Clinical Biochemistry

for a wide variety of substances—substrates, enzymes, hormones, etc—and their use in diagnosis
and monitoring of disease. Analysis of other body fluids (eg, urine, ascitic fluids, CSF) is also
included.Blood carries a history of its interactions with both physiologic and
disease processes. The balance of chemical reactions makes possible homeostasis,
the stable equilibrium that defines health. Blood tests can identify abnormal
processes that jeopardize homeostasis, from the specific imbalance among
electrolytes to the pH (acidity) of the blood that is the end-result of illness.

The Metabolic Profile: When speaking of clinical biochemistry, the starting point
is the metabolic profile, which tests an entire battery of physiologic functions
specific to different organs by measuring the amounts of individual products
from these organs.

Clinical biochemistry is a crucial test for appraising organ function.

Kidney Function

 Blood urea nitrogen (BUN): Is a waste product of protein metabolism, and

its excretion falls with kidney disease, raising its level in the blood. Bun is
also sensitive to dehydration.
 Creatinine: Is a waste product of muscle metabolism, which accumulates
when the kidneys fail to excrete it in kidney disease.
 BUN/creatinine ratio: Is the ratio used to quantify kidney function, an
elevated ratio > 20:1 indicating decrease its function.
 Calcium elevations: Indicate kidney dysfunction and predict those at risk
for kidney stones. Calcium can also be used to detect abnormal
parathyroid function.
 Sodium, potassium, and chloride: Are electrolytes whose balance is
maintained by normal kidney function. Elevations indicate kidney disease.
 Uric acid: Can show when there is a buildup of uric acid crystallization, a
prime contributor to gout.

Liver Function

 Albumin: Is a protein made by the liver and its level documents liver
function.
 Alkaline phosphatase (ALP): Alanine aminotransferase (ALT), and
Aspartate aminotransferase (AST) are biomarkers that become elevated
with liver disease.
  Total protein: Another product of the liver, consists mainly of the globulin
and albumin manufactured there. When low can indicate liver disease or
malnutrition.
 Bilirubin: rises with obstruction in the biliary tract or in primary liver
failure, such as cirrhosis. It is also elevated in neonatal jaundice, which
puts an infant at risk for brain damage.

Pancreas and Glucose Metabolism

 Glucose rises when insulin falls: As it does absolutely in Type 1 DM and

relatively in Type 2 DM. It is also a measure for how effectively the kidney
excretes excess glucose in the blood.
 Hemoglobin A1c: Is a type of hemoglobin molecule whose affinity for
glucose is used to advantage to get a long-term estimate of average
glycemic control or the lack thereof.

Clinical Biochemistry ALSO TRACK PROGRESS OF -

Diabetics that are at increased risk for cardiovascular disease, lipid abnormalities,
and kidney failure

Immunosuppression Doctor-caused immunosuppression, e.g.,

chemotherapy, can be quantitated to adjust dosages and the timing of
intravenous anti-cancer therapyRF (rheumatoid factor) and ANA (antinuclear
antibody), when positive, can make the difference in whether a person is
treated for age-related osteoarthritis or immunological rheumatoid arthritis.

Thyroid Disease When the thyroid function is low (hypothyroidism) or high

(hyperthyroidism), metabolism is severely affected. The brain’s pituitary gland
acts accordingly by either lowering thyroid stimulating hormone (TSH) or
making more. The TSH serves as a screen for thyroid dysfunction and its normal
value can indicate successful management with medication used to stabilize
thyroid function.

Test Panel:-
Total protein level increases due to dehydration, chronic inflammation, and paraproteinemia. It
decreases due to overhydration, severe congestive heart failure (with edema), protein-losing
nephropathy, protein-losing enteropathy, hemorrhage, burns, dietary protein deficiency,
malabsorption, and some viral conditions (especially in horses).

Albumin level increases due to dehydration. It decreases due to the same factors as total protein,
plus liver failure.
Urea level increases due to excess dietary protein, poor quality dietary protein, carbohydrate
deficiency, catabolic states, dehydration, congestive heart failure, renal failure, blocked urethra,
and ruptured bladder. It decreases due to low dietary protein, gross sepsis, anabolic hormonal
effects, liver failure, portosystemic shunts (congenital or acquired), and inborn errors of urea
cycle metabolism. Urea measurement is used especially to indicate renal disease and to a lesser
extent liver dysfunction.

Creatinine level increases due to renal dysfunction, blocked urethra, and ruptured bladder. It
decreases due to sample deterioration. Animals with a high muscle mass have high-normal
creatinine concentrations, whereas animals with a low muscle mass have low-normal creatinine
concentrations. Creatinine measurement is used especially for renal disease.

ALT is present in the cytoplasm and mitochondria of liver cells and, therefore, increases due to
hepatocellular damage. It has a half life of 2–4 hr and rises higher than AST but recovers quicker.
There are minor increases with muscle damage and hyperthyroidism.

ALP level increases due to increased bone deposition, liver damage, hyperthyroidism, biliary
tract disease, intestinal damage, hyperadrenocorticism, corticosteroid administration, barbiturate
administration, and generalized tissue damage (including neoplasia). The most common causes
for an increase is raised levels of circulating steroids and biliary disease. The half-life is 72 hr in
dogs but only 6 hr in cats. Levels in the cat are generally much lower than in the dog,
and any increase in cats is considered significant. In dogs, ALP levels in the thousands of units
are usually associated with increased steroid levels. ALP and ALT levels rarely rise above 1,000
units, even in severe liver disease.

GDH level increases in hepatocellular damage, particularly hepatic necrosis, in horses and
ruminants.

GGT increases in longer-term liver damage; it is particularly useful in horses and ruminants.

CK, the classic “muscle enzyme,” increases markedly in rhabdomyolysis and aortic
thromboembolism. Slight level increases are reported in hypothyroidism. Only a very small
amount of muscle damage such as bruising or IM injections can result in high serum CK levels. In
dogs and cats, unless investigating specific muscle disease, increased levels are generally of no
clinical significance.

AST level increases in both muscle and liver damage but is of less value than ALT. The half-life
is 5 hr in dogs and 77 min in cats. It is also reported to increase in hypothyroidism.
Chloride level increases in acidosis, and in parallel with increases in sodium concentration. It
decreases in alkalosis, vomiting (especially after eating), and in association with hyponatremia.

Total CO2 (bicarbonate) level increases in metabolic alkalosis and decreases in metabolic
acidosis. It is less useful to assess respiratory acid/base disturbances.

Calcium level increases due to dehydration (which is also associated with increased albumin),
primary hyperparathyroidism (neoplasia of parathyroid gland), primary
pseudohyperparathyroidism (neoplasms producing parathormone-related peptide [PRP], usually
perianal adenocarcinoma or some form of lymphosarcoma), bone invasion of malignant
neoplasms, thyrotoxicosis (uncommon), and overtreatment of parturient paresis. It decreases due
to hypoalbuminemia, parturient paresis, oxalate poisoning, chronic renal failure (secondary renal
hyperparathyroidism), acute pancreatitis (occasionally), surgical interference with parathyroid
glands, and idiopathic (autoimmune) hypoparathyroidism.

Phosphate level increases due to renal failure (secondary renal hyperparathyroidism). Decreases
are seen in some downer cows and as part of the stress pattern in horses and small animals.

Magnesium level increases are rarely seen, including during acute renal failure. It decreases in
ruminants due to dietary deficiency, either acute (grass staggers) or chronic, and diarrhea
(uncommon).

Glucose level increases due to high-carbohydrate meals, sprint exercise, stress or excitement
(including handling and sampling stress), glucocorticoid therapy, hyperadrenocorticism,
overinfusion with glucose/dextrose-containing IV fluids, and diabetes mellitus. It decreases due
to insulin overdose, insulinoma, islet cell hyperplasia (uncommon), acetonemia/pregnancy
toxemia, acute febrile illness, and idiopathically (in certain dog breeds).

Bilirubin level increases due to fasting (benign effect in horses and squirrel monkeys, may be
caused by hepatic lipidosis in cats), hemolytic disease (usually mild increase), liver dysfunction,
and biliary obstruction (intra- or extrahepatic). Theoretically, hemolysis is characterized by an
increase in unconjugated (indirect) bilirubin, whereas hepatic and post-hepatic disorders are
characterized by an increase in conjugated (direct) bilirubin; however, in practice this
differentiation is unsatisfactory. Better appreciation of the source of the jaundice is gained from
bile acid measurements.

Cholesterol level increases due to fatty meals, hepatic or biliary disease, protein-losing
nephropathy (and other protein-losing syndromes to some extent), diabetes mellitus,
hyperadrenocorticism, and hypothyroidism. It decreases in some cases of severe liver dysfunction
and occasionally in hyperthyroidism.
Vitamin B12 deficiency frequently causes macrocytic anemia, glossitis, peripheral
neuropathy, weakness, hyperreflexia, ataxia, loss of proprioception, poor coordination,
and affective behavioral changes. These manifestations may occur in any
combination; many patients have the neurologic defects without macrocytic anemia.

Vitamin D is first converted into 25-hydroxyvitamin d by the liver. It circulates in the blood.
Simple blood test of 25 hydroxyvitamin d helps to monitor how much vitamin D is present in
body. 25-hydroxyvitamin d test is considered as most accurate marker to know vitamin D
status in your body. Deficiency of 25 hydroxyvitamin d in is an indicator of bone problems
such as osteoporosis and rickets.

Triglycerides are lipids (waxy fats) that give your body energy. Your body
makes triglycerides and also gets it from the foods you eat. High triglycerides
combined with high cholesterol raise your risk of heart attack, strokes and
pancreatitis. Diet and lifestyle changes can keep triglyceride levels in a healthy
range.

Alkaline phosphatase is one kind enzyme found in your body. Enzymes are
proteins that help chemical reactions happen. For instance, they can break big
molecules down into smaller parts, or they can help smaller molecules join
together to form bigger structures.

If your free T3 and T4 levels are low, you might experience:- Hair
loss, Weight gain, Tiredness Anxiety, Weight loss, Difficulty sleeping

A gamma-glutamyl transferase (GGT) test measures the amount of GGT in the

blood. GGT is an enzyme found throughout the body, but it is mostly found in the liver.
When the liver is damaged, GGT may leak into the bloodstream. High levels of GGT
in the blood may be a sign of liver disease or damage to the bile ducts. Bile ducts are
tubes that carry bile in and out of the liver. Bile is a fluid made by the liver. It is
important for digestion
What are immunology and serology?

Immunology is the study of the body's immune system and its

functions and disorders. Serology is the study of blood serum (the
clear fluid that separates when blood clots).

Immunology and serology laboratories focus on the following:

Identifying antibodies. These are proteins made by a type of

white blood cell in response to a foreign substance (antigen) in
the body.

Investigating problems with the immune system. These

include when the body's immune system attacks its own tissues
(autoimmune diseases) and when a body's immune system is
underactive (immunodeficiency disorders).

Determining organ, tissue, and fluid compatibility for

transplantation

Common immunology and serology tests

Phlebotomy is the process of making a puncture in a vein, usually in the arm,
with a cannula for the purpose of drawing blood. The procedure itself is known
as a venipuncture, which is also used for intravenous therapy. A person who
performs a phlebotomy is called a phlebotomist, although most doctors, nurses,
and other technicians can also carry out a phlebotomy. In
contrast, phlebectomy is the removal of a vein.

Phlebotomies are carried out by phlebotomists – people trained to draw blood

mostly from veins for clinical or medical testing, transfusions, donations, or
research. Blood is collected primarily by performing venipunctures, or by
using fingersticks or a heel stick in infants for the collection of minute
quantities of blood.The duties of a phlebotomist may include interpreting the
tests requested, drawing blood into the correct tubes with the proper additives,
accurately explaining the procedure to the person and preparing them
accordingly, practicing the required forms of asepsis, practicing standard
and universal precautions, restoring hemostasis of the puncture site, giving
instructions on post-puncture care, affixing tubes with electronically printed
labels, and delivering specimens to a laboratory. [4] Some countries, states, or
districts require that phlebotomists be licensed or registered.

A therapeutic phlebotomy may also be carried out in the treatment of some

blood disorders such as chronic hives.

Common diagnostic tests used in

immunological/serology testing -
 Alere HIV Combo - Rapid Test

 ELISA tests

 Lymphocyte Proliferation Test

 PCR test

 Mantoux test

 Viral Load Assays

 Flow Cytometry

 Hepatitis B Surface Antigen

 Rapid HIV Test

 Ouchterlony test

 CD4 Count