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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: 1 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. 2 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 3 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 4 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 5 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) 6 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 7 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 8 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 9 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 10 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 11 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 12 13