Lecture 1 - BMS2043 - Analytical and Clinical Biochemistry Week 1 PDF

BMS2043- ANALYTICAL AND CLINICAL BIOCHEMISTRY ANALYTICAL AND CLINICAL BIOCHEMISTRY DR PENNY LYMPANY [email protected] 28AY04 ANALYTICAL BIOCHEMISTRY: AN OVERVIEW WHAT IS ANALYTICAL BIOCHEMISTRY? The study of biochemical components found in a cell or other biological sample Uses a broad range of...

BMS2043- ANALYTICAL AND CLINICAL BIOCHEMISTRY ANALYTICAL AND CLINICAL BIOCHEMISTRY DR PENNY LYMPANY [email protected] 28AY04 ANALYTICAL BIOCHEMISTRY: AN OVERVIEW WHAT IS ANALYTICAL BIOCHEMISTRY? The study of biochemical components found in a cell or other biological sample Uses a broad range of techniques for separation, identification, quantification and functional characterisation of biological molecules REQUIREMENTS FOR ANALYTICAL TESTING COMMONLY USED TECHNIQUES IN ANALYTICAL BIOCHEMISTRY Chromatography – separates components of a mixture based on their chemical properties. separates and identifies components of a complex mixture Examples – HPLC, GC, TLC Electrophoresis separates charged molecules based on their size and charge separates and identify proteins, DNA, and RNA Spectroscopy – uses the interaction of light with matter to study the properties of biological molecules used to study the structure and function of proteins, nucleic acids, and other biological molecules This Photo by Unknown Author is licensed under CC BY-SA-NC CLINICAL BIOCHEMISTRY: A SHORT OVERVIEW WHAT IS CLINICAL BIOCHEMISTRY? AKA - clinical chemistry, chemical pathology, or medical biochemistry generally concerned with analysis of bodily fluids for diagnostic and therapeutic purposes an applied form of biochemistry CLINICAL BIOCHEMISTRY –CATEGORIES OF TEST sub-specialities General or routine chemistry – commonly ordered blood chemistries (e.g., liver and kidney function tests) Special chemistry - elaborate techniques such as electrophoresis, and manual testing methods Clinical endocrinology – the study of hormones, and diagnosis of endocrine disorders. Toxicology – the study of drugs of abuse and other chemicals. Therapeutic Drug Monitoring – measurement of therapeutic medication levels to optimize dosage. Urinalysis – chemical analysis of urine for a wide array of diseases, along with other fluids such as CSF and effusions Faecal analysis – mostly for detection of gastrointestinal disorders, screening. COMMON CLINICAL BIOCHEMICAL TESTS https://www.ouh.nhs.uk/biochemistry/tests/ https://en.wikipedia.org/wiki/Clinical_chemistry BASIC METABOLIC PANEL (UREA & ELECTROLYTES) Four electrolytes: sodium (Na+) potassium (K+) chloride (Cl−) bicarbonate (HCO3−) blood urea (blood urea nitrogen, BUN) creatinine glucose https://en.wikipedia.org/wiki/Basic_metabolic_panel COMPREHENSIVE METABOLIC PANEL General tests Serum glucose Calcium Kidney function assessment Blood urea nitrogen (BUN) Creatinine Liver function assessment ALP ALT AST Bilirubin Electrolytes: Sodium Potassium Chloride Carbon dioxide (CO2) Protein: Albumin Total protein RELEASE OF ENZYMES FROM DISEASED OR DAMAGED CELLS Tissue breakdown Abnormal release (abnormal production) Lippincott’s Illustrated Reviews: Biochemistry. Enzymes in Clinical Diagnosis LIVER FUNCTION TESTS (LFT) Total protein (serum) Albumin Globulins A/G ratio (albumin-globulin) Protein electrophoresis Urine protein Bilirubin: direct + indirect = total Aspartate transaminase (AST) Also marker of liver injury? Alanine transaminase (ALT) Gamma-glutamyl transpeptidase (GGT) Alkaline phosphatase (ALP) LIVER FUNCTION TESTS: BILIRUBIN glucuronyltransferase UDP-glucuronosyltransferases Tsai and Tarng 2018 Int. J Mol Sci, 20, 117 DIAGNOSIS OF A MYOCARDIAL INFARCTION (WHO) A patient is diagnosed with myocardial infarction if 2 (probable) or 3 (definite) criteria: Clinical history of ischaemic type chest pain lasting for more than 20 minutes Changes in serial ECG tracings Rise and fall of serum cardiac biomarkers, e.g. creatine kinase-MB or troponin CARDIAC MARKERS H-FABP Troponin Myoglobin CK-MB B-type natriuretic peptide (BNP) CARDIAC MARKERS https://www.beckmancoulter.com/en/blog/diagnostics/acute-mi-detection-with-a-high-sensitivity-cardiac-troponin-assay CREATINE KINASE (CK) Present in muscle (skeletal & cardiac) and brain (not liver) Dimer, with two different subunits: Muscle (M), Brain (B) May exist as CK-MM, CK-MB, CK-BB Skeletal muscle: ~99% MM, ~1% MB Cardiac muscle: ~80% MM, ~20% MB Brain: predominantly BB CK-MB levels are increased in myocardial infarction ? https://en.wikipedia.org/wiki/Reference_ranges_for_blood_tests WHAT IS NEAR PATIENT TESTING? May also be called point of care testing Performed near or at site of patient – result may change care pathway for patient Advantages Generally faster than traditional lab testing May require smaller sample Disadvantages May be less accurate – clinical staff APPLICATIONS OF NPT Diagnosis of infectious diseases Monitoring of chronic diseases Detection of drug abuse Guide to other problems NEAR PATIENT TESTING – DEVICES Blood glucose meters Pregnancy Tests Rapid Strep Tests Covid Tests Johnson, S. 2020 https://doi.org/10.1016/B978-0-12-820050-6.00010-2 NEAR PATIENT TESTING - URINALYSIS ‘Visual’ exam Urine’s appearance: Clear cloudiness Colour: Watery Yellow Orange Red/brown B/R Milky white Unusual odour NEAR PATIENT TESTING – URINALYSIS DIPSTICK Leukocytes: small number Nitrites/Leukocyte Esterase: sign of infection or inflammation Urobilinogen: breakdown product of bilirubin –Not normally present Bilirubin: 80-85% from haemoglobin released by breakdown of senescent red blood cells; 12-20% breakdown myoglobin, bone marrow –Not normally present Protein [albumin]: not normally present Glucose: present in small amount pH Blood Specific Gravity = weight of urine/weight of water Ketones: –appear in urine as a consequence of accelerated fat metabolism –when in large amount: fruity odour “pear drops” THERAPEUTIC DRUG MONITORING THERAPEUTIC DRUG MONITORING - EXAMPLES Types of drugs which might require TDM – Antibiotics – aminoglycosides (gentamicin), vancomycin Antiepileptics – phenytoin, carbamazepine, valproic acid Cardiac drugs – digoxin, amiodarone Immunosuppressants - cyclosporin Anti-psychotics - clozapine Anti-coagulants - warfarin ? ANY QUESTIONS? We made it! This Photo by Unknown Author is licensed under CC BY-SA Please use the discussion board for general questions and queries: https://surreylearn.surrey.ac.uk/d2l/le/252546/discussions/List