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Global requirements of clinical
biochemistry labPrepared by: mazen fahad mazen musaid
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Introduction :
Clinical biochemistry lab :It is a discipline of medical lab and also known as
(Clinical chemistry ,chemical pathology, medical
biochemistry or pure blood chemistry) is the area ofpathology that is generally concerned with analysis of body
fluids.
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this large array of tests can be further subcategories into sub
specialties:
- general or routine chemistry .
- endocrinology : the study of hormone .- enzymology : the study of the enzymes.
- pharmacology or toxicology : the study of drugs.
Clinical Biochemistry Test compromise over one third of allhospital investigation . Clinical biochemistry is that branch
of laboratory medicine in which chemical and biochemical
method are applied to study of disease .
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Most studies are confined to blood and urine because the
relative ease in obtaining such specimen , although
analysis are made on other body fluid such CSF and
gastric aspirate .
Most current laboratories are now highly automated and
use assays that are closely monitored and quality
controlled.
Some techniques that applied including the use and
measurement ofenzyme activity , spectrophotometry ,
electrophoresis and immunoassay.
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Clinical biochemistry laboratory
organization
Core lab :
- found virtually in all hospital
- operates 24h 7 days a week
- highly automated environment- instrument with multi-analytes capabilities
- high volume test , many test you can do in
this type of lab .
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Core lab instruments:
In this lab we use auto analyzer, based on the procedure which is called
automation ,self regulation , where the specimen is accurately pipetted
by a mechanical probe and mixed with a particular volume of the
reagent and results are displayed in digital forms and also printed by a
printer.
The automated instruments not only save the labour and time but allow
reliable quality control, reduce subjective crrors and work economically
by using smaller quantities of samples and reagents.
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there are many type of auto analyzer :
A- continuous flow analyzer:
In these systems, the samples and reagents are passed sequentially
through the same analytical pathway and separated by means of air
bubbles.B- discrete analyzer:
1-Batch analysers 2- stat analyzer.
1- batch analyzer:
These are convenient to analyse specimen in batches such as of
sugar, urea creatinine etc.
can be automated and semiautomated.
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Semi automated batch analyzer:
the initial step you will do by your self ,pipitting ,mixing , incupation .
ADV:
1- cheap &compact.
2- cheap sample analysis since the amount of reagent 0.5 ml.
3- Enzyme determinations by kinetic methods are performed
accurately in 1 to 3 minutes.
4-The enzymatic reagents are not corrosive and involve monostep
testing.2- stat analyzer(random access analyzer)
'Stat' (means immediate reporting or emergency determination
analysers.
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Electrolytes analyzer:
Atomic absorption spectroscopy: It is a modification of the flame
photometer in that it measures the amount of light absorbed by the
nebulized sample while moving from ground state to excited state.
Ion selective electrodes:measure the potential difference between two
electrodes. Specific electrodes are used for the determination of
sodium, potassium and chlorides.The requirement is for an ion selective
membrane to separate the solution of known activity from the detecting
system.
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Special lab :
- less frequently ordered test
- labor intensive and often manual method
- general not-stat tests
- lower volume test
This type of lab not available in on auto analyzer
because:
- the demand is not there.
- the test is not easily automated (extraction step).
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Instruments are usually batch analyzers. Either
research instruments or diagnostic instruments that
perform 1 specific test on multiple samples.
More training involved with test protocols and
instrumentation than Core Lab instrumentation.
Longer time required to reach competency.
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Special Chemistry Instrumentation
and Analytical Methods
Electrophoresis: Used to separate serum proteins into 5 distinct bands
Used to separate Lipoproteins into 4 distinct bands
Often used to separate isoforms of enzymes
HPLC :Used to measure vitamins and hemoglobin variants
Infrared Spectroscopy :
Used to analyze components of Kidney stones
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Radioimmunoassay (RIA) Used less and less but still employed for those analytes present in
minute amounts (pmol) in the blood (ie. testosterone)
GC-MS (Gas chromatography-massspectroscopy) and/or LC-MS (liquidchromatography- mass spectroscopy. Used for quantitative drug measurement
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Point of Care Testing (POCT): Instruments located outside of chemistry laboratory such as CCU, ER,
ICU or satellite centre (clinic).
Why we use like these instruments? Tests are of urgent importance, and results will affect the immediate
management of the patient
Instruments are available that can perform certain tests at remote
locations, such as at the bedside on in a clinical care unit.
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Some of test that can performed :
Blood test ,electrolyte, urinalysis, blood gases,cardiac marker
(troponin,t), drug screen.
POC are nearly always more expensive, than the same tests
performed in the central laboratory.
Many are immunoassay based. Can be qualitative or quantitative
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POCT INSTRUMENTATION
Cardiac Markers Drug Screen Urinalysis
Visual qualitative tests
Results must be recorded
and reported manually
Can be qualitative, semiquantitativeand/or quantitative.Hard copy of result
generated
Possible to interface hospital LIS
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Lab Safety
The lab is an exciting place but it can be a dangerous place if the safe
procedure is not followed.
KNOW YOUR SURROUNDING !
Should be aware of potential harms that can be caused by any object inthe surrounding
Hazard in lab:
Any object or material in a lab that can cause injury to human or harm
the environment is called hazard.
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Depending upon the nature of hazardous substance the hazards are of
3 types:
1. Physical hazard
2. Chemical hazard
3. Biological hazard
Physical hazard
Flammable
Combustible Compressed Gas
High voltage equipments
Sharp
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Chemical hazard
Corrosives
Oxidative
Toxic
Poisonous
Corrosive :
A chemical that causes visible destruction of or irreversible alterations of
living tissue by chemical action at the site of contact.
ex: amines , acids
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Oxidizers : Reactive chemical that releases oxygen and accelerates combustion.
They may be corrosives, irritants, toxins, sensitizers, etc.
ex: Oxygen, peroxides. Toxic :
A chemical capable of adversely affecting a body. Capable of
adversely affecting one or multiple organs of the body.
ex:
Xylene - Kidney, Liver, Central nervous system.
Isocyanates - Lungs.
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Poisons:
Poisons are likely to cause death or serious injury if they are
swallowed, inhaled, or come in contact with the skin. May interfere with
oxygen distribution in the bloodstream.
Can enter the body through inhalation, absorption, or ingestion.ex:
Methanol, carbon monoxide
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Carcinogens
A substance capable of causing or producing cancer in humans oranimals.
Exposure to a carcinogen can, over time, cause changes in cell divisionwithin the body that leads to uncontrolled cell growth.
ex: Formaldehyde, silica, benzene
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Personnel protection:
After knowing about the nature of substances around the primary mean
of safety is protecting your self
For this personal protective equipment (PPE) is desired
The basic concept of PPE lies in
how the hazard contact our body?
Ingestion swallowing
Inhalation breathing
Absorptionskin contact
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To secure the contacts with our
body
We should have following as
Personal Protective Equipment
A-Safety Glasses
B -Gloves
C -Apron
D -Face Shield E - Respirator
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!Still require Safe Practice
Despite having all PPE we are still require to practice safely in labsince PPE never protects us completely from hazards
Instruction for using chemical safety: Never touch, taste, or smell any chemical that you do not know is
harmless.
If you are instructed to smell fumes, do so by gently waving your hand
over the container so that the fumes are brought to you. Do not bring the container to your nose.
Do not inhale the fumes directly from the container.
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Labels
Name of material
Suppliers
Name/addressHealth hazard
Physical hazard
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Importance of Labeling
To identify hazards in your
work area.
Labels must be on every bag, barrel, bottle, box, can, cylinder, drum,
storage tank, etc.
Notify your supervisor or safety representative if there are no labels ona container.
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Material Safety Data Sheets
Data sheet containing information about the hazards associated with achemical.
All manufacturers, distributors, and consumers must have MSDS.
All hazardous materials MUST have a corresponding MSDS.
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Electrical Equipment Safety
Be careful not to shock yourself or another person.
Turn off all power sources when setting up circuits or repairing
equipment.
Do not use metal articles such as rulers, metal pencils or pens; do
not wear rings, metal watchbands, or bracelets when working withelectrical equipment.
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General Lab Rules
Read all directions for doing an investigation before beginning.
Be alert and listen for directions. Ask questions if you are unsure
of anything.
Never perform activities that are not authorized by the teacher.
Do not handle equipment without permission.
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First aid
Be aware of the locations of the first-aid kit, but allow the
teacher to administer first aid to an injured student
Report all accidents to your teacher immediately.
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Thank you&all the best