27. Clinical Biochemistry

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27. Clinical Biochemistry

 

 

CATEGORY: Medical & Medicine – 500 Courses

COURSE NUMBER: 27

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Syllabus

Electronic books 2
1. Pre-Analytical Effects on Laboratory Examinations ………………………….4
1.1. Introduction 4
1.2. Pre-Analytical Phase and Its Sources of Variability 4
1.3. Before the Biological Material Collection 5
1.4. During the Biological Material Collection 6
1.5. Between Biological Material Collection and Analysis 7
2. Reference Values and Methods for Their Determination………………………………..9
2.1. Introduction 9
2.2. Basic Terms and Definitions 9
2.3. Options for Determining Reference Intervals 10
2.4. Importance of Reference Interval when Interpreting Results 15
3. Analytical Properties of the Laboratory Method, Quality Control …………………………….16
3.1. Introduction 16
3.2. Performance Characteristics of the Analytical Method 16
3.3. Validation and Verification of Methods 28
3.4. Quality Control 29

4. Diagnostic Sensitivity, Specificity of the Method, Methods of Determination, Interrelations, Laborato-
ry Screening…………………………….34

4.1. Introduction 34
4.2. Diagnostic Sensitivity and Specificity of the Method 35
4.3. Other Clinical Characteristics 38
4.4. Laboratory Screening 39
5. Basic Urine Tests……………………………….42
5.1. Summary 42
5.2. Sample Collection and the Pre-Analytical Phase 42
5.3. Physical Properties of Urine 43
5.4. Chemical Examination of Urine Using Test Strip (Dipstick) 44
5.5. Microscopic Examination of Urine 51
6. Kidney Function Tests …………………………..55
6.1. Glomerular Filtration Tests (GF) 55
6.2. Tubule Function Test 58
6.3. Acute Renal Failure 61
6.4. Chronic Renal Failure 62
7. The Importance of Plasma Protein Assays…………………..64
7.1. Methods for Plasma Protein Examination 64
8. The Importance of Na, K, Cl Assays in Clinical Practice…………………….79
8.1. Natrium 79
8.2. Kalium 84
8.3. Chloride Anion 87
9. Metabolism of Calcium, Phosphorus and Magnesium…………………………88
9.1. Metabolism of Calcium, Phosphorus and Magnesium – Preparation 88
9.2. References: 98
9.3. Metabolism of Calcium, Phosphorus and Magnesium 99
9.4. References: 107
10. Trace Elements………………………..108
10.1. Esential Trace Elements 108
10.2. Iodine 111
10.3. Iron 112
10.4. Zinc 113

10.5. Copper 115
10.6. Selenium 117
10.7. Chromium 119
10.8. Manganese 119
10.9. Molybdenum 120
10.10. Cobalt 120
11. Vitamins ………………….122
11.1. Vitamins – Preparation 122
11.2. Vitamins 126
12. Thyroid Gland……………………………….137
12.1. Thyroid Gland – Preparation 137
12.2. References: 147
12.3. Laboratory Tests for Thyroid Gland Disorders 148
12.4. References: 158
13. Hormones of hypothalamus and hypophysis……………………………………160
13.1. Prolactin 160
13.2. FSH – Follicle Stimulating Hormone 160
13.3. LH – Luteinizing Hormone 160
13.4. Oxytocin 161
13.5. ADH – Antidiuretic Hormone 161
13.6. TSH – Thyroid-Stimulating Hormone or Thyrotropin 161
13.7. ACTH – Adrenocorticotropic Hormone 161
13.8. STH – Somatotropin (GH – growth hormone) 162
14. Adrenal Cortex Hormones…………………………………….163
14.1. Biochemistry Histology, Secretion Regulation and Effects of Adrenal Cortex Hormones 163
14.2. Laboratory Diagnostics 164
14.3. Functional Tests 166
14.4. Hypercorticalism 168
14.5. Hypocorticalism 168
15. Disorders of Acid-Base Balance…………………………………..170
15.1. Metabolic and Respiratory Disorders of Acid-Base Balance 170
15.2. Combined Metabolic Acid-Base Balance Disorders 179
16. Importance of Oxygen Assays…………………………………….184
16.1. Role of Oxygen in the Body 184
16.2. Partial Oxygen Pressure along the Oxygen Pressure Gradient 184
16.3. Monitored Parameters Related to Oxygen Metabolism (Guidance Values) 184
16.4. Conditions for Adequate Oxygen Supply to Tissues and Possible Causes of Hypoxia 185
16.5. Respiratory Insufficiency 190
16.6. Lactate 190
16.7. Perinatal Asphyxia 190
16.8. High Altitude Effect 190
16.9. Diving 190
16.10. Measured and Counted Oxygen Metabolism Parameters 191
16.11. Treatment for Hypoxia 192
17. Importance of Osmolality Tests, Water Metabolism ……………………………194
17.1. Osmolality and Water Metabolism 194
18. Serum Lipids and Lipoproteins, Relation to Atherogenesis ………………………201
18.1. Lipids 201
18.2. Lipoproteins 207
18.3. Apolipoproteins 209
19. Risk Factors for Atherosclerosis (Except Lipids)…………………….211
19.1. Markers of Inflammation 211

19.2. Markers of Haemostasis and Thrombosis 212
20. Free Radicals, Relation to Diseases and Protection against Them……………………….215
20.1. What Is Oxidative Stress? 215
20.2. Oxidants – Free Radicals and Reactive Forms of Oxygen and Nitrogen 215
20.3. Antioxidants – Substances Acting against Oxidants 216
20.4. Compounds Generated Due to Oxidative Stress – Radical Reaction Products and Their Importance in
Tissue Damage 217

20.5. Physiological and Pathological Role of the Reactive Forms of Oxygen and Nitrogen, Importance in Patho-
genesis 218

20.6. Laboratory Diagnostics 219
20.7. Possible Therapies 220
21. Biochemical Tests for Liver Diseases…………………………….222
21.1. Tests indicative of impairment of hepatocyte integrity 222
21.2. Tests indicative of disorders at the level of bile duct system and the canalicular pole of hepatocytes222
21.3. Tests measuring protein synthesis by the liver 223
21.4. Analytes measuring the transport and excretory capacity of the liver 225
21.5. Tests measuring the liver’s ability and capacity to metabolize endogenous and xenogenous substances
225
21.6. Laboratory assays for the diagnosis of specific liver diseases 225
22. Laboratory Diagnosis of Jaundice……………………….229
22.1. Classification of Hyperbilirubinaemias 229
22.2. Predominantly Unconjugated Hyperbilirubinaemias 230
22.3. Predominantly Conjugated Hyperbilirubinaemias 233
22.4. Laboratory assays for differential diagnosis of jaundices 236
23. Bone Metabolism…………………………………237
23.1. Bone Metabolism – Preparation 237
23.2. References 246
23.3. Bone Metabolism 247
23.4. References 261
24. Laboratory Diagnostics in Gastroenterology…………………………262
24.1. Screening programmes 262
24.2. Function tests 262
24.3. Laboratory diagnostics of gastric pathologies 262
24.4. The laboratory diagnostics of malabsorption syndrome 264
25. Diabetes Mellitus………………………270
25.1. Definition and Incidence of the Disease 270
25.2. Clinical and Laboratory Signs of Diabetes 271
25.3. Blood Glucose (Glycaemia) Testing 271
25.4. Diagnosis of Diabetes 271
25.5. Laboratory Monitoring of Diabetes 273
25.6. Other Laboratory Tests of Diabetic Patients 276
25.7. Complications of Diabetes 278
25.8. Diabetes Management Options 280
25.9. Stress-Induced Hyperglycaemia 282
25.10. Causes of Hypoglycaemia 282
26. Cardiac Markers………………………….283
26.1. Cardiac Markers – Preparation 283
26.2. Laboratory Diagnosis of Acute Myocardial Infarction and Heart Failure – Use of Cardiac Markers 290
26.3. References 295
27. Laboratory Signs of Malignant Tumours……………………………..297
27.1. Tumour Markers – Definition and Classification 297
27.2. Tests for Tumour Markers, Indication and Interpretation 304
27.3. Tumour Marker Evaluation 304

28. Cytochemical Examination of Cerebrospinal Fluid……………………………305
28.1. Cerebrospinal Fluid Cytology 305
28.2. Types of Cytological Findings in CSF 308
28.3. Biochemical Examination of Cerebrospinal Fluid 310
28.4. Examination of Intrathecal Immunoglobulin Synthesis 311
28.5. Spectrophotometry of Cerebrospinal Fluid 313
28.6. Microbiological Examination and Pathogenic Agent Detection 313
28.7. Prospects for New Advances in CSF Examination 314
28.8. Determination of Liquorrhoea 314
29. Inherited Metabolic Diseases – Laboratory Diagnostics………………………….315
29.1. IMD Characteristics 315
29.2. Incidence 315
29.3. Pathophysiology 316
29.4. Classification of IMDs and Characteristics of Basic Groups 319
29.5. Clinical Symptoms and Indications for IMD Examination 320
29.6. Diagnosis of IMDs 325
29.7. Options for IMD Treatment and Prevention 326
30. Laboratory Test for Urolithiasis……………………….328
30.1. Characteristics of Urinary Concrements 328
30.2. Laboratory Diagnostics of Urolithiasis 329
30.3. Analysis of Urinary Concrements 329
30.4. Case Reports 329
31. Laboratory Examinations during Pregnancy……………………………….332
31.1. Introduction 332
31.2. Laboratory Examinations during Pregnancy 332
31.3. Conditions and Extent of Screening 336
31.4. Most Common Developmental Defects 337
31.5. Screening for Congenital Defects 338
31.6. Cytogenetic Methods 343
31.7. Conclusion 344
31.8. Case Reports 344
32. Specificities of Laboratory Examination during Childhood………………………….347
32.1. Metabolic Differences 347
32.2. Collection of Biological Material from Children 348
32.3. Reference Range 352
33. Basics of Toxicology in Clinical Laboratory……………..353
33.1. Introduction 353
33.2. Toxicology 353
33.3. Toxicological Indications in Clinical Laboratories 354
33.4. Poisons 355
33.5. Toxicological Tests 362
33.6. Analytical Techniques 365
33.7. Most Common Forms of Intoxication 366
34. Laboratory investigation of Ovarian and Testicular Disorders …………………….373
34.1. Hormone Tests for Ovarian and Testicular Disorders 373
35. Therapeutic Drug Monitoring……………….384
35.1. Introduction 384
35.2. Indications for Drug Level Determination 384
35.3. ADTM (Advanced Therapeutic Drug Monitoring) 387
35.4. Pharmacogenetics – Polymorphism – Genotype – Phenotype 388
35.5. Personalized Pharmacotherapy 389
36. Trends in Laboratory Medicine (POCT, Automation, Consolidation, EBM, Omics) ……………………390
36.1. POCT (Point-Of-Care Testing) 390

36.2. References 394
36.3. Automation and Consolidation 394
36.4. References 396
36.5. EBM 396
36.6. References 398
36.7. OMICS 398
36.8. References 405
37. Anticoagulant Therapy Monitoring………………406
37.1. Blood Coagulation Physiology 406
37.2. Laboratory Tests 407
37.3. Laboratory Monitoring of Anticoagulant Therapy 407
38. Clinical Nutrition and Metabolic Balance …………….410
38.1. General Nutrition Disorders 410
38.2. Causes of Undernutrition 410
38.3. Incidence of Hospital Malnutrition 410
38.4. Risks and Impacts of Hospital Malnutrition 411
38.5. Diagnosis of Malnutrition 411
38.6. Two Types of Malnutrition 412
38.7. Who Requires Nutritional Intervention? 413
38.8. Types of Nutritional Intervention – What We Can Offer to Patients 414
38.9. Monitoring Nutritional Status in Hospital 414
38.10. Determination of Energy Requirement 417
38.11. Body Composition 418
38.12. Examples – PN Specification for All-in-One Bags 419

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