Jaypee Brothers
In Current Chapter
In All Chapters
X
Clear
X
GO
Normal
Sepia
Dark
Default Style
Font Style 1
Font Style 2
Font Style 3
Less
Normal
More
Clinical Chemistry
DM Vasudevan, Sreekumari S, Kannan Vaidyanathan, Geetha Damodaran K
CHAPTER 1:
Glucose Homeostasis: Abnormalities and Assessment
REGULATION OF BLOOD GLUCOSE
Post-prandial Regulation
Regulation in Fasting State
Normal Plasma Glucose Level
Sugar in Urine
ORAL GLUCOSE TOLERANCE TEST (OGTT)
Indications for OGTT
Contra-indications for OGTT
Preparation of the Patient
Conducting the Glucose Tolerance Test
Normal Values and Interpretations
Diagnostic Criteria for Diabetes Mellitus
Abnormal GTT Curve
1. Impaired Glucose Tolerance (IGT)
2. Impaired Fasting Glycemia (IFG)
3. Gestational Diabetes Mellitus (GDM)
4. Alimentary Glucosuria
5. Renal Glucosuria
REDUCING SUBSTANCES IN URINE
Hyperglycemic Glucosuria
Lactosuria
Pentosuria
Non-carbohydrate Reducing Compounds
Benedict's Test
Biosynthesis of Insulin
Factors Increasing Insulin Secretion
1. Glucose
2. Gastrointestinal Hormones
Factors decreasing the Insulin Secretion
Physiological Actions of Insulin
1. Uptake of Glucose by Tissues
2. Utilisation of Glucose
3. Hypoglycemic Effect
4. Lipogenesis
5. Anti-lipolytic Effect
6. Anti-ketogenic Effect
GLUCAGON
DIABETES MELLITUS
Metabolic Syndrome (MetS) and Polycystic Ovary Syndrome (PCOS)
Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Metabolic Syndrome
Metabolic Derangements in Diabetes
1. Derangements in Carbohydrate Metabolism
2. Derangements in Lipid Metabolism
3. Derangement in Protein Metabolism
Clinical Presentations in Diabetes Mellitus
Cardinal Symptoms
Acute Metabolic Complications
KETOSIS
Causes for Ketosis
Consequences of Ketosis
Diagnosis of Ketosis
Differential Diagnosis of Ketosis
Management of Ketoacidosis
Hyperosmolar Nonketotic Coma
Chronic Complications of Diabetes Mellitus
Laboratory Investigations in Diabetes
1. Blood Glucose Level:
2. Complete lipid profile
3. Kidney Function Tests
4. Micro Albuminuria and Frank Albuminuria
5. Glycated Hemoglobin
7. Other Glycated Proteins (Fructosamines)
Management of Diabetes Mellitus
Hypoglycemia
CHAPTER 2:
Plasma Lipids, Lipoproteins, Cholesterol and Cardiovascular Diseases
PLASMA LIPIDS
Classification of Lipoproteins
Separation by Ultracentrifugation
Separation by Electrophoresis
Apo-lipoproteins
Cholesterol
CHYLOMICRONS
Metabolism of Chylomicrons (exogenous pathway) (dietary pathway)
Function of Chylomicrons
VERY LOW DENSITY LIPOPROTEINS
Metabolism of VLDL (endogenous pathway)
Function of VLDL
LOW DENSITY LIPOPROTEINS (LDL)
Metabolism of LDL and LDL Receptors
Fate of Cholesterol Released in the Cells
LDL and Clinical Applications
Lipoprotein (a)
HIGH DENSITY LIPOPROTEIN (HDL)
Function of HDL
Clinical Significance of HDL
FREE FATTY ACID (FFA)
HYPO-LIPOPROTEINEMIAS
1. Abeta Lipoproteinemia
2. Hypo-Alpha Lipoproteinemia
3. Tangier Disease
HYPERLIPIDEMIAS
Type IIA (Primary Familial Hypercholesterolemia)
Type IIB Hyperlipoproteinemia
Type IV (Familial Endogenous Type)
ATHEROSCLEROSIS
PLASMA LIPID PROFILE
Who should be checked?
RISK FACTORS FOR ATHEROSCLEROSIS
Serum Cholesterol Level
Serum Triglyceride
Homocysteine Level
PREVENTION OF ATHEROSCLEROSIS
CHAPTER 3:
Plasma Proteins
ELECTROPHORESIS
Electrophoretic Separation of Proteins
Normal Pattern
Abnormal Patterns in Clinical Diseases
ALBUMIN
Functions of Albumin
Colloid Osmotic Pressure of Plasma
Transport Function
3. Buffering Action
Clinical Applications
Blood Brain Barrier
Drug Interactions
Therapeutic use
Edema
Hypo-albuminemia
Albumin-Globulin Ratio
Hypoproteinemia
TRANSPORT PROTEINS
Acute Phase Proteins
C-Reactive Protein (CRP)
Ceruloplasmin (Cp)
Wilson's Disease
Alpha-1 Antitrypsin (AAT)
Alpha-2-Macroglobulin (AMG)
Negative Acute Phase Proteins
CLOTTING FACTORS
Prothrombin Time (PT)
Clinical Utility of Prothrombin Time (PT)
Reference Limits of PT
Fibrinolysis
Clinical Significance
ABNORMALITIES IN COAGULATION
Hemophilia A (Classical Hemophilia)
Hemophilia B or Christmas Disease
Other Disorders
IMMUNOGLOBULINS
Heavy and Light Chains
Variable and Constant Regions
lmmunoglobulin G (IgG)
Immunoglobulin M (IgM)
Immunoglobulin A (IgA)
Immunoglobulin E (IgE)
PARAPROTEINEMIAS
1. Multiple Myeloma (Plasmacytoma)
Bence Jones Proteinuria
Waldenstrom's Macroglobulinemia
Hypergamma Globulinemia
Clinical Utility
COMPLEMENT SYSTEM
AUTO IMMUNITY
CHAPTER 4:
Clinical Enzymology
CREATINE KINASE (CK)
CK and Heart Attack
CK and Muscle Diseases
Iso-enzymes of CK
CARDIAC TROPONINS (Tnl AND TnT)
LACTATE DEHYDROGENASE (LDH) (LD)
LDH and Heart Attack
Iso-enzymes of LDH
ASPARTATE AMINO TRANSFERASE (AST)
Brain Natriuretic Peptide (BNP)
Enzyme Profile in Liver Diseases
ACID PHOSPHATASE (ACP)
PROSTATE SPECIFIC ANTIGEN (PSA)
Glucose-6-phosphate dehydrogenase (GPD)
Amylase and Lipase
Enolase
CHAPTER 5:
Mineral Metabolism and Abnormalities
CALCIUM (Ca++)
Sources of Calcium
Daily Requirement of Calcium
Absorption
Factors Causing Increased Absorption
Factors Causing Decreased Absorption
Functions of Calcium
Calcium in Blood
Factors Regulating Blood Calcium
Vitamin D and Calcitriol
Activation of Vitamin D
Vitamin D and Absorption of Calcium
Effect of Vitamin D on Bone
Effect of Vitamin D on Renal Tubules
Regulation of Calcitriol Formation
Deficiency of Vitamin D
Causes for Vitamin D Deficiency
Clinical Features of Rickets
Clinical Features of Osteomalacia
Different Types of Rickets
Requirement of Vitamin D
Sources of Vitamin D
Hypervitaminosis D
Parathyroid Hormone (PTH)
Mechanism of Action of PTH
Calcitonin
Calcitonin, Calcitriol and PTH act together
Effect of Phosphorus on Calcium
Serum Proteins
Alkalosis and Acidosis
Hypercalcemia
Hypocalcemia
Pseudo-hypoparathyroidism
Osteoporosis
PHOSPHORUS
Requirement and Source
Serum Level of Phosphorus
MAGNESIUM (Mg++)
Requirement
Normal Serum Level of Magnesium
Functions of Magnesium
Clinical Conditions
IRON (Fe)
Distribution of Iron
Requirement of Iron (ICMR, 1990)
Sources of Iron
Factors Influencing Absorption of Iron
Iron Transport in Blood
Storage of Iron
Excretion of Iron
Iron Deficiency Anemia
Clinical Manifestations
Laboratory Findings
Treatment of Iron Deficiency
Iron Toxicity
COPPER (Cu)
Copper Toxicity
Zinc (Zn)
Zinc Deficiency
Acrodermatitis Enteropathica
Zinc Toxicity
IODINE (I)
SELENIUM (Se)
CHAPTER 6:
Liver Function Tests
A GLIMPSE OF ANATOMY OF LIVER
A REVIEW OF FUNCTIONS OF LIVER
Synthetic Function
Carbohydrate Metabolism
Amino Acid Metabolism
Lipid Metabolism
Bilirubin Metabolism
Detoxification Functions
Excretory Functions
Clinical Manifestations of Liver Dysfunction
Jaundice
Portal Hypertension
Ascites
Liver Function Tests and their Clinical Utility
Indicators of Synthetic Function
Alpha-fetoprotein (AFP)
Transthyretin (Pre-albumin)
Alpha-1 Antitrypsin (AAT)
Haptoglobin
Serum Electrophoresis
Indicators of Metabolic Function
Lipoprotein X
Serum / Plasma Amino Acids
Indicators of Excretory and Detoxification Function
Serum Bilirubin (Excretory Function)
Clinical Utility
Urinary Bilirubin
Urinary Urobilinogen
Causes of Jaundice
Plasma Bile Acids
Urine Bile Salts
Aminopyrine Excretion Test
Tests Based on Serum Enzymes (Liver Enzyme Panel)
Enzymes Indicating Hepatocellular Damage
Markers of Obstructive Liver Disease
Alkaline Phosphatase (ALP)
Gamma Glutamyl Transferase (GGT)
Nucleotide Phosphatase (NTP)
Blood Ammonia
Immunological Tests in Liver Diseases
Special Tests
Staging of Cirrhosis by Noninvasive Methods
Selection of Tests
Summary of Liver Function Tests
PORPHYRIAS
Heme Biosynthetic Pathway
Diagnosis of Porphyrias
Other Porphyrias
CHAPTER 7:
Renal Function Test
RENAL FUNCTION TESTS
Glomerular Function
Glomerular Filtration Rate (GFR)
Functions of the Tubules
Reabsorption of Water
Screening for Kidney Disease
Nonprotein Nitrogen (NPN)
MARKERS OF GFR
Clearance Tests
Creatinine Clearance Test
Procedure for Creatinine Clearance Test
Interpretation
Direct Calculations
Creatinine Co-efficient
Cystatin C as a Filtration Marker
Chronic Kidney Disease (CKD)
Urea Clearance Test
Interpretation of Urea Clearance Value
Normal Serum Urea Level
MARKERS OF GLOMERULAR PERMEABILITY
1. Glomerular Proteinuria
2. Microalbuminuria
3. Overflow Proteinuria
4. Tubular Proteinuria
5. Nephron Loss Proteinuria
6. Urogenic Proteinuria
TESTS FOR TUBULAR FUNCTION
1. Specific Gravity of Urine
2. Measurement of Osmolality
3. Concentration Test
4. Dilution Tests
5. Urinary Acidification
6. Fractional Excretion of Sodium (FENa)
7. Fractional Excretion of Phosphate (FEPO4)
Monitoring Renal Transplantation
Immunological Tests in Renal Diseases
Cryoglobulinemia
Anti-Neutrophil Cytoplasmic Antibody (ANCA)
Anti-Glomerular Basement Membrane Antibody
CHAPTER 8:
Acid-Base Disorders
ACID–BASE BALANCE
Volatile and Fixed Acids
Mechanisms of Regulation of pH
BUFFERS OF THE BODY FLUIDS
Bicarbonate Buffer System
Phosphate Buffer System
Protein Buffer System
Respiratory Regulation of pH
The Second Line of Defense
Renal Regulation of pH
A. Excretion of H+; Generation of Bicarbonate
B. Reabsorption of Bicarbonate
C. Excretion of H+ as Titratable Acid
D. Excretion of Ammonium Ions
Acidification of Urine
Relationship of pH with K+ ion Balance
Disturbances in Acid–Base Balance
Classification of Acid-Base Disturbances
1. Acidosis (fall in pH)
2. Alkalosis (rise in pH)
3. Compensatory Responses
Metabolic Acidosis
Anion Gap
High Anion Gap Metabolic Acidosis (HAGMA)
Normal Anion Gap Metabolic Acidosis (NAGMA)
Decreased Anion Gap is seen in
Osmolal Gap
Compensated Metabolic Acidosis
Clinical Features of Metabolic Acidosis
Treatment of Metabolic Acidosis
Metabolic Alkalosis
Subclassification of Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
Respiratory Failure
Assessment of Acid-Base Parameters
SUMMARY
CHAPTER 9:
Electrolyte and Water Balance
POTASSIUM (K+)
Requirement
Sources
Normal Level
Potassium Excretion
Hypokalemia
Treatment
Hyperkalemia
CHLORIDE (Cl−)
Hyperchloremia is seen in
Causes for Hypochloremia
Chloride Channels
CHAPTER 10:
Inherited Metabolic Disorders and Prenatal Diagnosis
PRENATAL DIAGNOSIS
Genetic Counseling
Amniocentesis
Chorionic Villus Sampling (CVS)
Cordocentesis
Cytogenetics and Molecular Cytogenetics
Biochemical Screening
Positive Maternal Serum Screen
The Quadruple Test (Quad Screen)
Screening During the First Trimester
X-linked Disorders
Biochemical Genetics
Enzyme Assays
NEWBORN SCREENING
Screening Technology
Tandem Mass Spectrometry (MS-MS)
LABORATORY INVESTIGATIONS TO DIAGNOSE METABOLIC DISORDERS
Lactic Acidemia
Plasma and Urinary Amino Acids
Organic Acidurias
Mucopolysaccharide Screening
Oligosaccharide Screening Tests
CHAPTER 11:
Molecular Diagnostics
CHAPTER 12:
Endocrine Disorders
HORMONE SECRETION AND REGULATION
Types of Endocrine Dysfunction
PITUITARY FUNCTION
GROWTH HORMONE (GH)
Prolactin (PRL)
Prolactin Assay
Prolactin Stimulation Test by Chlorpromazine
Prolactin Stimulation Test by TRH
Prolactin Suppression Test by L-Dopa
ADRENOCORTICOTROPIN (ACTH)
GONADOTROPINS (FSH AND LH)
24-hour Urine FSH
Serum Luteinizing Hormone (LH)
24-hour Urine LH
Serum TSH (Thyroid Stimulating Hormone)
POSTERIOR PITUITARY HORMONES
Vasopressin
Disorders of Vasopressin Secretion
Diabetes Insipidus (DI)
Adipsic Hypernatremia
SIADH (Oversecretion of ADH)
Antidiuretic Hormone (ADH)
Water Deprivation ADH Stimulation Test
Saline Infusion Test for Diabetes Insipidus
ASSESSMENT OF THYROID HORMONES
Laboratory Evaluation of Thyroid Dysfunction
Total Hormone versus free hormone
Total Thyroxine (T4)
Total Tri Iodothyronine (T3)
Free Thyroxine (FT4)
Thyroid Hormone Binding Ratio (THBR)
Free Tri-iodothyronine (FT3)
Reverse T3 (3,5,5′-Tri-iodo thyronine) (rT3)
Thyroxine Binding Globulin (TBG)
Thyroglobulin (Tg)
Thyroid Stimulating Hormone (TSH)
Thyroid Antibodies
Evaluation of Hypothyroidism
Evaluation of Hyperthyroidism
Sick Euthyroid Syndrome (SES)
ASSESSMENT OF ADRENAL CORTICAL HORMONAL STATUS
Metabolism of Steroid Hormones
Total Cortisol in Blood (Free + Bound)
Serum Free Cortisol
Urinary Free Cortisol
Renin Angiotensin Aldosterone System
Aldosterone in Blood
Aldosterone in Urine
DHEA, Unconjugated in Urine
Dehydro-epiandrosterone Sulfate (DHEA-S)
DHEA, Unconjugated in Serum
11-Deoxycortisol
17-Hydroxy Progesterone in Serum
Plasma Renin Activity
Angiotensin II
Stimulation Tests
Metyrapone Stimulation Test
Low Dose Dexamethasone Suppression Test
Multiple Low Dose Dexamethasone Test
High Dose Dexamethasone Suppression Test
Tests to Assess Mineralocorticoid Function
Furosemide Stimulation Test
Saline Suppression Test
Fludrocortisone Suppression Test
Disorders of Adrenal Cortex
Congenital Adrenal Hyperplasia (CAH)
ADRENAL MEDULLARY CATECHOLAMINES
Catecholamines in Blood
Catecholamines in Urine
Metanephrines in Urine
Vanillyl Mandelic Acid in Urine
Homovanillic Acid (HVA) in Urine
Clonidine Suppression Test
INTESTINAL ENDOCRINE FUNCTION
Serotonin
5-HIAA (Hydroxy Indole Acetic Acid) in Urine
Gastrin
Vasoactive Intestinal Polypeptide (VIP)
Pancreatic Polypeptide
Insulin Immunoassay
C- Peptide Immunoassay
ASSESSMENT OF MALE REPRODUCTIVE HORMONAL STATUS
ASSESSMENT OF FEMALE REPRODUCTIVE HORMONAL STATUS
Estradiol Unconjugated (E2) in Serum
Estradiol and Pregnancy
Estrogen Receptor Protein (ERP)
Total Estrogens (Estradiol + Estrone) in Blood
Progesterone in Serum
Progesterone Receptor Protein (PRP)
ASSESSMENT OF PARATHYROID HORMONE STATUS
Parathyroid Hormone in Serum
Appendices
REFERENCE VALUES
INTERPRETATION OF LABORATORY RESULTS
Establishment of Reference Values
Standardization of Specimen Collection
Pre-analytical Variables
Processing and Preservation of Specimens
Quality Management
Quality Control
Accuracy
Precision
Specificity
Sensitivity
Total Quality Management (TQM)
Reference Materials and Calibration
Control Charts
External Quality Assurance (EQAS)
OVERVIEW OF TECHNIQUES IN CLINICAL CHEMISTRY
ELECTROPHORESIS
Factors Affecting Electrophoresis
Electrophoresis Apparatus
Visualisation of Protein Bands
Modification of Conventional Techniques
Chromatography
Adsorption Chromatography
Partition Chromatography
Thin Layer Chromatography (TLC)
Ion–Exchange Chromatography
Gel Filtration (Size Exclusion) Chromatography
Affinity Chromatography
High Performance Liquid Chromatography
Mass Spectrometry
Potentiometry
Ion Selective Electrodes (ISE)
Voltammetry and Amperometry
Conductometry
Coulometry
Optical Chemical Sensors
Biosensors
Immunochemical Methods
Immunoblotting (Western Blotting)
Quantitative Techniques
RADIO-IMMUNO-ASSAY (RIA)
Advantage and Disadvantage of RIA
Nonisotopic Immunoassays
ELISA TEST
Antigen Detection by ELISA Method
Antibody Detection by ELISA
COLORIMETER
Spectrophotometer
Luminiscence
MOLECULAR BIOLOGY TECHNIQUES
Polymerase Chain Reaction (PCR)
Nested PCR
RT-PCR (Reverse Transcriptase PCR)
Quantitative PCR
Quantitative Real-time PCR (RQ-PCR)
RACE-PCR
Multiplex-PCR
MUTATION DETECTION TECHNIQUES
Single Strand Conformation Polymorphism (SSCP)
Heteroduplex Analysis
Conformation Sensitive Gel Electrophoresis (CSGE)
Protein Truncation Test (PTT)
Denaturing High Performance Liquid Chromatography (DHPLC)
DNA Sequencing
NUCLEIC ACID HYBRIDIZATION TECHNIQUES
Southern Blotting
Applications of Southern Blotting
In Situ Hybridization (ISH)
INDEX
TOC
Index
×
Chapter Notes
Save
Clear
