INTRODUCTION TO

CLINICAL CHEMISTRY
Prepared by: Miss Nada
 Clini cal ch em istr y is the measurement of the amount of

chemicals in body fluids.

 Tests are often performed in groups of individual tests,

called panels. The Liver Function Test (LFT) is an example of

a panel. 

 Proper sam ple col lec ti on an d h and ling help ensure

that the results are valid.  Many different specimens can be

used, including whole blood, serum, plasma, urine, faeces,

Difference between Plasma &
Serum
 Bl ood pl asm a is the liquid component of blood, in which

the blood cells are suspended. It makes up about 55% of

total blood volume. It is composed of mostly water (90% by
volume), and contains dissolved proteins, glucose, clotting
factors, mineral ions, hormones and carbon dioxide. Blood
plasma is prepared simply by spinning a tube of fresh blood
in a centrifuge until the blood cells fall to the bottom of the
tube. The blood plasma is then poured or drawn off.

 Bl ood se rum is blood plasma without fibrinogen or the

 Type of anticoagulant:
 The preferred anticoagulant for chemistries is

he par in —in interferes with the fewest tests.  It

functions by inactivating prothrombin, one of the

clotting factors, and has a green cap.  EDTA usually

contains sodium or potassium which inhibits the

testing process and/or changes the levels of some

reagents. 
 Hemolysis & Lipemia:
 He moly sis is the rupture of red
blood cells with the release of
hemoglobin and the cellular
constituents into the plasma,
or liquid portion of whole blood.
The release of hemoglobin causes
the serum or plasma to appear
pale red to cherry red in color.
 Hemoly sis ca n in terf ere wit h lab res ul ts due to sev eral
proce sses:

 Leakage of analytes from lysed erythrocytes may cause a false

increase in the amount of analyte measured in serum if the
analyte is normally present in a greater amount inside the RBC
than in plasma.  This can occur when measuring the levels of
potassium, creatine kinase (CK), and alanine amino transferase
(ALT).

 If the analyte is normally present in greater amounts in plasma

than in the erythrocytes, the analyte will be diluted by the lysing
 Color interference (tinting the serum pink or red) can cause

false increases when using a spectrophotometer.

Hemoglobin, bilirubin and protein are a few of the analytes

affected by hemolysis.

 Sometimes erythrocyte constituents can react with analytes,

causing a false decrease. This can occur when testing for

carbon dioxide, thyroxin and insulin. 

 Hemolysis can cause increased turbidity when using the

 Lipemia:

 Lipemia: is the presence of an

abnormally high concentration of

lipid in the blood.

Lipemia is another interference

that can adversely affect test results. 

Hemolysis is enhanced by lipemia,

 Lipids present in a specimen scatter light and can cause

either an increase or decrease in values, depending

upon the analytes being evaluated. 

Because electrolytes are in the aqueous phase of blood,

lipids may dilute their concentration.  Lipemia can be

minimize d by fasting the patient prior to blood

collection, by ultracentrifuging the sample or using

polymers to precipitate the lipids out of the sample.

 CHEMISTRY SYSTEMS
 Dry reag en t st rips require the comparison of a color
change on the reagent strip with a color chart. These are
most commonly used as quick screening tests, and their
accuracy is only low to moderate.

 We t an d d ry c hem istr y sys tem s utilize a

spectrophotometer to mechanically measure color change
and are much more accurate than dry reagent trips. The
reagent is the difference between the two systems—most
 Spe ctr oph otom ete rs use the Beer-Lambert (or Beer’s) law

to measure concentrations. This law states that the amount

of light absorbed by a solution varies with the concentration

of the colored solute. Light is shown through a specimen in

a cuvette and the amount of light transmitted is recorded by

a photocell. This is then converted into the amount of

substance in the sample.

ଊ Know your glassware