Download CHEMISTRY SECTION

CHEMISTRY SECTION
I. GENERAL: Specimens for chemistry procedures should be obtained in a fasting state (12-14 hour fast).
If this is not practical, an "order comment" should be made in CHCS to verify this. Accuracy of results on a
lipemic (most commonly caused by a non-fasting specimen) or hemolyzed specimen is questionable. It is
also important to make the Chemistry Section aware of medications so that proper precautions can be taken
to assure the best results. Close adherence to the information and instructions contained herein will insure
more effective laboratory support and services by the Chemistry Section. Our laboratory personnel are as
anxious to provide the highest quality patient support as the physicians who rely on it.
II. REQUEST FORMAT:
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III. CHEMISTRY TESTS:
A. Blood Chemistry:
1. All blood chemistries are done on samples drawn in the fasting state (12 hours), except in
emergencies. The fasting state means that food and drinks, except for water, are to be withheld from the
patient. Water may be given, except when a gastric analysis, gastric wash or urinary concentrating
ability test is to be done. If at all possible, all drug medications should be
withheld from 24 to 48 hours prior to having blood drawn except for
therapeutic drug monitoring. A minimum of 14 hours fast is necessary for
triglycerides, HDL-cholesterol, and LDL-cholesterol.
2. In the analysis of therapeutic drugs, additional data on the patient will be helpful. When ordering a
therapeutic drug in CHCS, the dose time will be asked and should be answered as accurately as possible in
the Order Comment section.
B. Urine Chemistry:
1. Instructions and appropriate urine containers with required preservative
for 24-hour urine collections are to be obtained at the laboratory front desk. A
24-hour urine test request that requires an acid preservative may be collected in
conjunction with a 24-hour test that does not require any acid or other preservative
if the specimen is refrigerated during collection and is brought to the laboratory
immediately upon completion.
2. If at all possible, instruct patient to withhold all drug medications from 24 to 48 hours prior to
timed-urine collection. For timed specimens, the patient should be instructed to empty the bladder upon
arising in the morning of the starting day and discard that urine. All urine passed throughout the subsequent
timed period is collected in the container provided and refrigerated. Upon arising the next morning, the
patient completely empties the bladder and adds this urine to the container. This last specimen terminates
the 24-hour collection and the urine collection is submitted to the laboratory. If a creatinine clearance test is
requested, a blood creatinine specimen must be collected by the laboratory within the 24-hour time frame
usually after termination of the collection. The patient’s height and weight must be recorded on the
instruction sheet. Complete instructions for collection and diet will be given at the time the collection
container is procured.
3. Collection time for quantitative urine chemistry tests is of utmost importance in order to properly
report urine chemistry results. It is essential to be able to distinguish 24-hour urine collections from those
collections which are less than 24 hours. The volume of urine measured without any written indication of
the collection period cannot be relied upon solely as a means of identifying the time interval of collection.
In order to insure meaningful and accurate reporting, please indicate the time period of urine collection. All
that is required is an indication such as "random", "spot", "2 hour", "12 hour", "24 hour", or other in the
comment section of CHCS. Your attention to the matter will facilitate the initial processing and final
reporting of urine chemistry tests.
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Tubes used :.
Tubes
Additive
Green Tube
Lithium
Heparin
Plain Tube
Lavender
Tube
Sample
Tests
Plasma
All
Test
No additive
Serum
EDTA
Whole
Blood
Hormone
Iron
TP
CSF
HbA1c
There are 3 technicians including the chief of this department
1. Daily, weekly and monthly maintenance of the instruments
2. Doing and checking the calibrations and quality control
3. Checking the results
Equipments:.
4. Rotator (Mix )
5. Centrifuge (separated serum & plasma from blood cell )
6. Dimension( Mex ,Rxl ) ،Bakment : Spectrophotometer
7. Elecsys 2010 : for hormone
8. ABG : Arterial blood gases
Testes performers :.
9. Glucose
10. Lipid Profile
11. Liver Function Test
12. Renal Function Test
13. Routine Urine Analysis
14. Hormone
15. Arterial blood gases
Routine Test :.
16. Glucose
17. Urea
18. Creat.
19. Na/ K
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SAMPLE RECEIVING AND PROCESSING
1. Upon receiving specimen, see to it that an appropriate amount of blood has been sent,
properly labeled with name, number of patient and the date of collection. Data on the tube
should coincide with the data written on the request slip.
2. Assign laboratory number on the sample and write the number on the tube and on the
request slip.
3. Centrifuge specimen for 5 minutes at 3,500 rpm See if sample is not
hemolyzed. Hemolysis affects certain chemistry determinations (i.e
.serum electrolytes, glucose etc.)
4. Separate serum/plasma from red cells at once and
place inside assay cups labeled with the
corresponding number of the patient.
5. Test for the desired chemistry determination on the Dimension and/or SYNCHRON
autoanalyzer Enter the necessary data in the machine.
6. Record results in the logbook
7. Release results that has been signed and stamped with the name of technician who
performed the test.
TESTS USED IN LABORATORIES :.
1. GLUCOSE:
(1) Fasting blood sugar (FBS)
measures blood glucose after fasting for at least 8 hours. It often is the first test done to
check for diabetes.
(2) 2-hour postprandial blood sugar (2-hour PP)
measures blood glucose exactly 2 hours after eating a meal.
(3) Random blood sugar (RBS)
measures blood glucose regardless of when the person last ate. Several random
measurements may be taken throughout the day. Random testing is useful because glucose
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levels in healthy people do not vary widely throughout the day. Blood glucose levels that
vary widely may indicate a problem. This test is also called a casual blood glucose test.
(4) Oral glucose tolerance test (OGTT)
measures the body's ability to use glucose. It is used mainly to diagnose prediabetes and
diabetes. An oral glucose tolerance test is a series of blood glucose measurements taken after
you drink a sweet liquid that contains glucose. This test is commonly used to diagnose
diabetes that occurs during pregnancy (gestational diabetes). This test is not commonly
used to diagnose diabetes in a person
(5) Glycosylated hemoglobin HbA1c:
Glycosylated hemoglobin is an indicator of the blood glucose concentration over a longer
period of time than either a single blood glucose measurement (which reflects the glucose
concentration at the time of blood collection)
A glycohemoglobin test indicates how well diabetes has been controlled in the 2 to 3
months before the test. The A1C level is directly related to complications from diabetes:
(The lower the A1C level, the lower the risk for complications)
2. Lipid Profile
CHOLESTEROL
Elevated cholesterol has been seen in artherosclerosis, diabetes, hypothyroidism and
pregnancy. Low levels are seen in depression, malnutrition, liver insufficiency, malignancies,
anemia and infection.
Normal Adult Range: 120 - 240 mg/dl
Optimal Adult Reading: 180
TRIGLYCERIDES
Increased levels may be present in artherosclerosis, hypothyroidism, liver disease,
pancreatitis, myocardial infarction, metabolic disorders, toxemia, and nephrotic syndrome.
Decreased levels may be present in chronic obstructive pulmonary disease, brain infarction,
hyperthyroidism, malnutrition, and malabsorption.
Normal Adult Range: 0 - 200 mg/dl
Optimal Adult Reading: 100
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LDL (Low Density Lipoprotein)
LDL is the cholesterol rich remnants of the lipid transport vehicle VLDL (very-low density
lipoproteins) there have been many studies to correlate the association between high levels
of LDL and arterial artherosclerosis.
Normal Adult Range: 62 - 130 mg/dl
Optimal Adult Reading: 81 mg/dl
HDL (High Density Lipoprotein)
HDL or High-density lipoprotein is the cholesterol carried by the alpha lipoproteins. A high
level of HDL is an indication of a healthy metabolic system if there is no sign of liver disease
or intoxication.
Normal Adult Range: 35 - 135 mg/dl
Optimal Adult Reading: +85 mg/dl
3. Liver Function Test ( LFT )
a. Tests of excretion by the liver
Alkaline apahosphatase.
Bilirubin.
b. Evaluation of synthesis in liver.
Total Protein- TP
Albumin-Alb
c. Evaluation of enzyme activity.
Alanine Aminotransferase (ALT)=SGPT
Aspartate Aminotransferase (AST)=SGOT
Gamma Glutamic Transpeptidase (GGT)
Lactate Dehdrogenase (LDH)
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FIRST: Tests of excretion by the liver
SGOT (Serum Glutamic-Oxalocetic Transaminase - AST)
Serum Glutamic Oxalocetic Transaminase or AST is an enzyme found primarily in the
liver, heart, kidney, pancreas, and muscles. Seen in tissue damage, especially heart and
liver, this enzyme is normally elevated. Vitamin B deficiency and pregnancy are two
instances where the enzyme may be decreased.
Normal Adult Range: 0 - 42 U/L
Optimal Adult Reading: 21
SGPT (Serum Glutamic-Pyruvic Transaminase - ALT)
Serum Glutamic Pyruvic Transaminase or ALT is an enzyme found primarily in the
liver but also to a lesser degree, the heart and other tissues. It is useful in diagnosing
liver function more so than SGOT levels. Decreased SGPT in combination with
increased cholesterol levels is seen in cases of a congested liver. We also see increased
levels in mononucleosis, alcoholism, liver damage, kidney infection, chemical
pollutants or myocardial infarction.
Normal Adult Range: 0 - 48 U/L
Optimal Adult Reading: 24
GGT (Gamma-Glutamyl Transpeptidase)
Believed to be involved in the transport of amino acids and peptides into cells as well
as glutithione metabolism, Gamma-Glutamyl Transpeptidase is mainly found in liver
cells and as such is extremely sensitive to alcohol use. Elevated levels may be found in
liver disease, alcoholism, bile-duct obstruction, cholangitis, drug abuse, and in some
cases excessive magnesium ingestion. Decreased levels can be found in
hypothyroidism, hypothalamic malfunction and low levels of magnesium.
Normal Adult Female Range: 0 - 45 U/L
Optimal Female Reading: 22.5
Normal Adult Male Range: 0 - 65 U/L
Optimal Male Reading: 32.5
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LDH (Lactic Acid Dehydrogenase)
Lactic acid dehydrogenase is an intracellular enzyme from particularly in the kidney,
heart, skeletal muscle, brain, liver and lungs. Increases are usually found in cellular
death and/or leakage from the cell or in some cases it can be useful in confirming
myocardial or pulmonary infarction (only in relation to other tests). Decreased levels
of the enzyme may be seen in cases of malnutrition, hypoglycemia, adrenal exhaustion
or low tissue or organ activity.
Normal Adult Range: 0 - 250 U/L
Optimal Adult Reading: 125
SCEOND : Excretory Function
ALKALINE PHOSPHATASE
Produced in the cells of the bone and liver with some activity in the kidney, intestine,
and placenta, it is mostly found in an alkaline state with a pH of 9. Used extensively
as a tumor marker it is also present in bone injury, pregnancy, or skeletal growth
(elevated readings). Growing children have normally higher levels of this enzyme also.
Low levels are sometimes found in hypoadrenia, protein deficiency, malnutrition and
a number of vitamin deficiencies.
Normal Adult Range: 20 - 125 U/L
Optimal Adult Reading: 72.5
Normal Children’s Range: 40 - 400 U/L
Optimal Children’s Reading: 220
BILIRUBIN, TOTAL
A by-product of the breakdown of red blood cells in the liver, bilirubin is a good
indication of the liver’s function. Excreted into the bile, bilirubin gives the bile its
pigmentation. Elevated in liver disease, mononucleosis, hemolytic anaemia, low levels
of exposure to the sun, and toxic effects to some drugs, decreased levels are seen in
people with an inefficient liver, excessive fat digestion, and possibly a diet low in
nitrogen bearing foods.
Normal Adult Range 0 - 1.3 mg/dl
Optimal Adult Reading: .65
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Thirds : Synthetic Function
PROTEIN, TOTAL
Proteins are the most abundant compound in serum. The protein makeup of the
individual is of important diagnostic significance because of proteins involvement in
enzymes, hormones and antibodies as well as osmotic pressure balance, maintaining
acid-base balance and as a reserve source of nutrition for the bodies tissues and
muscles. The major serum proteins measured are Albumin and Globulin (alpha1,
alpha2, beta and gamma). Decreased levels may be due to poor nutrition, liver disease,
malabsorption, diarrhoea, or severe burns. Increased levels are seen in lupus, liver
disease, chronic infections, alcoholism, leukaemia, and tuberculosis amongst many
others.
Normal Adult Range: 6.0 -8.5 g/dl
Optimal Adult Reading: 7.25
ALBUMIN
Albumin is the major constituent of serum protein (usually over 50%). It is
manufactured by the liver from the amino acids taken through the diet. It helps in
osmotic pressure regulation, nutrient transport and waste removal. High levels are
seen rarely in liver disease, shock, dehydration, or multiple myeloma. Lower levels are
seen in poor diets, diarrhea, fever, infection, liver disease, inadequate iron intake,
third-degree burns and edemas or hypocalcemia.
Normal Adult Range: 3.2 - 5.0 g/dl
Optimal Adult Reading: 4.1
4. Renal Function Test ( RFT , KFT )
B.U.N. (Blood Urea Nitrogen)
The nitrogen component of urea, B.U.N. is the end product of protein metabolism and
its concentration is influenced by the rate of excretion. Increases can be caused by
excessive protein intake, kidney damage, certain drugs, low fluid intake, intestinal
bleeding, exercise or heart failure. Decreased levels may be dur to a poor diet,
malabsorption, liver damage or low nitrogen intake.
Normal Adult Range: 7 - 25 mg/dl
Optimal Adult Reading: 16
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CREATININE
Creatinine is the waste product of muscle metabolism. Its level is a reflection of the
bodies muscle mass. Low levels are sometimes seen in kidney damage, protein
starvation, liver disease or pregnancy. Elevated levels are sometimes seen in kidney
disease due to the kidneys job of excreting creatinine, muscle degeneration, and some
drugs involved in impairment of kidney function.
Normal Adult Range: .7 - 1.4 mg/dl
Optimal Adult Reading: 1.05
URIC ACID
Uric acid is the end product of purine metabolism and is normally excreted through
the urine. High levels are noted in gout, infections, kidney disease, alcoholism, high
protein diets, and with toxaemia in pregnancy. Low levels may be indicative of kidney
disease, malabsorption, poor diet, liver damage or an overly acid kidney.
Normal Adult Female Range: 2.5 - 7.5 mg/dl
Optimal Adult Female Reading: 5.0
Normal Adult Male Range: 3.5 - 7.5 mg/dl
Optimal Adult Male Reading:5.5
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All test estimation in this Apparatus
BECKMAN
Apparatus photo:
Method
1_Separate blood from serum
2_ Put blood in special cups of the apparatus
3_Put the cups in special rack of the apparatus and ensure the numbers
written on the
4_Put the rack inside the apparatus
5_Go the screen and write patient data (patient ID, name, sample no. )
6_Select type of analysis serum or plasma depending on the tube type normal or
anticoagulant.
7_Select the required investigations (glucose, urea, creatinin) according to what is written
in the request paper.
8_After ending press save
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Dimension( Mex ,Rxl )
Apparatus photo :
Method
1. Press on button F1 - enter data
2. Write sector number
3. Write patient name
4. Write location, sample ID
5. Write required investigations through keyboard
6. If there is more than one sample press F1 then F3 then F4
7. Press F2 if one sample
8. The system start work automatically
9. After ending the results will be printed automatically
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