the final assessment. 1 1 1 2 2 2 3 5 4 Identify common test groups performed in the clinical chemistry laboratory Course Review Identify common disease states Diabetes Diabetes is a disease in which the body does not produce or properly use insulin Common tests: Blood Glucose and Urine Glucose Liver Disease Liver diease can be cause by viral infections, toxins, drugs and alcohol, cancer or hereditary conditions Common tests: Total Bilirubin, Direct Bilirubin, Liver enzymes (AST, ALT, ALP, GGT) Atherosclerosis Atherosclerosis is the progressive buildup of plaque in the walls of the arteries Common tests: Total Cholesterol, HDL Cholesterol, LDL Cholesterol, Triglycerides Heart Attacks Heart attacks occur when a clot in the coronary artery blocks the supply of blood and oxygen to the heart Cardiac markers: CK, CK-MB, LDH, Troponin I, Troponin T Identify the principles of immunochemistry and potentiometry Antigen + Antibody = Immune Complex Immunochemistry utilizes antibody as reagent to react with the analyte in the sample to form an immune complex Immunoassay test groups include: Specific proteins – blood proteins that increase or decrease in response to disease conditions Therapeutic drugs – monitors effective dosage, determines a patient’s medication compliance, and prevents toxicity Toxicology/drugs of abuse – obtains drug levels in forensic and legal situations, and to monitor employees in certain workplace programs for exposure to industrial hazards or evidence of substance abuse Potentiometry Compares potentials of the reference electrode in an electrolyte solution to the indicator electrode in contact with sample Identify common test groups performed in the clinical chemistry laboratory General metabolic tests These tests check overall metabolism of several organs including the pancreas, liver, bones and kidneys Lipids Lipids are particularly associated with cardiovascular health Enzymes Body organs contain different levels of specific enzymes and, as a result, enzyme levels can increase in blood when organ inflammation, disease or damage occurs Electrolytes Electrolyte balance plays a vital role in maintaining body fluid, pH and water balance, and controlling nerve conduction and muscle contractions Electrolyte values can be abnormal in cases of dehydration, vomiting, diarrhea, kidney failure, respiratory problems and heart failure Identify the components of chemical reactions Analyte + Reagent = End-Product Sample and reagent are mixed in a reagent container Analyte in the sample reacts with reagent to form an end-product End-product is measured to determine the amount of analyte in the sample Identify the purpose of the clinical chemistry laboratory The Clinical Chemistry Laboratory applies the principles of analytical chemistry, organic chemistry and biochemistry to perform qualitative and quantitative analysis on a variety of analytes found in serum, plasma, urine, spinal fluid and other body fluids Results help oversee a patient’s health as well as diagnose, monitor and treat disease Clinical chemistry tests are often run on automated instruments or analyzers which can process hundreds of tests per hour Please note that the learning material is for training purposes only! For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Copyright © Siemens Healthcare GmbH 2021 Siemens Healthineers Headquarters\Siemens Healthcare GmbH\Henkestr. 127\ 91052 Erlangen, Germany\Telephone: +49 9131 84-0\siemens-healthineers.com Disclaimer Disclaimer Assessment This assessment will test your retention of the presented content. A passing score of 80% or higher is required to complete the course and earn your certificate. You may repeat the assessment as many times as needed. Start Assessment Sample analyte and reagent react to form an end-product Antibody binds to an antigen to form an immune complex Sample analyte and antibody bind to form an immune complex Antigen and reagent react to form an end-product What are the components of a chemical reaction? Question 1 of 5 Select the best answer. Multiple Choice Question Incorrect These are not the correct components. Incorrect These are not the correct components. Incorrect These are the components of an immunochemical reaction. Correct Reports results to the physician only if the test is abnormal Processes individual tests and profiles Uses automated instrumentation which can process hundreds of tests per hour Applies the principles of analytical chemistry, organic chemistry, and biochemistry Functions of the chemistry laboratory include all of the following EXCEPT: Question 2 of 5 Select the best answer. Multiple Choice Question Incorrect The chemistry laboratory does apply the principles of analytical chemistry, organic chemistry, and biochemistry to the analysis of patient samples. Incorrect It is true that the chemistry laboratory uses automated instrumentation which can process hundreds of tests per hour. Incorrect The chemistry does process individual tests and profiles. Correct General metabolic tests Lipids Enzymes Specific proteins At an annual physical, which chemistry tests would the physician most likely order to check your overall health? Question 3 of 5 Select the best answer. Multiple Choice Question Incorrect Specific proteins are typically used to confirm a suspected diagnosis or to monitor treatment. Incorrect Enzymes are ordered when specific organ inflammation, disease or damage is suspected. Incorrect Lipids are often ordered to specifically check for cardiovascular health. Correct Therapeutic drugs Drugs of abuse Electrolytes General metabolic tests A patient with a kidney infection is placed on intravenous vancomycin - a powerful antibiotic. What type of testing would the physician likely order to monitor the treatment? Question 4 of 5 Select the best answer. Multiple Choice Question Incorrect General metabolic tests check the overall metabolism of several organs including the pancreas, liver, bones and kidneys. Incorrect Electrolytes play a role in maintaining body fluid pH and water balance, and controlling nerve conduction and muscle contractions. Incorrect Drugs of abuse screenings are done to obtain drug levels in forensic and legal situations. Correct CK, LDH, Troponin I Total Cholesterol, HDL Cholesterol, LDL Cholesterol, Triglycerides Total Bilirubin, Direct Bilirubin, Liver enzymes Blood Glucose, Urine Glucose Which chemistry tests would the physician most likely order to determine the extent of heart muscle damage after a heart attack? Question 5 of 5 Select the best answer. Multiple Choice Question Incorrect These chemistry tests are related to the diagnosis and monitoring of diabetes. Incorrect These chemistry tests are related to the diagnosis and treatment of liver disease. Incorrect These chemistry tests are related to the diagnosis and treatment of atherosclerosis. Correct Review Review Retry Assessment Results %Results.ScorePercent%% %Results.PassPercent%% Continue YOUR SCORE: PASSING SCORE: Assessment Results You did not pass the course. Take time to review the assessment then select Retry to continue. Congratulations. You passed the course. Exit To access your Certificate of Completion, select the Launch button drop down on the course overview page. You can also access the certificate from your PEPconnect transcript. You have completed the Clinical Chemistry Basic Overview Online Training. Completion HILS2201 | Effective Date: 02-Apr-2021 1 Genzen JR, Burnham C-AD, Felder RA, Hawker CD, Lippi G, Peck Palmer OM. Challenges and Opportunities in Implementing Total Laboratory Automation. OUP Academic. https://academic.oup.com/clinchem/article/64/2/259/5608875. Published February 1, 2018. Accessed March 16, 2021. 1.1 Welcome 1.2 Clinical Chemistry Functions 1.3 Chemistry Automation 1.4 Measurement Types 1.5 Chemical Reactions 1.6 Chemistry Tests 1.7 Immunochemical Reactions 1.8 Immunoassay Tests 1.9 Specific Proteins 1.10 Therapeutic Drugs 1.11 Toxicology/Drugs of Abuse 1.12 Potentiometry 1.13 Analytes & Disease States 1.14 Course Review 1.15 Disclaimer 1.16 Assessment 1.23 Completion