MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1

CLinical chemistry 1
MR. nickson r. patawaran, RMT | Introduction to clinical chemistry | MTAP 1 MIDTERMS
____________________________________________________________________________________
OUTLINE • SYSTÈME INTERNATIONAL d’UNITES (SI)
I. Introduction and Basic o Adopted internationally in 1960
Principles o Based on metric system
§ Units of Measurement • TWO CLASSIFICATIONS:
and Conversions o Basic Units: meter, kilogram,
II. Specimen Types and seconds
Considerations
o Derived units: meter per second
§ Type of Samples
§ Sample Processing and (m/s)
Sample Variable • STANDARD PREFIXES
III. Laboratory Safety, o Added to basic units to indicate
Regulations, and Safety decimal fractions or multiple
Equipments units.
§ Different Hazards and
• SI CONVERSIONS
Safety Hazards
§ Biosafety Cabinet o Move decimal by the difference
IV. Method Evaluation and between the exponents
Quality Control represented by the prefix;
§ Descriptive Statics: § Right (from larger to a
Measuremes of Center, smaller unit)
Spread, and Shape § Left (from smaller to
§ Type of Errors
§ Quality Control and larger unit)
Multirules Rule
Decimal point
§ Quality Assurance
V. Intrumentation & Analytic 000 #.000
Techniques
§ Spectrophotometry, Smaller to larger unit | larger to smaller unit
Fluorometry,
Chemiluminescence, Convert smaller to larger: move LEFT
Turbidity, and
Nephelometry Convert larger to smaller: move RIGHT
§ Electrophoresis
§ Chromatography and
Mass Spectrometry
VI. Principles of Automation

I. INTRODUCTION AND BASIC PRINCIPLES

• Clinical Chemistry
o Biochemical Analysis of Body
Fluids
• Clinicical Chemistry Laboratory
o Involves performance of
analytics procedures that yield
accurate and precise
information

UNITS OF MEASURES AND CONVERSION

•
 MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1
CLinical chemistry 1
MR. nickson r. patawaran, RMT | Introduction to clinical chemistry | MTAP 1 MIDTERMS
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CONVERSIONS

ANALYTICAL CHEMICALS

• Meets or exceed
purity standard
set by ACS
Analytical
• Used in most
Reagent
analytic
laboratory
procedures
• Used in
chromatography,
atomic
adsorption,
immunoassays,
molecular
Ultrapure diagnostics,
standardization,
or other
techniques that
requires
TEMPERATURE AND CONCENTRATION extremely pure
chemicals
CONVERSIONS
United States • Used in drug
Pharmacopeia manufacturing
Technical or
• Industrial
Commercial
manufacturing
Grade
• Not
recommended
for clinical
Chemically
laboratory
Pure
• Needs further
COMMON CONVERSIONS IN CLINICAL purification or
reagent blank
CHEMISTRY

REFERENCE MATERIALS

• A highly purified
chemical and
procedures a
ACS Primary
substance of
Standard
exact known
concentration
and purity

Standard • Used in place of

Reference an ACS primary
Materials standard on
(SRMs) clinical work

WATER SPECIFICATION

1. Reagent Grade Water

o Clinical Lanoratory Reagent
Water
o Special Reagent Water
o Water supplied by manufacturer
o Autoclave and wash water
ANALYTICAL REAGENTS AND WATER o Commercially bottled purified
SPECIFICATION water
2. Distilled Water
• Reagents – ready-to-use form / ”kit”
3. Deionized Water
• Analytical Chemicals- “purity”
4. Reverse Osmosis Water
 MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1
CLinical chemistry 1
MR. nickson r. patawaran, RMT | Introduction to clinical chemistry | MTAP 1 MIDTERMS
____________________________________________________________________________________
5. Ultrafiltration and enzyme
analyses)
WATER SPECIFICATION
Distilled Water • Distillation
• Water is boiled
II. SPECIMEN TYPES AND CONSIDERATIONS
and vaporized
Ultrafiltration & • Excellent in • General Methods of Blood Collection:
Nanofiltration removing o Arterial Puncture
particulate o Venipuncture
matter, o Skin Puncture
microorganisms,
and pyrogens ARTERIAL PUNCTURE
or endotoxins
• Method of • Oxygenated blood- bright red color
eliminating o Uniform in composition
bacteria by- throughout the body
products • Preferred specimen for blood gas
(alkaline
analysis & blood pH measurement
phosphatase,
endotoxins) of o Venous blood -> readily
significant in obtained; reflects acid-base
immunoassays status of extremity, not the whole
Deionized Water • Ion exchange body.
resins • Preferred sites (in order):
• Removal of ions o Radial
with
o Branchial
replacement of
OH- or H+ ions o Femoral
Ultraviolet • Can destroy o Scalp
Oxidation bacteria but o Umbilical Arteries
may leave • Unacceptable sites:
behind residual o Irritated
products
o Edematous
Reverse • Uses pressure to
o Near a wound
Osmosis force water
through a o Area of an arteriovenous (AV)
semipermeable shunt or fistula
membrane • ARTERIAL SPASMS – reflex constriction
restricting blood flow with possible serve
consequences on circulation and tissue
WATER SPECIFICATION TYPES
perfusion.
• Autoclave
• ARTERIAL PUNCTURE MATERIALS
wash water is
o Glass syringe
acceptable
for glassware o Needle gauge
Type III washing but § Branchial artery: 18-20 g
not for (45-69o)
analysis or § Radial artery: 23-25 g
reagent § Femoral artery: 90o
preparation
o Cotton (dry & wet), alcohol or
Type II • Acceptable iodine
for most o Heparin- preferred anticoagulant
analytic o Warm towel (45oC) – for
requirements, arterializations
including o Iced water bath or other coolant
reagent
(1-5oC -> transport preservations)
quality
control, and to minimize leukocyte
standard consumption of O2
preparation
Type I • Used for test VENIPUNCTURE
methods • Deoxygenated blood – dark red color
requiring
• Preferred specimen for clinical chemistry
minimum
interference & immunology
(eg: trace • Frequent site: ANTECUBITAL FOSSA
metals, iron,
 MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1
CLinical chemistry 1
MR. nickson r. patawaran, RMT | Introduction to clinical chemistry | MTAP 1 MIDTERMS
____________________________________________________________________________________
1. Median cephalic o Insert the needle bevel up into
§ most commonly the skin at 15-300.
used o Most common gauge:
§ well anchored 19,20,21,22
§ good blood flow § Larger the gauge, the
§ bruises less easily smaller the bore
2. Cephalic o Most common needle length: 1
§ Rolls and bruises to 1 ½ in. (2.5 to 3.7 cm)
less easily
§ Blood flows more
easily
§ Tougher to puncture
3. Basilic
§ Tends to roll more easily
§ Near branchial artery

PRECAUTIONS:

§ IV therapy sites should be avoided

o If not possible;
§ Site BELOW IV line should
be sought
§ 5 mL initial sample drawn EVACUATED TUBE SYSTEM
should be discarded ->
contaminated with IV • Made from:
fluid and only subsequent o soda-lime
samples are analyzed o borosilicate glass
§ Do not extract blood from patients while o plastic
they are receiving IV MEDICATIONS as it (polyethylene
may influence the analysis terephtalate)
§ Masectomy patients arm veins should • Historically,
mot be used because it may caused additive tubes
lymphostatis (a blood flow stoppage (including gel tubes) were drawn after
and lymph drainage through the site) citrate tube to avoid interference of
affecting blood composition. coagulation.
o If they had double masectomy, • Order of draw
blood should be drawn from the
arm of the side on which the first
procedure was done.
o If the surgery was done within 6
months on both sides, a vein on
the back of the hand or ankle
should be used.
§ Veins on the back of the
hand or ankle are less
desirable and should be
avoided in DIABETIC
PATIENTS and others with
poor circulation.

NOTES TO REMEMBER

• Tourniquet Application
o Application must be applied 3-4
in. ABOVE the site
o It should not exceed 1 min.
o Alternative tourniquet: Blood
pressure cuff (40 mmHg)
• Needles and Gauges
 MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1
CLinical chemistry 1
MR. nickson r. patawaran, RMT | Introduction to clinical chemistry | MTAP 1 MIDTERMS
____________________________________________________________________________________
PHLEBOTOMY COMPLICATIONS EDTA tubes
According to Turgeon, the following are some Other additives: microtainer
complications during blood extraction:
Serum additives: microtainer
1. Vascular complications
• Most common
2. Infections FASTING REQUIRED & DIURNAL VARIATIONS
• 2nd most common
3. Anemia
• iatrogenic (nosocomial) anemia
4. Neurological complications
• seizure or pain
5. Cardiovascular
• orthostatic hypotension, syncope,
shock and cardiac arrest
6. Dermatological
• allergic reaction to iodine

SKIN PUNCTURE

• Mixture of blood from arterioles,

venules, capillaries
• Preferred method for pediatric px.
o Venipuncture of deep veins
may rarely cause;
§ M.I
§ Hemorrhage
§ Thrombosis
§ venous constriction PRE-ANALYTICAL VARIABLES
followed by
gangrene of
extremity
§ damage to organs or
tissues.
• Also preferred in geriatric px.
o Skin of geriatric px is thinner
and less elastic
o Venipuncture may cause
hematoma
• Preferred sites
o Plantar heel surface (infants)
o Plantar surface of big toe
(children)
o Plantar surface of the last
digit of the 2nd, 3rd, or 4th
fingers
o Lateral side of finger
adjacent to nail
o Earlobe
• Skin puncture is useful in adults with
o Extreme obesity
o Severe burns
o Thrombotic tendencies

ORDER OF DRAW: CAPILLARY SPECIMENS

Blood gases

Slide/Smears
 MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1
CLinical chemistry 1
MR. nickson r. patawaran, RMT | Introduction to clinical chemistry | MTAP 1 MIDTERMS
____________________________________________________________________________________
SAMPLE TYPES § All human blood, tissue,
and most body fluids are
• Whole blood
handled as if known to
o Cellular components
be infectious for the
• Plasma
human
o From anticoagulated blood
immunodeficiency virus
o Fibrinogen (+)
(HIV), hepatitis b virus
• Serum
(HBV), and other blood
o Mostly used in clinical chemistry
borne pathogens
o Must be completely clotted
o Formaldehyde standards
before centrifugation
o Laboratory standards
o From clotted blood o Hazard communication standard
§ 29 CFR 1910.1200
§ HazCom standard
§ Defines hazardous
substances provided
guidance for evaluating
and communicating
identified hazards
o Respiratory protection standard
Reasons for rapid separation of blood o Air contaminant standard
o PPE standard
1. To prevent; b. STANDARD PRECAUTIONS
Ø Glycolysis
• Work practices required to achieve
Ø Lipolysis
basic level of infection control
Ø Electrolytes shift
o Hand hygiene
Ø Hemolysis o PPEs
2. Certain substances are very unstable
o Prevention of needle sticks injury
SAMPLE PROCESSING o Respiratory hygiene and cough
etiquette
1. Specimen arrival in the laboratory o Proper handling of linens
2. Correct matching of requisition and o Environmental cleaning and
sample waste disposal
3. Check for acceptability of specimen o Proper use of patient care
4. Testing equipment
5. Reporting of results
C. STANDARD HAZARD IDENTIFICATION SYSTEM
III. LABORATORY SAFETY, REGULATIONS,
• Diamond shape color coded symbol
AND SAFETY REGULATIONS
• HAZARD
o Potentially to cause harm
o Example:
§ Injury
§ Risk to people, property,
and environment
• SAFETY
o Condition of being protected
o Unlikely to cause danger, risk, or
injury

LABORATORY SAFETY AND REGULATIONS

a. OCCUPATIONAL SAFETY AND HEALTH

ACT (OSHA)
• Law monitored and enforced by OSHA
standards that regulate safety in the
laboratory including the:
o Blood-borne pathogens
§ 29 CFR 1910.1030
§ UNIVERSAL PRECAUTION
 MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1
CLinical chemistry 1
MR. nickson r. patawaran, RMT | Introduction to clinical chemistry | MTAP 1 MIDTERMS
____________________________________________________________________________________
o Health hazard
o Handling precautions
o Engineering
o Work practice control
o Disposal
• OSHA required manufacturers to
indicate lot number, physical or
biological health hazard of the
chemical reagents, and precautions for
safe use.
• Chemical spills or exposure
o 1st step: assist or evacuate
personnel
TYPES OF HAZARD
o Skin or eye contact:
1. BIOLOGICAL HAZARDS § flush area with large
• Disease producing agents amount of water for at
(pathogens) transmitted via various least 15 mins.
route of transmission. § After flushing, seek
• Exposure may result in acute or medical attention
chronic conditions. o Contaminated clotting – remove
ASAP
o No attempt should be made to
neutralize chemicals contacted
with the skin.
4. ELECTRICAL HAZARD
• The laboratory
environment features
electrical devices that
workers frequently handle,
necessitating adherence
to the same electrical
safety protocols applicable
outside the workplace.
• The risk of water or other fluids
interacting with equipment is
INFECTION CONTROL
heightened in laboratories, thus it
Ø Control and monitor infections occurring
is imperative that devices are not
within the facility.
operated with damp hands.
Ø HANDWASHING – break chain of
infection 5. FIRE HAZARD
• critical component of laboratory
2. SHARP HAZARDS
safety program
• Sharp objects in the
• Minimize usage of flammable
laboratory presents serious
and combustible liquids
biological hazard, specifically
• Ensure no more than 2 gallons
for blood-borne pathogens
are stored per 100 square feet in
transmission.
approved storage cabinets
• All sharp objects must be
disposed in puncture resistant, • Limit <1 gallon if placed open
leakproof container w/ shelves.
biohazard symbol sharp
container.
3. CHEMICAL HAZARD
• Safety data sheets (SDS) includes
the following that should be readily
accessible to the lab. personnel:
o manufacturers
information (name, address,
contact number)
o Chemical properties
 MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1
CLinical chemistry 1
MR. nickson r. patawaran, RMT | Introduction to clinical chemistry | MTAP 1 MIDTERMS
____________________________________________________________________________________
§ Allow room air (unsterile) air into
cabinet
§ Samples are exposed to
contamination
• CLASS II, TYPE A1
Description:
§ Open- fronted type
§ For biological samples
Air Flow:
§ 70% recirculated
§ 30% exhausted
• CLASS II, TYPE A2
Description:
§ Open- fronted type
§ Most commonly used BSC in
clinical and microbiology section
§ Biological and clinical
(infectious) samples and
specimens treated with minimal
concentration of volatile
chemicals
§ Mostly used in BSL 1&2 agents
and sometimes in BSL 3
6. ERGONOMIC HAZARD organisms.
Air Flow:
• Musculoskeletal disorder § 70% recirculated
due to clinical laboratory § 30% exhausted
work • CLASS II, TYPE A2
• Due to: Description:
o repetitive twisting § Open- fronted type
o lifting § Most commonly used BSC in
o static posture for an extended clinical and microbiology section
period of time § Biological and clinical
o functionality of work place (infectious) samples and
specimens treated with minimal
concentration of volatile
LABORATORY SAFETY EQUIPMENT chemicals
§ Mostly used in BSL 1&2 agents
BIOSAFETY CABINETS
and sometimes in BSL 3
organisms.
Air Flow:
§ 70% recirculated
§ 30% exhausted
• CLASS II, TYPE B1
Description:
§ Biological and clinical
(infectious) samples with minimal
concentration of volatile
chemicals
Air Flow:
• CLASS 1 § 30% recirculated
Description: § 70% exhausted
§ Open- fronted type • CLASS II, TYPE B2
§ Protects laboratory worker & Description:
environment § For processing chemicals,
§ Mostly used in BSL 1 agents and radioisotopes, and carcinogens
sometimes in BSL 2 organisms. aside from biological samples
Air Flow: treated with toxic or hazardous
chemicals
 MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1
CLinical chemistry 1
MR. nickson r. patawaran, RMT | Introduction to clinical chemistry | MTAP 1 MIDTERMS
____________________________________________________________________________________
Air Flow: oDifference between highest and
§ 0% recirculated lowest in a given data
§ 100% exhausted § VARIANCE
• CLASS III o Average squared distance of
Description: data points from the mean
§ CLOSE- fronted type w/ airtight § STANDARD DEVIATIONS
system o square of the variance
§ Aka GLOVE-BOX CABINET o Average distance of each data
§ Infectious samples is handled points in a normal distribution
with rubber gloves attached and from the mean
sealed onto the cabinet o Commonly used in laboratory to
§ Provides HIGHEST LEVEL OF measure dispersion of a group
SAFETY to the laboratory workers values around mean
§ Preferred for BSL 4 agents
Air Flow:
§ Air coming into and going out of
the cabinet is sterilized using
HEPA filter.

PERSONAL PROTECTIVE EQUIPMENT

• PPEs must be used to

protect workers from
exposure:
o Laboratory coat/PPE QUALITY CONTROL
suit/Isolation gown Ø Monitor the quality of testing or reliability
o Safety eyeglasses/ by ensuring the accuracy and precision
goggles in every measurement.
o Face mask o ACCURACY
§ Respirators may be used § Closeness of
in processing samples measurement to the true
depending on severity of value
samples § Reflected by: producing
§ FIT TEST is important values of standard known
before using N95 / HEPA concentrations
respirators. o PRECISION
o Gloves § Repeated results
o Shoe cover agreeing with each other
• DONNING OF PPE: GMGG § Repeated result of a true
1. Gown value
2. Mask § Represents:
3. Goggles reproducibility of a lab
4. Gloves test when run repeatedly
Ø DOFFING OF PPE: GGGM under identical
1. Gown
2. Gloves
3. Goggles
4. Mask
IV. METHOD EVALUATION AND QUALITY
CONTROL
STATISTICS
§ MEAN
o Center / midpoint value of
observation
§ MEDIAN
o Calculated average of values conditions
§ MODE QUALITY CONTROL TYPES
o Greatest frequency value
§ RANGE 1. Internal QC / Intralab QC
 MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1
CLinical chemistry 1
MR. nickson r. patawaran, RMT | Introduction to clinical chemistry | MTAP 1 MIDTERMS
____________________________________________________________________________________
ØPrecision of laboratory test; § Aging Reagents
monitors precision of true value § Deterioration of control or
Ø Based: results of control standards
specimen/ patient specimen § Deterioration of incubation
Ø Monitors day-to-day chamber temperature (enzymes)
performance of laboratory test; § Deterioration of light filter and
daily monitoring of qc sera calibration of machine
Ø Immediate decisions to accept SHIFT
or reject patient results. Ø An abrupt systematic error
2. External QC / Interlab QC changes in the mean that
Ø Profiency testing / External becomes continuous;
Quality Assurance Scheme Ø >6 values that goes up and
(EQAS) down; below or.
Ø Accuracy of laboratory test of Ø CAUSES OF SHIFT
different laboratory (free § Change in reagent
standing or hospital based) formulation
Ø Compare performance to other § Major instrument
laboratory (peer to peer maintenance
comparison) § Failure in the system
§ Inaccurate calibration
TYPE OF ERRORS IN LAB TESTING

ERROR

Ø Difference between test and reference

method

TYPES OF ERROR

1. Random Error
Ø Imprecision of test system causing
scatter or spread of control values.
Ø Personnel errors
Ø Occur once; easy to spot QC CHART
Ø Affects few analysis
Ø Example: 1. LEVEY JENNINGS/SHEWART CHART
§ Mislabeling of specimen • Control values obtained for a period of
§ Analytical result assigned to a 20 days are plotted on this chart
wrong specimen • It is monitored over time to evaluate the
§ Pipetting errors precision and accuracy of repeated
§ Improper mixing of sample and measurement
reagents • aka S-L-J and Dot Chart
2. Systematic Error 2. FINDINGS OVER TIME
Ø Analytical error • Ideally should have control values
Ø Repeating errors; difficult to spot clustered about the mean (+/- 2 SD )
Ø Affect series of analysis o IN-CONTROL
Ø Example § when the control values fall
§ Erroneously calibrated pipettor within the confidence limit
of (+/- 2 SD )
§ Deteriorating/ expired reagents
o OUT-OF-CONTROL
§ Improper calibration
§ Sample instability § when the control values
§ Changes in standard materials falls outside the
confidence limit of
TRENDS (+/- 2 SD )
3. WESTGARD RULES
Ø Gradual/ systematic error in the mean
• Developed by Dr. James Westgard in
proceeding in one direction
1981
Ø >6 values goes up / down
• Aka “Multirule Quality Control”
Ø CAUSES
• Uses combination of 6 decision criteria or
§ Deterioration of light source
6 control rules
§ Gradual accumulation of debris
in the tubing
 MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1
CLinical chemistry 1
MR. nickson r. patawaran, RMT | Introduction to clinical chemistry | MTAP 1 MIDTERMS
____________________________________________________________________________________
• Allows determination of whether an • Reject the run when 2 consecutive
analytical run is “in-control” or “out-of- control measurements exceed the same
control” +/-2SD control limit.

WESTGARD 12S RULE WESTGARD R4S RULE

• One central value outside plus or minus

• One control exceeds the mean by -2SD
2 SD (+/- 2 SD )
and the other control exceeds the
• Warning Rule
mean by +2SD
• Accept analytical run
• The range between the two results will
• Patient Results can be reported Warning
therefore exceed 4 SD
to trigger careful inspection of the
• Reject the run
control data
• Do not release patient’s result
WESTGARD 13S RULE • Investigate possible cause of problem

WESTGARD 41S RULE

• One control value outside +/- 3 SD

• Reject the run
• Do not release patient’s result
• Investigate possible cause of problem • Four consecutive QC results are outside
• Reject the run when a single control +/- 1SD
measurement exceeds the +/-3SD • Does not necessarily require rejection of
WESTGARD 22S RULE the run (but some reject this error also)
• May indicate small error that is not often
• 2 consecutive control values fall outside clinically significant or relevant
of +/- 2SD on the same side of the mean • Check the calibration of the machine
• Reject the run
• Do not release the patient’s result
• Investigate possible cause of the
problem
 MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1
CLinical chemistry 1
MR. nickson r. patawaran, RMT | Introduction to clinical chemistry | MTAP 1 MIDTERMS
____________________________________________________________________________________
WESTGARD 10x RULE o Medium and high-pressure mercury
lamps
§ Ultraviolet (UV) to the mid-
visible region
2. MONOCHROMATORS
• Isolation of individual wavelengths of
light
• TYPES OF MONOCHROMATORS
o Interference Filter: based on
constructive interference of
waves
o PRISM: separates white light
into a continuous spectrum
• Ten consecutive QC results for o Diffraction gratings:
one level of control are one side separates light into
of the mean. component wavelengths
• Reject the run 3. SAMPLE CONTAINER OR CUVETTES
• Do not report patient’s results. • The light path must be kept constant
• Reject the run when 10 to have absorbance proportional to
consecutive control concentration.
measurements fall one side of • TYPES OF CUVETTES
the mean o Square
! REMEMBER o Round
o Quartz: Transmission and
• Random Error- 12S , 13S , R4S
absorption of light by analyte
• Systematic Error- 22S, 41S, 10
at ultraviolet range
V. INSTRUMENTATION & ANALYTICAL
o Glass cuvettes: Visible region
TECHNIQUES
o Alumina silica glass: most
SPECTROPHOTOMETRY commonly used (350-
2000nm)
• Used to measure the light transmitted by a
solution to determine the concentration of 4. PHOTODETECTORS
the light-absorbing substance in the solution. • Converts light energy transmitted by
SPECTROPHOTOMETRY COMPONENTS a solution into an electrical signal.
• TYPES OF PHOTODETECTORS
o PHOTOCELL – Most common,
least expensive
o PHOTOTUBE – also contains
photosensitive materials,
some with photocell but
requires voltage
o PHOTOMULTIPLIER TUBE – Very
sensitive, highly sensitive to
ultraviolet and visible
1. LIGHT SOURCE
• Produces an intense, reproducible, constant radiation
beam of light o Phototransistor
& Photoiodide – uses a
• TYPES OF LIGHT SOURCE
o Incandescent tungsten or tungsten- photosensitive pos-neg
iodide lamp junction diode to produce a
§ Most common photocurrent
§ used in visible and near 5. READ-OUT-DEVICE
infrared (IR) regions • Electrical energy coming from a
o Deuterium discharge lamp and the detector is displayed on some
mercury arc lamp type of digital display or readout
§ For ultraviolet (UV) region system.
o Low-pressure mercury lamps
§ With both ultraviolet (UV) and
visible lines
 MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1
CLinical chemistry 1
MR. nickson r. patawaran, RMT | Introduction to clinical chemistry | MTAP 1 MIDTERMS
____________________________________________________________________________________
QUALITY ASSURANCE OF SPECTROPHOTOMETER § Uses a GLASS COIL in mixing of
sample and reagents
§ Wavelength or Photometric accuracy
§ Disadvantage: tests are
o Implies that a photometer is
performed in parallel
measuring at the wavelength
that it is set to
2. Centrifugal analysis/analyzer
o assessed using glass-type optical
§ 1 test = 1 cuvet
filters (Didymium, Holmium
§ Uses the force
oxide)
generated by
§ Stray light
centrifugation to
o refers to any wavelengths
transfer spx and
outside the band transmitted by
reagents
the monochromator
§ Centrifugal force
o can be evaluated by using
(rotor) or bubbling
special cutoff filters
of air is used for
§ Linearity
mixing solutions
o demonstrated when a change in
§ Advantage: Batch Analysis (1
concentration results in a
batch=1 test)
straight-line calibration curve
(i.e., Beer’s Law);
3. Discrete analysis/analyzer
o can be determined using
§ MOST POPULAR and VERSATILE
optical filters or solutions that
§ Advantage: capable of running
have known absorbance values
stat over others (random access
for a given wavelength.
capability)
§ Absorbance check
§ Measures only the test requested
o performed using glass filters or
on the sample
solutions that have known
§ Each sample-reagent mixture is
absorbance values for a specific
handled separately in its own
wavelength
vessel
§ (1 test = 1cuvet); prevents carry
VI. AUTOMATION
over (1 tip = 1 specimen)
v Automation § For dry-slide technology
Ø is the mechanization of the steps (reflectance photometry), the
in a procedure. spreading layer permits a rapid
uniform spreading layer over the
v ADVANTAGES OF AUTOMATION reagent layer
Ø Increase the number of tests
performed
Ø Minimize variation in results
Ø Eliminates potential errors of
manual analyses
Ø Only small amount of sample is
required
Ø Only small amount of reagent is
used

THREE BASIC APPROACHES OF AUTOMATION

1. Continuous flow
§ All liquids
(reagents, diluents,
and samples) are
pumped through a
system of continuous tubing and
samples are introduced in
sequential manner.
§ Bubbles serve as separating and
cleaning media.
§ Uniformity of performances in the
test: Problem
 MEDICAL TECHNOLOGY ASSESSMENT PROGRAM 1
CLinical chemistry 1
MR. nickson r. patawaran, RMT | Introduction to clinical chemistry | MTAP 1 MIDTERMS
____________________________________________________________________________________

TERMS TO REMEMBER:
1. Batch testing – all samples are loaded at
the same time and a single test is
conducted on each sample.
2. Parallel testing – more than 1 test is
analyzed concurrently on a given
clinical spx
3. Random access testing – any test can
be performed on any spx in any
sequence