Clinical chemistry, also known as clinical biochemistry, chemical pathology, medical
biochemistry or pure blood chemistry is the area of pathology that is generally concerned with
analysis of body fluids. Blood Chemistry involves the assays of blood constituents like
electrolytes, hormones and various important substances present in blood are measured and then
used as an index for the presence of disease. The measurement of these blood constituents
entails not only lots of skill and proficiency but also relevant, updated principles behind each
The discipline originated in the late 19th century with the use of simple chemical tests
for various components of blood and urine. Subsequently other techniques were applied
including the use and measurement of enzyme activities, spectrophotometry (application of
Beer’s law—see Figure 1.1 for diagram), electrophoresis and immunoassay.
Tests are performed in groups of individual tests called panels. The liver function test
(LTF) is an example of a panel. However, tests that require examination and measurement of
the cells of blood, as well as blood clotting studies, are not included as in the UK these are
usually grouped under hematology, but in many countries these specialties along with
immunology and microbiology are grouped under laboratory medicine.
All biochemical tests come under chemical pathology. These are performed on any kind
of body fluid, but mostly on serum or plasma. Serum is the yellow watery part of blood that
separates from clotted blood, similar to plasma but without clotting agents. This is most easily
done by centrifugation which packs the denser blood cells and platelets to the bottom of the
centrifuge tube, leaving the liquid serum fraction resting above the packed cells. Plasma is
essentially the same as serum, but is obtained by centrifuging the blood without clotting. Plasma
therefore contains all of the clotting factors, including fibrinogen.
A large laboratory will accept samples for up to about 700 different kinds of tests. Even the
largest of laboratories rarely does all these tests themselves and some need to be referred to
other labs. This large array of tests can be further sub-categorized into sub-specialties of:
General or routine chemistry
Endocrinology - the study of hormones
Immunology - the study of the immune system and antibodies
Pharmacology or Toxicology - the study of drugs
Today, clinical chemistry plays an essential role in disciplines such as cardiac care, cancer
testing, prenatal testing, diabetes management, infectious disease testing, maternal care, blood
banking, genetic testing, and customized medicine.
Although increased automation, advanced analytical techniques and sophisticated
information technology have greatly improved the performance and quality in medical
laboratory testing, several studies show that significant amounts of errors occur. Detailed
analysis revealed that most of the errors occur in the pre-analytical phase, while fewer errors
occur in the intra- and post-analytical phase. The majority of errors is caused by wrong
sampling or occurs during transport to the laboratory. This review focuses on the analytical
procedures in a large central laboratory. Possible problems are described by following samples
from the patient to the laboratory and back.
Finally, the advantages and disadvantages of point-of-care testing versus central laboratory
are compared. Nowadays, most current laboratories are now highly automated and use
examinations that are closely monitored and quality controlled.
Today, an international society comprised of medical professionals with an interest in
clinical chemistry, clinical laboratory science, and laboratory medicine called American
Association of Clinical Chemistry (AACC) serves as the pillar of Clinical Chemistry in the form
of journals, conferences and on-line lab tests. The said association was founded in 1948; the
society has over 9,000 members and is headquartered in Washington, DC.
Our Group visited the Bulacan Medical Mission Group Hospital in Sta. Maria, Bulacan. The
succeeding data in the next pages was obtained according to our interview with the Medical
Technologists assigned there.
Figure 1.1 Diagram of Beer’s Law
The Beer-Lambert law (also called the Beer-Lambert-Bouguer law or simply Beer's law) is
the linear relationship between absorbance and concentration of an absorber of electromagnetic
Biological Supplies Horiba CBC Analyzer
Blood Banking Microfuge Na, K, CL Spectronic Stat Fax Centrifuge
Refrigerator Analyzer 200
Figure 1.2 Floor Plan of Clinical Chemistry Section at Bulacan Medical Mission Group
Figure 1.3 Actual Flow of Specimen at the Bulacan Medical Mission Group Hospital
II. FUNCTIONS OF THE SECTION
A. General Function
The Clinical Chemistry section of the laboratory provides an effective, efficient and
quality assured service that reacts with all laboratory requests and performs a qualitative
analysis that is related with chemistry dealing with body fluids like blood, urine, CSF and
as such. It performs laboratory tests using serum most of the time. This section performs
stat chemistry and average volume routine chemistry tests.
B. Special Function
The Clinical Chemistry section of the laboratory is semi-automated that performs
qualitative analysis of body fluids like blood, urine, CSF and as such. These analyses are to
test the different chemical components of body fluids, which include glucose, electrolytes,
enzymes, hormones, lipids, proteins and other metabolic substances. The section is
responsible for evaluating the results of the patient. It determines enzymes that are
clinically substantial for the diagnosis and prognosis of diseases like cardiac diseases. Also
the section is capable of STAT testing as well maintaining a point-of-care testing. The
section is a 24/7 service of the hospital that provides routine and special tests like Diabetes
panel tests, Immunochemistry panel tests, Chemistry panel tests (Urea, Creatinine, Uric,
Sodium, Calcium, Albumin, Bilirubin, Phosphate, Lipids, Glucose, Chloride, Potassium,
III. LISTS OF TESTS
How do the Medical Technologists extract the specimen (i.e. blood)?
Blood is drawn from a vein, usually from the inside of the elbow or the back of the
hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider
wraps an elastic band around the upper arm to apply pressure to the area and make the vein
swell with blood.
Next, the health care provider gently inserts a needle into the vein. The blood collects
into an airtight vial or tube attached to the needle. The elastic band is removed from your
Once the blood has been collected, the needle is removed, and the puncture site is
covered to stop any bleeding.
In infants or young children, a sharp tool called a lancet may be used to puncture the
skin and make it bleed. The blood collects into a small glass tube called a pipette, or onto a
slide or test strip. A bandage may be placed over the area if there is any bleeding.
When the needle is inserted to draw blood, some people feel moderate pain, while
others feel only a prick or stinging sensation. Afterward, there may be some throbbing.
Figure 3.1 Blood Extraction Diagram
A. ROUTINE TESTS
1. Fasting blood sugar (FBS) test - also known as blood sugar; Blood glucose; Oral
Glucose Tolerance Test; OGTT; GTT; Urine glucose
Related tests: Urinalysis; Insulin; C-Peptide; A1c; Microalbumin
The blood glucose test is ordered to measure the amount of glucose in the blood
right at the time of sample collection. It is used to detect both hyperglycemia and
hypoglycemia, to help diagnose diabetes, and to monitor glucose levels in persons with
diabetes. Blood glucose may be measured on a fasting basis (collected after an 8 to 10
hour fast), randomly (anytime), post prandial (after a meal), and/or as part of an oral
glucose tolerance test (OGTT / GTT). An OGTT is a series of blood glucose tests. A
fasting glucose is collected; then the patient drinks a standard amount of a glucose
solution to "challenge" their system. This is followed by one or more additional glucose
tests performed at specific intervals to track glucose levels over time. The OGTT may
be ordered to help diagnose diabetes and as a follow-up test to an elevated blood
This is usually done by placing a drop of blood from a skin prick onto a glucose
strip and then inserting the strip into a glucose meter, a small machine that provides a
digital readout of the blood glucose level.
In those with suspected hypoglycemia, glucose levels are used as part of the
"Whipple triad" to confirm a diagnosis.
2. High density lipoprotein test (HDL test)
Related tests: Cholesterol; LDL-C; Triglycerides; Lipid profile; Cardiac risk
HDL-C may be ordered as a follow up test to a high result on a cholesterol
screening test. HDL-C is usually not ordered by itself but with other tests, including
cholesterol, LDL cholesterol (LDL-C), and triglycerides as part of a lipid profile
during a health check-up. It is recommended that all adults be tested at least once
every five years.
HDL-C, as part of the lipid profile, may be ordered more frequently for those who
have one or more risk factors for heart disease. Major risk factors include:
Age (men 45 years or older and 55 years or older)
Hypertension (blood pressure of 140/90 or higher or taking high blood
Family history of premature heart disease (heart disease in an immediate
family member—male relative under age 55 or female relative under age
Pre-existing heart disease or already having had a heart attack
A complete lipid profile requires fasting for 9-12 hours. If the testing occurs when
a person is not fasting, only the HDL-C and total cholesterol values may be used for risk
HDL cholesterol should be measured when a person is not ill. Cholesterol is
temporarily low during acute illness, immediately following a heart attack, or during
stress (like from surgery or an accident). You should wait at least six weeks after any
illness to have cholesterol measured.
3. Low-density lipoprotein cholesterol test (LDL test)- LDL-C levels are ordered as
part of a lipid profile, along with total cholesterol, HDL, and triglycerides. This profile
may be ordered as a screening profile in a healthy person as part of a routine physical
exam. A fasting lipid profile may be ordered more frequently on those who have one
or more major risk factors for heart disease. It may be ordered on someone who
has had a high screening cholesterol result to see if the total cholesterol is high because
of too much LDL-C.
LDL-C levels may also be ordered at regular intervals to evaluate the success of
lipid-lowering lifestyle changes such as diet and exercise or to determine the
effectiveness of drug therapy such as statins.
4. Very low density lipoprotein (VLDL) test- There are three major types of
lipoproteins. VLDL contains the highest amount of triglycerides. VLDL is considered
a type of bad cholesterol, because it helps cholesterol build up on the walls of arteries.
Your doctor may order this test to determine your risk of heart disease. Increased
levels of VLDL are linked to atherosclerosis, which can lead to coronary heart disease.
High levels may be associated with a higher risk for heart disease and stroke.
5. Blood Urea Nitrogen (BUN) test-
BUN is often ordered with creatinine when kidney problems are suspected. BUN
also may be ordered at regular intervals to monitor kidney function in patients with
chronic diseases or conditions such as diabetes, congestive heart failure, and
myocardial infarction (heart attack), at regular intervals to monitor kidney function
and treatment in patients with known kidney disease , at regular intervals to monitor
the effectiveness of dialysis.
What does the test result mean?
Increased BUN levels suggest impaired kidney function.
BUN concentrations may be elevated when there is excessive protein breakdown
(catabolism or gastrointestinal bleeding (because of the proteins present in the
Low BUN levels are not common and are not usually a cause for concern. They may
be seen in severe liver disease, malnutrition, and sometimes when a patient is over
hydrated (too much fluid volume), but the BUN test is not usually used to diagnose
or monitor these conditions.
Both decreased and increased BUN concentrations may be seen during a normal
Related tests: Creatinine; Creatinine Clearance; eGFR; CMP; BMP; Urinalysis;
6. Creatinine test- also known as creat; blood creatinine; serum creatinine; urine
Related tests: BUN; BUN/creatinine ratio; eGFR; Creatinine clearance; CMP; BMP;
Urinalysis; Urine protein to creatinine ratio; Microalbumin
The creatinine blood test is used along with a BUN (blood urea nitrogen) test to
assess kidney function. Both are frequently ordered as part of a basic or
comprehensive metabolic panel (BMP or CMP), groups of tests that are performed to
evaluate the function of the body’s major organs. BMP or CMP tests are used to
screen healthy people during routine physical exams and to help evaluate acutely or
chronically ill patients in the emergency room and/or hospital. If the creatinine and
BUN tests are found to be abnormal or if you have an underlying disease, such as
diabetes, that is known to affect the kidneys, then these two tests may be used to
monitor the progress of kidney dysfunction and the effectiveness of treatment. Blood
creatinine and BUN tests may also be ordered to evaluate kidney function prior to
some procedures, such as a CT (computed tomography) scan, that may require the use
of drugs that can damage the kidneys.
A combination of blood and urine creatinine levels may be used to calculate a
creatinine clearance. This test measures how effectively your kidneys are filtering
small molecules like creatinine out of your blood
7. Total protein test- also known as TP; Albumin/Globulin ratio
Related tests: Albumin; Liver panel; Protein electrophoresis
A total serum protein test measures the total amount of protein in the blood. It
also measures the amounts of two major groups of proteins in the blood: albumin and
globulin. A test for total serum protein reports separate values for total protein,
albumin, and globulin. The amounts of albumin and globulin also are compared
(albumin/globulin ratio). Normally, there is a little more albumin than globulin.
Total protein measurements can reflect nutritional status and may be used to
screen for and help diagnose kidney disease, liver disease, and many other conditions.
Sometimes conditions are first detected with routine testing before symptoms have
begun to appear. If total protein is abnormal, further tests must be performed to
identify which specific protein is abnormally low or high so that a specific diagnosis
can be made.
A total protein test is one component of a Comprehensive Metabolic Panel (CMP)
that is often ordered as part of a routine health checkup. Total protein may also be
ordered to provide general information about your nutritional status, such as when you
have undergone a recent weight loss. It can be ordered along with several other tests to
provide information if you have symptoms that suggest a liver or kidney disorder or to
investigate the cause of abnormal pooling of fluid in tissue (edema).
Low total protein levels can suggest a liver disorder, a kidney disorder, or a
disorder in which protein is not digested or absorbed properly. Low levels may be seen
in severe malnutrition and with conditions that cause malabsorption, such as Celiac
disease or inflammatory bowel disease (IBD).
8. Albumin test
Since albumin is low in many different diseases and disorders; albumin testing is
used in a variety of settings to help diagnose disease, to monitor changes in health
status with treatment or with disease progression, and as a screen that may indicate the
need for other kinds of testing.
An albumin test may be ordered as part of a liver panel to evaluate liver function,
along with a creatinine and BUN (Blood Urea Nitrogen) to evaluate kidney function,
or along with a prealbumin to evaluate a person’s nutritional status.
Low albumin levels can suggest liver disease. Other liver enzyme tests are
ordered to determine exactly which type of liver disease.
Low albumin levels can reflect diseases in which the kidneys cannot prevent
albumin from leaking from the blood into the urine and being lost. In this case, the
amount of albumin or protein in the urine also may be measured. Low albumin levels
may be seen with conditions in which the body does not properly absorb and digest
protein, such as Crohn’s disease or celiac disease, or in which large volumes of protein
are lost from the intestines.
High albumin levels can be seen with dehydration, although the test is not
typically used to monitor or detect this condition.
Certain drugs increase albumin in the blood, including anabolic steroids,
androgens, growth hormones, and insulin.
If someone is receiving large amounts of intravenous fluids, the results of this test
may be inaccurate.
Related tests: Prealbumin, Microalbumin, Urinalysis, Liver panel
9. Triglyceride Test
A simple blood test to measure the level of triglycerides in the blood. Triglyceride
levels are influenced by recent fat and alcohol intake, so you should fast from food for
at least 12 hours and abstain from alcohol for at least 24 hours before being tested. The
normal level of triglycerides depends on the age and sex of the individual. Mild to
moderate triglyceride increases occur in many conditions, including alcohol abuse,
obstruction of the bile ducts, and diabetes. High levels of triglycerides (greater than
200 mg/dl) are associated with a heightened risk of coronary heart disease. Markedly
high triglyceride levels (greater than 500mg/dl) can cause inflammation of the
10. Uric Acid Test
This is a blood test that measures the amount of uric acid. Blood is drawn from a
vein or a capillary. The laboratory centrifuges the blood to separate the serum from the
cells and the uric acid test is done on the serum. This test is performed to detect
elevated uric acid levels. Increased levels of uric acid can cause gout.
Uric acid is the end product of purine metabolism (purines are building blocks of
RNA and DNA). Most uric acid produced in the body is excreted by the kidneys. An
overproduction of uric acid occurs when there is excessive breakdown of cells, which
contain purines, or an inability of the kidneys to excrete uric acid.
B. SPECIAL TESTS
1. Globulin electrophoresis
Serum globulin electrophoresis is a form of protein electrophoresis that examines
the globulin proteins. This test is performed when the amount of globulin proteins
are of particular interest. Identification of the various types of globulins (globulin
electrophoresis) can be useful in the diagnosis of various disorders. Proteins are
made from amino acids and are important constituents of all cells and tissues. There
are many different kinds of proteins in the body with many different functions, for
example, enzymes, some hormones, hemoglobin (oxygen transport), LDL
(cholesterol transport), fibrinogen (blood clotting), collagen (structure of bone and
cartilage), and immunoglobulins (antibodies).
2. Glycolated Hemoglobin
HbA1c is a test that measures the amount of glycosylated labelled in your blood.
The test gives a good estimate of how well diabetes is being managed over time.
This test measures blood sugar control over an extended period in people with
diabetes. In general, the higher your HbA1c value, the higher the risk that you will
develop complications from diabetes (eye disease, kidney disease, nerve damage,
heart disease, and stroke). This is especially true if your HbA1c remains elevated on
more than one occasion.
The closer your HbA1c value is to normal, the less risk you have for these
3. ASPARTATE AMINOTRANSFERASE (SGOT); Serum glutamic-oxaloacetic
AST is in high concentration in heart muscle, liver cells, skeletal muscle cells,
and to a lesser degree, in other tissues. Although elevated serum AST is not specific
for liver disease, it is used primarily to diagnose and monitor the course of liver
disease (in combination with other enzymes such as ALT, ALP, and bilirubin). It has
also been used to monitor patients with heart attacks, but it is much less specific than
CPK isoenzyme and LDH isoenzyme for this purpose.
4. SERUM GLUTAMATE PYRUVATE TRANSAMINASE (SGPT); Alanine
This test is used to determine if a patient has liver damage. ALT is an enzyme
involved in the metabolism of the amino acid alanine. ALT is in a number of tissues
but is in highest concentrations in the liver. Injury to the liver results in release of the
enzyme into the blood.
5. Bilirubin Test
A bilirubin test is a diagnostic blood test performed to measure levels of bile
pigment in an individual's blood serum and to help evaluate liver function. Bilirubin
is a yellow-orange bile pigment produced during the breakdown of hemoglobin, the
iron-bearing and oxygen-carrying protein in red blood cells. All individuals produce
bilirubin daily as part of the normal turnover of red cells. A higher than normal
(elevated) bilirubin test can reflect accelerated red blood cell destruction or may
indicate that bilirubin is not being excreted as it should be, suggesting that liver
function problems or other abnormalities may be present.
6. Alkaline Phosphatase
An alkaline phosphatase (ALP) test measures the amount of the enzyme ALP in
the blood. ALP is made mostly in the liver and in bone with some made in the
intestines and kidneys. It also is made by the placenta of a pregnant woman. The
liver makes more ALP than the other organs or the bones. Some conditions cause
large amounts of ALP in the blood. These conditions include rapid bone growth
(during puberty), bone disease (osteomalacia or Paget's disease), or a disease that
affects how much calcium is in the blood (hyperparathyroidism), or damaged liver
cells. If the ALP level is high, more tests may be done to find the cause.
TABLE 4.1 Reference Range of Analytes
TEST REFERENCE DESCRIPTION
Fasting blood sugar (FBS) test 60-100 mg/dl ordered to measure the amount of
glucose in the blood right at the time
of sample collection. It is used to
detect both hyperglycemia and
hypoglycemia, to help diagnose
diabetes, and to monitor glucose
levels in persons with diabetes.
High density lipoprotein test 30-75 mg/dl used along with other lipid tests to
(HDL test) screen for unhealthy levels of lipids
and to determine your risk of
developing heart disease.
Low-density lipoprotein 60-178 mg/dl used to predict your risk of
cholesterol test (LDL test) developing heart disease. This test
may be used to monitor levels after
the start of diet or exercise programs
or to determine whether or not
prescribing one of the lipid-lowering
drugs would be useful
Very low density lipoprotein 0-40 mg/dl used to determine your risk of heart
(VLDL) test disease
Blood Urea Nitrogen (BUN) test 7-21 mg/dl The BUN test is primarily used,
along with the creatinine test, to
evaluate kidney function in a wide
range of circumstances, to help
diagnose kidney disease, and to
monitor patients with acute or
chronic kidney dysfunction or
Creatinine test 0.5-1.7 mg/dl This is used along with a BUN
(blood urea nitrogen) test to assess
kidney function. Both are frequently
ordered as part of a basic or
comprehensive metabolic panel
(BMP or CMP), groups of tests that
are performed to evaluate the
function of the body’s major organs.
Total protein test 6.0-8.0 gm/dl total serum protein test measures the
total amount of protein in the blood.
Albumin 3.5-5.5 gm/dl An albumin test may be ordered as
part of a liver panel to evaluate liver
function, along with a creatinine and
BUN (Blood Urea Nitrogen) to
evaluate kidney function, or along
with a prealbumin to evaluate a
person’s nutritional status.
Triglyceride Test The normal level of triglycerides
3.61 – 6.38 depends on the age and sex of the
mmol/L individual. Mild to moderate
triglyceride increases occur in many
conditions, including alcohol abuse,
obstruction of the bile ducts, and
diabetes. High levels of triglycerides
(greater than 200 mg/dl) are
associated with a heightened risk of
coronary heart disease. Markedly
high triglyceride levels (greater than
500mg/dl) can cause inflammation
of the pancreas (pancreatitis)
Uric Acid Test Uric acid urine test is performed to
3.6-8.3 gm/dl check for the amount of uric acid in
urine. Urine is collected over a 24
hour period and is sent to the
laboratory for testing. The most
common reason for measuring uric
acid levels is in the diagnosis or
treatment of gout, because gout
results from crystallization of uric
acid crystals in joints. Some kidney
stones are also composed of uric
Globulin electrophoresis This test is performed to look at
1.1 – 2.5 g/L globulin proteins in the blood.
Identifying the types of globulins
can help diagnose certain
disorders.Certain diseases are
associated with overproduction of
ASPARTATE AST is normally found in red blood
AMINOTRANSFERASE 3-45 units/L cells, liver, heart, muscle tissue,
(SGOT); Serum glutamic- (units per liter). pancreas, and kidneys. AST
oxaloacetic transaminase formerly was called serum glutamic
oxaloacetic transaminase (SGOT).
An aspartate aminotransferase (AST)
test is done for liver damage, liver
disease and the success of an
operation on the liver.
SERUM GLUTAMATE This test measures the amount of an
PYRUVATE TRANSAMINASE 8 – 35 U/L enzyme called glutamate pyruvate
(SGPT); Alanine transaminase transaminase (GPT) in your blood.
This enzyme is found in many body
tissues in small amounts, but it is
very concentrated in the liver. It is
released into the blood when cells
that contain it are damaged. This
enzyme is also called alanine
transaminase, or ALT.
Bilirubin Direct A bilirubin test is a diagnostic blood
bilirubin: 0 test performed to measure levels of
to 0.3 bile pigment in an individual's blood
mg/dL serum and to help evaluate liver
0.3 to 1.9
Alkaline Phosphatase Direct An alkaline phosphatase (ALP) test
bilirubin: 0 measures the amount of the enzyme
to 0.3 ALP in the blood. ALP is made
mg/dL mostly in the liver and in bone with
Total some made in the intestines and
0.3 to 1.9
IV. FLOW OF SPECIMEN
A. Issuing of Laboratory Request (In-Patients)
1. Doctors requesting for laboratory tests send the list of in-patients with the
corresponding type of tests to be performed to the laboratory a day before the
actual testing. The in-patients are then informed of the necessary preparations
prior to testing, i.e. fasting.
2. The following day, the medical technologists would take their rounds and
commence extraction from 6AM to 8AM.
3. The extracted specimens are then placed in containers labelled with the
patient’s name, specimen type, date and time of extraction and name of test
4. The collected specimens are then brought to the laboratory for immediate
B. Issuing of Laboratory Request (Out-Patients)
1. Walk-in patients are required to present a valid referral from a doctor
requesting a specific test.
2. The patient then proceeds to the information desk for processing of the
3. The patient is then directed to the waiting area until a nurse calls for his/her
4. The patient proceeds to the extraction area and a medical technologist
performs the extraction.
A. In-patients and Out-patients
1. After the medical technologist has gone through the list of patients
requesting for laboratory tests, the extracted samples are then grouped by batch
according to the type of test.
2. The first batch of samples is then placed on a centrifuge to allow separation
of blood components.
3. After all the batches have gone through the centrifuge; the specific tests
needed to be performed on a certain batch of samples are commenced.
4. The testing is repeated three times to ensure that the result obtained is
accurate and precise.
5. After performing the needed tests, the results are then jotted down on a
laboratory result sheet and kept in a file cabinet with another copy to be released
to the patient.
6. The resident pathologist then double-checks the results.
1. The laboratory result sheet with affixed signatures of the medical technologist
that performed the test and the pathologist that affirmed the result is then sent
to a station where the doctor would pick-up the result.
2. The doctor then interprets the results to the patient.
1. The laboratory result sheet with affixed signatures of the medical technologist
that performed the test and the pathologist that affirmed the result is then sent to
the station where the customer would pick-up the result in a given time.
V. QUALITY ASSURANCE AND QUALITY CONTROL
Bulacan Medical Mission Group Hospital
Chemistry control, according to CHEMplus diagnostics, (Texas U.S.A.) is used for
monitoring the accuracy and precision of clinical chemistry procedures. Since the quality
control material is made out of human serum, (and other constituents) it is handled as if it is
potentially infectious. “Each donor unit used was tested by Fda-approved methods and found
non reactive for hepatitis B surface antigen (HbsAg), Hepatitis C (HCV), and HIV1 and
HIV2…” – CHEMplus diagnostics, (Texas U.S.A.)
In terms of storage of the specimen, the medical technologist tightly seals the vials after
reconstitution and use to prevent evaporation. Vials are also stored upright to prevent leakage;
these are also 19labelled according to name and expiry date. Specimens are also stored in
incubators or refrigerators; depending on the required temperature. Some are required to be
stored in the absence of light.
Quality control materials are used according to the directions accompanying the
instrument used. It is treated in the same manner as patient samples.
CHEMplus diagnostics, (Texas U.S.A.)
1. Remove screw cap and gently remove the rubber stopper from the vial.
2. Pipette exactly 5.0 ml of distilled or deionized water to the vial using a volumetric
3. Replace the stopper in the vial; allow the vial to sit for 10 minutes.
4. Gently invert the vial three times and swirl until contents are homogeneous.
5. Record the results according to your quality assurance program.
As for the results, refer to the Expected Values table supplied for assay mean and
ranges. Make sure that the vial’s lot number is the same as the lot number written on the table
of expected values.
ALWAYS make sure that the specimen as well as the instruments are clean, well calibrated,
and is handled with care. (Dispose it properly.)
In Bulacan Medical Mission Group Hospital, the samples are tested at least three times before
the resident pathologist checks it, and then releases the result to be interpreted by the physician.
VI. UPDATES, AUTOMATIONS AND TECHNOLOGIES
A. Machines Used by the Bulacan Medical Mission Group Hospital
Figure 6.1 Spectronic 20
The Spectronic 20 is a spectrophotometer. A spectrophotometer measures the intensity
of a light beam before and after it passes through a sample and compares these two intensities.
The Spec 20 reports two types of measurements: percent transmittance and absorbance. Percent
transmittance is the ratio of the intensity of the light passing through the sample to the intensity
of the light shining on the sample multiplied by 100%. Absorbance is the log of the
transmittance. The Spec 20 can measure absorbance and transmittance over a range of
wavelengths. You must select a wavelength and calibrate the instrument at that wavelength
before making any measurements.
The Spectronic 20 is a spectrophotometer developed by Bausch & Lomb in 1954. While
of simple design, requiring manual setting of the wavelength and making readings from a
moving-needle analogue display, the unit is rugged, accurate, and easy to use. This venerable
instrument is still in production, and used in chemistry laboratories in both commercial and
educational settings around the world.
Figure 6.2 Centrifuge
A laboratory centrifuge is a piece of laboratory equipment, driven by a motor, which
spins liquid samples at high speed. There are two main sizes for laboratory centrifuges. The
larger ones are known simply as centrifuges; samples are contained in centrifuge tubes or
centrifuge tips. The smaller centrifuges are known as microcentrifuges or microfuges, and
microcentrifuge tubes or microfuge tubes are used with them. Like all other centrifuges,
laboratory centrifuges work by the sedimentation principle, where the centripetal acceleration is
used to separate substances of greater and lesser density
Beckman Coulter Microfuge 22R
Figure 6.3 Beckman Coulter Microfuge 22R
Provides life science researchers with optimized pelleting of DNA, RNA, and protein on
the bench top. A brushless induction drive offers maintenance-free and quiet operation.
Standard 24-place fixed angle rotor holds 1.5–2.0mL tubes and features an integral O-ring for
safety. Digital display shows set and actual run conditions in time, rpm/rcf, and temperature.
Operations in timed, hold, or pulse (short run) can be selected. All interchangeable rotors come
standard with aerosol-tight lids, minimizing contamination from broken or leaking tubes.
1. Stat Fax® 2600 Plate Washer
Figure 6.4 Plate Washer
The Stat Fax® 2600 Plate Washer washes flat, round and v-bottom plates and strips. It has
large, non-volatile memory for up to 50 user entered wash protocols. It is a sophisticated
machine with six factory programmed wash or rinse modes. It is also fully-automated with a
programmable rinse cycle. One very notable feature of this machine is that it operates with
monitoring of pressure and vacuum with an aerosol shield.
2. Stat Fax® 3200 Plate Reader
Figure 6.5 Plate Reader
The Stat Fax® 3200 Plate Reader offers fully automatic reading with bichromatic optics.
It also offers on board data reduction calculations including regressions, curve fitting and cut-
off absorbance calculations with step-by-step user prompting.
Figure 6.6 Easylyte
The EasyLyte Na/K, EasyLyte PLUS Na/K/Cl, EasyLyte Lithium Na/K/Li, EasyLyte
Na/K/Cl/Li and EasyLyte Calcium Na/K/Ca/pH analyzers are completely automated,
microprocessor controlled electrolyte systems that use current ISE (Ion Selective Electrode)
technology to make electrolyte measurements. The EasyLyte product line measures various
combinations of sodium, potassium, chloride, lithium, calcium and pH in whole blood, serum,
plasma, or urine.
* New Equipments for Clinical Chemistry
Starlyte™ V ISE Analyzer
Figure 6.7 Starlyte ISE Analyzer
The High Efficiency ISE Analyzer that permits your laboratory to perform Accurate,
Reliable Determinations of Na+, K+, Cl-, Ca2+ and Li+ The Starlyte V Electrolyte Analyzer is
a powerful tool designed to quickly, accurately and efficiently conduct basic electrolyte testing
without requiring any additional resources. It measures Sodium, Potassium, Chloride, Calcium
and Lithium, using Ion Selective Electrodes (ISE) and is CE marked. This machine is highly
productive with result operations in fifty seconds. It includes reagent packs, electrodes and parts
that snap in and out for easy replacement.
PLD 951 Photometer
Figure 6.8 Photometer
The PLD 951 is compact unit for a wide range of measurements, combining
comprehensive data management with simplicity of use and low cost operation. It includes a
low volume flow-through cuvette for minimal reagent use and high stability of temperature,
peristaltic pump with stepper control, and peltier control of temperature and serial RS-232
ACE ® Clinical Chemistry System
Figure 6.9 Clinical Chemistry System
With its expanded test menu, the ACE clinical chemistry system is the comprehensive
solution to the chemistry diagnostic needs in today's healthcare settings. The ACE system offers
the capabilities of a large floor model analyzer in a compact bench top footprint. The low cost
per test and flexibility of single and panel testing makes the ACE system an ideal fit in a variety
of clinical settings. The ACE system can process up to 165 photometric tests per hour and up to
120 potentiometric (ISE) tests per hour. The ACE system gives you the option of using sample
cups or the patented STEP™ module. The STEP (Sample Tube Entry Port) module allows
closed tube sampling from primary blood tubes, minimizing the risk of bio hazardous exposure.