The clinical biochemistry laboratory

Published on 01/03/2015 by admin

Filed under Basic Science

Last modified 22/04/2025

Print this page

rate 1 star rate 2 star rate 3 star rate 4 star rate 5 star
Your rating: none, Average: 0 (0 votes)

This article have been viewed 1930 times

1

The clinical biochemistry laboratory

Clinical biochemistry, chemical pathology and clinical chemistry are all names for the subject of this book, that branch of laboratory medicine in which chemical and biochemical methods are applied to the study of disease (Fig 1.1). While in theory this embraces all non-morphological studies, in practice it is usually, though not exclusively, confined to studies on blood and urine because of the relative ease in obtaining such specimens. Analyses are made on other body fluids, however, such as gastric aspirate and cerebrospinal fluid. Clinical biochemical tests comprise over one-third of all hospital laboratory investigations.

Core biochemistry

Biochemical facilities are provided in every hospital, although not necessarily to the same extent. All biochemistry laboratories provide the ‘core analyses’, commonly requested tests that are of value in many patients, on a frequent basis (Table 1.1). The clinician will often request specific groupings of tests, and clinical biochemistry assumes a cryptic language of its own as request forms arrive at laboratory reception for ‘U & Es’ (urea and electrolytes), ‘LFTs’ (liver function tests) or ‘blood gases’.

Specialized tests

There are a variety of specialties within clinical biochemistry (Table 1.1). Not every laboratory is equipped to carry out all possible biochemistry requests. Large departments may act as reference centres where less commonly asked for tests are performed. For some tests that are needed in the diagnosis of rare diseases, there may be just one or two laboratories in the country offering the service.

Test repertoire

There are over 400 different tests that may be carried out in clinical biochemistry laboratories. They vary from the very simple, such as the measurement of sodium, to the highly complex, such as DNA analysis, screening for drugs, identificatication of intermediary metabolites or differentiation of lipoprotein variants. Many high-volume tests are done on large automated machines. Less frequently performed tests may be conveniently carried out by using commercially prepared reagents packaged in ‘kit’ form. Some analyses are carried out manually (Fig 1.3). Assays that are performed infrequently may be sent to another laboratory where the test is carried out regularly. This has both cost and reliability benefits.

Dynamic tests require several specimens, timed in relation to a biochemical stimulus, such as a glucose load in the glucose tolerance test for the diagnosis of diabetes mellitus. Some tests provide a clearcut answer to a question; others are only a part of the diagnostic jigsaw.

This book describes how the results of biochemistry analyses are interpreted, rather than how the analyses are performed in the laboratory. An important function of many biochemistry departments is research and development. Advances in analytical methodology and in our understanding of disease continue to change the test repertoire of the biochemistry department as the value of new tests is appreciated.

Laboratory personnel

As well as performing the analyses, the clinical biochemistry laboratory also provides a consultative service. The laboratory usually has on its staff both medical and scientific personnel who are familiar with the clinical significance and the analytical performance of the test procedures, and they will readily give advice on the interpretation of the results. Do not be hesitant to take advantage of this advice, especially where a case is not straightforward.