KIMIA KLINIK

DEFINITION
Clinical chemistry = chemical pathology = clinical biochemistry = medical biochemistry is the area of clinical pathology that is generally concerned with analysis of bodily fluids

HISTORY
The discipline originated in the late 19th century with the use of simple chemical tests for various components of blood and urine. Subsequent to this, other techniques were applied including the use and measurement of enzyme activities, spectrophotometry, electrophoresis, and immunoassay

now
Most current laboratories are now highly automated to accommodate the high workload typical of a hospital laboratory. Tests performed are closely monitored and quality controlled

 All biochemical tests come under chemical pathology. These are performed on any kind of body fluid, but mostly on serum or plasma. Serum is the yellow watery part of blood that is left after blood has been allowed to clot and all blood cells have been removed. This is most easily done by centrifugation, which packs the denser blood cells and platelets to the bottom of the centrifuge tube, leaving the liquid serum fraction resting above the packed cells.

 This initial step before analysis has recently been included in instruments that operate on the "integrated system" principle. Plasma is in essence the same as serum, but is obtained by centrifuging the blood without clotting. Plasma is obtained by centrifugation before clotting occurs. The type of test required dictates what type of sample is used

 A large medical laboratory will accept samples for up to about 700 different kinds of tests. Even the largest of laboratories rarely do all these tests themselves, and some must be referred to other labs

sub-category / sub-specialities of tests

General or routine chemistry - commonly ordered blood chemistries (e.g., liver and kidney function tests). Special chemistry - elaborate techniques such as electrophoresis manual testing methods. Clinical endocrinology - the study of hormones, and diagnosis of endocrine disorders. Toxicology - the study of drugs of abuse.

sub
Therapeutic Drug Monitoring - measurement of therapeutic medications blood levels to optimize dosage. Urinalysis - chemical analysis of urine for a wide array of diseases, along with other fluids such as CSF and effusions Fecal analysis - mostly for detection of gastrointestinal disorders

Common clinical chemistry tests include: Electrolytes

Sodium Potassium Chloride Bicarbonate

Renal (Kidney) Function Tests

Creatinine Blood urea nitrogen

Liver Function Tests

Total protein (serum)
Albumin Globulins A/G ratio (albumin-globulin) Protein electrophoresis Urine protein

Bilirubin; direct; indirect; total Aspartate transaminase (AST) Alanine transaminase (ALT) Gamma-glutamyl transpeptidase (GGT) Alkaline phosphatase (ALP)

Cardiac Markers
Troponin Myoglobin CK-MB B-type natriuretic peptide (BNP)

Minerals
Calcium Magnesium Phosphate Potassium

Blood Disorders
Iron Transferrin TIBC Vitamin B12 Folic acid

Miscellaneous
Glucose C-reactive protein Glycated hemoglobin (HbA1c) Uric acid Arterial blood gases Adrenocorticotropic hormone (ACTH) Toxicological screening and forensic toxicology (drugs and toxins) Neuron-specific enolase (NSE) fecal occult blood test (FOBT)

A set of commonly ordered tests are combined into a panel: Basic metabolic panel (BMP) - 8 tests - sodium, potassium, chloride, bicarbonate, blood urea nitrogen (BUN), creatinine, glucose, calcium Comprehensive metabolic panel (CMP) - 14 tests - above BMP plus total protein, albumin, alkaline phosphatase (ALP), alanine amino transferase (ALT), aspartate amino transferase (AST), bilirubin