Clinical Biochemistry

1001411

Course Coordinators
Adel M. Assiri, PhD.
Department of Biochemistry
Faculty of Medicine
Umm Al-Qura University
Tel: (02) 5270000 Ext 4495
[email protected]
When you have questions, concerns, or suggestions, please contact Prof. Assiri by e-mail, call
for an appointment, or catch them before or after class or lab.

Course title: Clinical Biochemistry 1001411

Credit hours: 4 credit hours
Program(s) in which the course is offered
- Bachelors Degree of Medicine Program
Level/year at which this course is offered: Fourth year
Pre-requisites for this course:
- Finishing Biochemistry course (10011211) in the second year

Course Description, Objectives, and Format

The students will be able to:
1- Understand the biochemical basis of diseases, correlate symptoms, signs, and
complications to biochemical events.
2- Understand the biochemical nature of the therapeutics approaches in the field of
medicine.
3- To select the biochemical tests appropriate to the diagnosis and management of the
disease.
4- Be able to interpret the laboratory data properly, which means that in assessing the
significance of a test result, the students should consider the clinical circumstances and
the possible contribution of any analytical or biological variation. Therefore, in future
during their clinical practice they should use the laboratory intelligently and selectively.

Topics to be Covered
Overview of Clinical Chemistry
Lecture No 1- THE BIOCHEMISTRY OF DISEASE
Review of clinical aspects of carbohydrates, Lipids, Proteins and Amino
Acids metabolism, Enzymes
Integration of Metabolism
Genetic Metabolism
Lecture No 2 THE CLINICAL CHEMISTRY LABORATORY AND
ORGAN SYSTEMS
The placeof clinical biochemistry in medicine
Interpretation of the laboratory data of:
Cardiovascular Circulatory System
Respiratory Tract
Liver
Renal System
Digestive System
Endocrine System
Bone
Central Nervous System
Diabetes and Other Carbohydrate Disorders
Lecture No 3 DIABETES MELLITUS
Glucose Challenge Test and Other Diagnostic Tests
Tests of Diabetes Control and Disease Progression
Lecture No 4 LABORATORY RESULTS IN TYPE 1 DIABETES
Hypertension and Microalbuminuria
Glycated Hemoglobin
Hypoglycemia
Lecture No 5 OTHER CARBOHYDRATE METABOLIC DISORDERS
Glycogen Storage Disorders
Fructosuria
GALACTOSEMIA
Additional Testing to Aid Interpretation of Carbohydrate
Disorders
Hemoglobin Production Disorders and Testing
Lecture No 6- HEME SYNTHESIS
ABSORPTION, TRANSPORT, AND STORAGE OF IRON
How Is Iron Absorbed in the Body?
How Is Iron Stored in the Body?
How Is Iron Transported in the Body?
ASSESSING IRON LEVELS AND FORMS
Iron Deficiency
Practice Calculation: UIBC and % Saturation of Iron
Interpretation of Iron Results

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Topics to be Covered
Assessment of Renal Function
Lecture No 7- Basic renal functions.
CREATININE METABOLISM
GLOMERULAR NEPHRITIS
NEPHROTIC SYNDROME
AZOTEMIA
TYPES AND ASPECTS OF RENAL FAILURE
CALCULATION OF FRACTIONAL EXCRETION OF SODIUM
Lecture No 8- RENAL CONTROL OF ACID-BASE BALANCE
THE ROLE OF ELECTROLYTES
Sodium, Potassium, Chloride, Bicarbonate
RENAL TUBULAR ACIDOSIS
ELECTROLYTE ANALYSIS
Calculation of Anion Gap, Use of Anion Gap
Electrolyte Critical Values
Abnormal Sodium Levels, Abnormal Potassium Levels
RENAL IMPACT ON WATER AND ELECTROLYTES
PHYSIOLOGY: HORMONAL AND RENAL CONTROL OF
ELECTROLYTES AND MINERALS
Water and Electrolytes
KIDNEY STONES
METABOLIC BONE DISEASE
Lecture No 9- Disorder of Calcium and Phosphate Metabolism.
Review of normal physiology and metabolism of bone, calcium,
phosphate and magnesium.
Clinical disorders of calcium, phosphorus, magnesium metabolism, their
etiology, pathophysiology, metabolic abnormalities, complication and
management.
Metabolic disorders of bone, biochemical markers of bone turnover,
biochemical profile in various clinical disorders of bone.
Assessment of Liver Function
Lecture No 10- TESTS FOR LIVER FUNCTION
BILIRUBIN METABOLISM
HYPERBILIRUBINEMIA
Obstructive Jaundice
Hepatitis
Lecture No 11- NEONATAL HYPERBILIRUBINEMIA
Physiological Jaundice of the Newborn
PATHOPHYSIOLOGY OF LIVER ENZYMES
ANALYTICAL ASPECTS OF LIVER ENZYMES
Interpretation of Alkaline Phosphatase Results
Liver Function of the Elderly or Pediatric Patient
CLINICAL SIGNIFICANCE OF ALKALINE PHOSPHATASE

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Topics to be Covered
Lecture No 12- OTHER LABORATORY TEST RESULTS THAT
CORRESPOND WITH LIVER DISORDERS
Proteins and Amino Acids
Interpretation of Total Serum Protein Levels
Cerebrospinal Fluid Proteins
Interpretation of Serum Albumin Levels
Other Serum Proteins
Nephelometry
Cirrhosis and Hepatitis
AMMONIA METABOLISM
Hepatic Encephalopathy
Assessment of Cardiovascular Disorders
Lecture No 13- THE FIRST THREE PATIENTS IN THE EMERGENCY
DEPARTMENT
ACUTE MYOCARDIAL INFARCTION, Biomarkers of AMI
LIPIDS AND LIPOPROTEINS
The Role of HDL
Physiological Changes in Lipid and Lipoprotein Levels
Diabetes and Cardiac Disease
National Cholesterol Education Program
C-Reactive Protein
Primary and Secondary Hyperlipoproteinemia
Apoproteins, Hypoalphalipoproteinemia, Hyperbetalipoproteinemia
Abnormalities With Apoprotein E
Abetalipoproteinemia
Lecture No 14- NATRIURETIC PEPTIDES
WHY WOMEN AND MEN EXPERIENCE
DIFFERENT RISK FOR HEART ATTACKS
DELAYED DIAGNOSIS OF AMI
DIFFERENCES IN ELDERLY PATIENTS
Lipoprotein (a)
Homocysteine
Assessment of Respiratory Disorders
Lecture No 15- COLLECTION AND HANDLING OF ARTERIAL BLOOD
GASES
ASSESSMENT FOR ARTERIAL BLOOD GASES
Calculations in Arterial Blood Gas Anaylsis
Arterial Collection, Venous Versus Arterial Samples
ACID-BASE STATUS
Metabolic Acid-Base Disturbances, Respiratory Acid-Base Disturbances
Approach to Interpreting Acid-Base Disturbance
VENTILATION AND PCO2 RELATIONSHIP
OXYGENATION STATUS
Oxygen-Carrying Capacity and Content

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Topics to be Covered

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Shift to the Right

Lecture No 16- RESPIRATORY DISORDERS
Chronic Bronchitis, Acute-on-Chronic CO2 Retention, Fetal Lung Maturity
Respiratory Distress Syndrome
ANALYSIS OF OXYGENATION, TOXIC GASES
Cyanide Poisoning, Carbon Monoxide Poisoning
Distribution of Gases via Circulation of Erythrocytes
Pathological Effects of Carbon Monoxide, Analysis of
Carboxyhemoglobin
Indirect Analysis of CO in a Venous Whole Blood Sample
Determining p50
Assessment of Nutrition and Digestive Function
Lecture No 17- NUTRITION
NITROGENOUS BIOMARKERS OF NUTRITIONAL STATUS
VITAMINS
TRACE ELEMENTS
NUTRITIONAL DISORDERS
VITAMIN A METABOLISM
Vitamin A Night Blindness
VITAMIN-RELATED MACROCYTIC ANEMIA
Testing Strategies for Macrocytic Anemia
Lecture No 18- PHYSIOLOGICAL AND NUTRITIONAL CHANGES
WITH AGE
PREDIABETES AND METABOLIC SYNDROME
Lecture No 19- DIGESTIVE DISORDERS
THE GASTROINTESTINAL TRACT
MALABSORPTION
GASTRIC FLUID ANALYSIS
ZOLLINGER-ELLISON SYNDROME
CYSTIC FIBROSIS
GASTRIC FLUIDS AND ELECTROLYTE LEVELS
OTHER ELECTROLYTE DISTURBANCES RESULTING
FROM GASTROINTESTINAL DISTURBANCES
Intestinal Loss
Bulimia Nervosa
Endocrine Disorders and Function
Lecture No 20- Classification of Hormones
Hormone Receptors
Feedback Control
THE PITUITARY GLAND
THE ADRENAL GLANDS
Cortisol Synthesis, Cortisol Activity
DISEASES OF THE ADRENAL CORTEX

Topics to be Covered
Hypocortisolism
ROLE OF ALDOSTERONE, Disorders Involving Aldosterone
GROWTH HORMONE, Disorders of Growth Hormone Secretion
Lecture No 21- ADRENAL MEDULLARY HORMONES
DISORDERS OF ADRENAL MEDULLARY HORMONES
Pheochromocytomas, Neuroblastomas
LABORATORY TESTING FOR ADRENAL MEDULLARY DISORDERS
ROLE OF ENDOCRINE GLANDS IN THYROID FUNCTION
Thyroid-Stimulating Hormone: Pituitary Hormone
Thyroid Hormone Metabolism, Hypothyroidism
Lecture No 22- TESTING FOR THYROID DISORDERS
Thyroid Function Testing
Enzyme-Multiplied Immunoassay Technique (EMIT)
Historical Methods of Thyroid Testing
HYPERTHYROIDISM
DISORDERS OF WATER BALANCE
MINERAL METABOLISM
PREANALYTICAL VARIATIONS IN HORMONE TESTING
Reproductive Endocrinology and Fetal Testing
Lecture No 23PREGNANCY, Markers of Pregnancy, Problems in Early Pregnancy
Trophoblastic Neoplasm, Multiple Fetuses and Pregnancy Hormones
PREGNANCY TESTS AND EARLY MARKERS OF PROBLEMS
SEX STEROIDS
Protein and Peptide Reproductive Hormones
ENDOCRINE GLANDS INVOLVED IN REPRODUCTION
Lecture No 24- OVERVIEW OF NORMAL FEMALE REPRODUCTIVE
PHYSIOLOGY
The Role of Inhibins
THE FEMALE REPRODUCTIVE CYCLE
NORMAL MALE REPRODUCTIVE PHYSIOLOGY
HORMONAL CHANGES IN MENOPAUSE
FEMALE INFERTILITY
Treatment for Infertility, Infertility of Multiple Causes
ALPHA FETOPROTEIN
Down Syndrome
Lecture No 25- FETAL SCREENING
MULTIPLES OF THE MEDIAN
Example Calculation of MoM
Alpha Fetoprotein Levels and Fetal Disorders
OTHER SIGNIFICANT BIRTH DEFECTS AND INBORN
ERRORS OF METABOLISM
REFERENCE RANGES IN NEONATES

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Topics to be Covered
Malignancy Disorders and Testing
Lecture No 26- LABORATORY TESTS TO SCREEN FOR DISEASE
TUMOR MARKERS FOR COLORECTAL CANCER
PROTEIN ELECTROPHORESIS
MULTIPLE MYELOMA
Waldenstrms Macroglobulinemia
Amyloidosis
Monoclonal Gammopathy of Undetermined Significance
CA 125
MEDICAL DECISION LIMITS
Lecture No 27- THE CELL CYCLE
MOLECULAR DIAGNOSTICS
PROSTATE CANCER, Tumor Markers for the Prostate, Prostate Specific
antigen
Prostatic Acid Phosphatase, Other Prostate Tumor Markers
Ectopic Hormone Production
PANCREATIC CANCER, Pancreatic Tumor Markers
Therapeutic Drug Monitoring and Toxicology
Lecture No 28- THERAPEUTIC DRUG MONITORING
DRUG METABOLISM
DRUG ACTION OF ANTIBIOTICS
DRUG ACTION OF CARDIOACTIVE AGENTS
TOXICITY OF CARDIOACTIVE DRUGS
METHODS OF ANALYSIS FOR THERAPEUTIC DRUGS
Complementary or Herbal Medicines Effect on Therapeutic Drug
Monitoring
ANTIEPILEPTIC DRUGS
OTHER THERAPEUTIC DRUGS
Psychoactive Drugs
Antiasthmatic Drugs
Antineoplastic Drugs
Immunosuppressive Drugs
Lecture No 29- TOXICOLOGY
ACETAMINOPHEN TOXICOLOGY, TOXICITY OF OTHER
ANALGESICS
ETHANOL AND ALCOHOL TESTING
OTHER ALCOHOLS
OSMOMETRY
Volatile Organic Toxicity Screening
THERAPEUTIC DRUG MONITORING AND TOXICOLOGY
DRUG-OF-ABUSE TESTING
HEAVY METAL TOXICITY
Mercury Exposure

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Topics to be Covered

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14

Case Presentation (Clinical Session)

As applications of laboratory tests for management of diseases or
conditions many Case Scenarios will be presented and discussed with
the students.
In the hospital
Diabetes and Other Carbohydrate Disorders
1. Diabetes Mellitus Type 1: The Emergency Department
2. Diabetes Mellitus Type 2 and the Diabetes Center
3. Gestational Diabetes Mellitus: The Prenatal Clinic
4. Transient Neonatal Hypoglycemia: The Big Baby
Hemoglobin Production Disorders and Testing
1. Case of Iron-Deficiency Anemia: Iron-Poor Blood
2. Low Hemoglobin of Unknown Cause: Lead Poisoning from Paint
in an Old House
3. Acute Variegate Porphyria: Darkening Urine Samples in the
Laboratory
4. Problems With Glycated Hemoglobin Analysis
Assessment of Renal Function
1. Glomerular Nephritis: Jennie
2. Nephrotic Syndrome Assessment: The Diabetic Patient
3. Azotemia Assessment: Out of Proportion
4. A Case of Renal Failure: A Review of the Laboratory Results
5. Renal Tubular Acidosis: A Matter of Balance
6. Hyperkalemia Due to Hemolysis: The Difficult Venipuncture
7. Pseudohyponatremia? A Problem With Analysis
8. Nephrogenic Diabetes Insipidus: Critical Values
9. Renal Calculi: Kidney Stones
Assessment of Liver Function
1. Hyperbilirubinemia: A Yellow Serum Sample in a Rack of Tubes
2. Neonatal Hyperbilirubinemia: Why Is the Baby Yellow?
3. Elevated Hepatic Enzymes: The Standout Patient
4. Acute Inflammation of the Liver: The Out-of-Range Bilirubin
Result
5. Acute Liver Failure: The STAT Ammonia
6. Quality Assurance in the Clinical Chemistry Laboratory: Why Are
All of the Alkaline Phosphatase Results the Same?
Assessment of Cardiovascular Disorders
1. Acute Myocardial Infarction: The Obese Smoker
2. Type 2 Diabetes With Cardiac Risk: Mildred Dodge, the Bonbon
Eater

Topics to be Covered
3. Apolipoprotein A Deficiency
4. Congestive Heart Failure: Joe Returns
5. Silent Myocardial Infarction: Woman at Risk
6. Medication Toxicity: Age-Related Drug Distribution
7. The Clot Thickens: Joe Returns Again
Assessment of Respiratory Disorders
1. Arterial Blood Gas Collection and Specimen Handling: The Case
of the Pink Patient With a Dark Blood Sample
2. Chronic Bronchitis: Blue Bloater or Pink Puffer Patient?
3. Acute Respiratory Failure: Pain Medication Made Things Worse
4. Neonatal Respiratory Distress: The Grunting Baby
5. Possible Carbon Monoxide Poisoning: The Nauseated Patient
With Cherry Red Lips
6. Correlation of POC Blood Gas Analyzer With Bench-Top
Instrument: Are We Comparing Apples to Oranges?
Assessment of Nutrition and Digestive Function
1. Alcoholic Liver Disease: Nutritional Effects of Alcohol Substance
Abuse
2. Dietary Assessment of the Elderly: Mrs. Jansens Anemia
rediabetes and Metabolic Syndrome: Apples and Pears
4. Zollinger-Ellison Syndrome: The Gastrinoma
5. Pancreatic Insufficiency: The Patient With Cystic Fibrosis
6. Electrolyte Disturbance in Acute Vomiting: Does Mr. Vijay Have
Metabolic Alkalosis?
Endocrine Disorders and Function
1. Cushings Syndrome: The Woman With the Buffalo Hump
2. Addisons Disease: The Man With Noticeable Pigments
3. Pheochromocytoma: A Red-Haired Woman With a Taste for
Bananas
4. Neonatal Hypothyroidism: Repeat Thyroid Testing on a Baby
5. Graves Disease: The Woman With Prominent Eyeballs
6. Diabetes Insipidus: A Patient With Very Dilute Urine
7. Hyperparathyroidism: The Patient With Elevated Calcium Levels
Reproductive Endocrinology and Fetal Testing
1. Pregnancy Testing: Yes or No?
2. Infertility and Polycystic Ovarian Disease: String of Pearls in a
Bearded Lady
3. Preanalytical Error in Reproductive Testing: How Important Is the
Timing?
4. Fetal Assessment for Open Neural Tube Defects and Down

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Syndrome: MoM Testing for Babys Health

5. Hemolytic Disease of the Newborn: Two Rh-Negative Mothers
Malignancy Disorders and Testing
1. Multiple Myeloma: An Unusual Band in Protein Electrophoresis
2. Medical Decision-Making for Malignancy: Correlating Tumor
Marker Results with Likely Disease
3. Ruling In or Ruling Out Breast Cancer: A Frightened Young
Woman Has a Breast Lump
4. Screening for Prostate Cancer: What Was the Current PSA?
5. Ectopic Hormone Production due to Oat Cell Carcinoma: Is
Hyperosmolar Urine due to SIADH?
6. Pancreatic Cancer: Searching for the Cause of High Amylase
Levels
Therapeutic Drug Monitoring and Toxicology
1. Therapeutic Ranges: Trouble for Baby Jones
2. Monitoring Digoxin Levels: A Confused Man in the ED
3. Antiepileptic Medication Testing: Why Is She Still Having
Seizures?
4. Acute Acetaminophen Overdose: A Child Gets Into the Medicine
Cabinet
5. Medical and Legal Alcohol Testing: Was Alcohol Involved in the
Accident?
6. Volatile Organic Toxicity: Unexplained Intoxication
7. Decision-Making: For Which Drugs of Abuse Should We Test?
8. Mercury Poisoning: The Fish in the Sea

Lectures
Each lecture is accompanied by a PowerPoint presentation, animation. Information from the
presentation and assigned reading is important for mastering the learning objectives which are
the primary focus of exam questions.

Review Sessions
Review sessions will be scheduled prior to each exam. The time and format for each session
will be arranged via the students coordinators.

Course Learning Objectives

The students will know the biochemical basis of diseases, and how to correlate symptoms,
signs, and complications to biochemical events, and the biochemical nature of the
therapeutics approaches in the field of medicine.
Also the student will know the most important laboratory data properly, the significance of a
test results.
Our student will :
-

Describe the development, structure and function of the healthy human body and each
of his major organ systems at molecular levels.

Recognize and discuss the implications of altered structure and function and chemistry
of the body and its major systems that are seen in various diseases and conditions.

Describe the molecular basis and maladies and the way in which they affect the body
.

Teaching strategies to be used to develop knowledge

The student will attend:
a- Regular 2 hour lecture per week
b- 2 hour tutorial class/ month
c- 4 hours clinical session per month
Assignments for independent study will be followed once per month
-

Introductory lecture gives an overview of the content and significance of the course and
of its relationship to students existing knowledge.

Each subsequent lecture begins with a similar overview linking the particular content of
the presentation to the general overview.

Tutorials review the content of each lecture and clarify any matters not understood.

Individual assignments require use of library reference material and web sites to
identify information required to complete tasks.

Roles and Responsibilities of Students and lecturers

Students are expected to:
1. Use all available resources to accomplish the learning objectives in each lecture and

case-based discussion and exercise session, including:

a. Attending all lecture and case-based discussion sessions.
b. Reading textbook assignments.
c. Participating in lecture and case sessions by answering questions posed in class
and asking questions when information is unclear or more information is needed.
d. Performing assigned exercises working individually or in groups, as directed.

2.
3.
4.
5.

e. Submitting completed assignments on or before the stated deadlines for timely

feedback.
f. Optimizing their learning strategies by trying the suggested tips and/or other
ideas, and working with others.
g. Asking for help from the course manager when they need it or even think they
might need it.
Notify the course manager as soon as they can if they are seriously ill or have an
emergency that prevents them from attending the case sessions or an exam.
Provide constructive feedback regarding the course on evaluation forms that will be
provided at the end of the semester.
Adhere to the faculty academic and professional rules.
Recognize that the study of microorganisms is critically important to everyday life and is
totally fun.

Lecturer is expected to:

-

Explanations and examples given in lectures and practiced under supervision in

tutorials and laboratory tasks. Transfer of learning encouraged by use of analytical tools
in different applications and through discussion of potential application in other areas.
Assignment tasks include some open ended tasks designed to apply predictive,
analytical and problem solving skills

Learning Resources

Clinical Biochemistry (an illustrated colour text). Allan Gaw

Churchill Livingstone

Clinical Chemistry, 3rd edition-1998, By William Marshall. MosbyLondon.

Clinical Chemistry: in Diagnosis & Treatment, 6th edition-1994; By

Philip D Mayne. Arnold-London.

Clinical Chemistry, a laboratory perspective 1St edition 2007; By

Wendey Arneson and Jean Brickell

Clinical Chemistry: Principle, Procedure, correlation, 3rd edition1996; By Michael L Bishop. Lippincott- New York.

Davidsons Principles & Practice of Medicine, 18th edition-1999;

6 By C Haslett, ER Chilvers, JAA Hunter, NA Boon.Churchill
Livingstone-London.

Methods of assessment of knowledge acquired

-

Mid semester examination: 60 minutes multiple choice test on studied topics with
results carrying 20% of final assessment.

120 minutes multiple choice test on studied topics in mid- year exam with results
carrying 50% of final assessment.

Multiple choice knowledge item in final exam.

Schedule of Assessment Tasks for Students
Assessment task

Week due Proportion of Final Assessment

1 First midterm exam

15 %

2 Seminar for search topics

16

10%

3 Mid year exam ( Final first term )

17

25 %

4 Second mid term Exam

24

20 %

5 End of year Exam

34

30 %