Clinical Chemistry, Immunology and Laboratory Quality Control - 1st Edition - ISBN: 9780124078215, 9780124079359

Clinical Chemistry, Immunology and Laboratory Quality Control

1st Edition

A Comprehensive Review for Board Preparation, Certification and Clinical Practice

Authors: Amitava Dasgupta Amer Wahed
eBook ISBN: 9780124079359
Hardcover ISBN: 9780124078215
Imprint: Elsevier
Published Date: 15th January 2014
Page Count: 504
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All pathology residents must have a good command of clinical chemistry, toxicology, immunology, and laboratory statistics to be successful pathologists, as well as to pass the American Board of Pathology examination. Clinical chemistry, however, is a topic in which many senior medical students and pathology residents face challenges. Clinical Chemistry, Immunology and Laboratory Quality Control meets this challenge head on with a clear and easy-to-read presentation of core topics and detailed case studies that illustrate the application of clinical chemistry knowledge to everyday patient care.

This basic primer offers practical examples of how things function in the pathology clinic as well as useful lists, sample questions, and a bullet-point format ideal for quick pre-Board review. While larger textbooks in clinical chemistry provide highly detailed information regarding instrumentation and statistics, this may be too much information for students, residents, and clinicians. This book is designed to educate senior medical students, residents, and fellows, and to "refresh" the knowledge base of practicing clinicians on how tests are performed in their laboratories (i.e., method principles, interferences, and limitations).

Key Features

  • Takes a practical and easy-to-read approach to understanding clinical chemistry and toxicology
  • Covers all important clinical information found in larger textbooks in a more succinct and easy-to-understand manner
  • Covers essential concepts in instrumentation and statistics in such a way that fellows and clinicians understand the methods without having to become specialists in the field
  • Includes chapters on drug-herb interaction and pharmacogenomics, topics not covered by textbooks in the field of clinical chemistry or laboratory medicine


Residents and fellows in pathology and clinical chemistry, practicing pathologists and clinical chemists

Table of Contents



Chapter 1. Instrumentation and Analytical Methods

1.1 Introduction

1.2 Spectrophotometry and Related Techniques

1.3 Atomic Absorption

1.4 Enzymatic Assays

1.5 Immunoassays

1.6 Nephelometry and Turbidimetry

1.7 Chemical Sensors

1.8 Basic Principles of Chromatographic Analysis

1.9 Mass Spectrometry Coupled with Chromatography

1.10 Examples of the Application of Chromatographic Techniques in Clinical Toxicology Laboratories

1.11 Automation in the Clinical Laboratory

1.12 Electrophoresis (including Capillary Electrophoresis)


Chapter 2. Immunoassay Platform and Designs

2.1 Application of Immunoassays for Various Analytes

2.2 Immunoassay Design and Principle

2.3 Various Commercially Available Immunoassays

2.4 Heterogenous Immunoassays

2.5 Calibration of Immunoassays

2.6 Various Sources of Interference in Immunoassays

2.7 Interferences from Bilirubin, Hemolysis, and High Lipid Content

2.8 Interferences from Endogenous and Exogenous Components

2.9 Interferences of Heterophilic Antibodies in Immunoassays

2.10 Interferences from Autoantibodies and Macro-Analytes

2.11 Prozone (or “Hook”) Effect


Chapter 3. Pre-Analytical Variables

3.1 Laboratory Errors in Pre-Analytical, Analytical, and Post-Analytical Stages

3.2 Order of Draw of Blood Collection Tubes

3.3 Errors with Patient Preparation

3.4 Errors with Patient Identification and Related Errors

3.5 Error of Collecting Blood in Wrong Tubes: Effect of Anticoagulants

3.6 Issues with Urine Specimen Collection

3.7 Issues with Specimen Processing and Transportation

3.8 Special Issues: Blood Gas and Ionized Calcium Analysis


Chapter 4. Laboratory Statistics and Quality Control

4.1 Mean, Standard Deviation, and Coefficient of Variation

4.2 Precision and Accuracy

4.3 Gaussian Distribution and Reference Range

4.4 Sensitivity, Specificity, and Predictive Value

4.5 Random and Systematic Errors in Measurements

4.6 Laboratory Quality Control: Internal and External

4.7 Levey–Jennings Chart and Westgard Rules

4.8 Delta Checks

4.9 Method Validation/Evaluation of a New Method

4.10 How to Interpret the Regression Equation?

4.11 Bland–Altman Plot

4.12 Receiver–Operator Curve

4.13 What is Six Sigma?

4.14 Errors Associated with Reference Range

4.15 Basic Statistical Analysis: Student t-Test and Related Tests


Chapter 5. Water, Homeostasis, Electrolytes, and Acid–Base Balance

5.1 Distribution of Water and Electrolytes in the Human Body

5.2 Plasma and Urine Osmolality

5.3 Hormones Involved in Water and Electrolyte Balance

5.4 Renin–Angiotensin–Aldosterone System

5.5 Diabetes Insipidus

5.6 The Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

5.7 Hyponatremia, Sick Cell Syndrome, and Hypernatremia

5.8 Hypokalemia and Hyperkalemia

5.9 Introduction to Acid–Base Balance

5.10 Diagnostic Approach to Acid–Base Disturbance

5.11 Short Cases: Acid–Base Disturbances


Chapter 6. Lipid Metabolism and Disorders

6.1 Lipids and Lipoproteins

6.2 Classes of Lipoproteins

6.3 Lipid Metabolism

6.4 Low Density Lipoprotein Metabolism

6.5 High Density Lipoprotein Metabolism

6.6 Lipid Profile and Risk of Cardiovascular Disease

6.7 Various Types of Hyperlipidemia

6.8 Various Types of Hypolipidemia

6.9 Newer Lipid Parameters and Other Factors Related to Risk for Cardiovascular Disease

6.10 Laboratory Measurements of Various Lipids

6.11 Drugs for Treating Lipid Disorders


Chapter 7. Carbohydrate Metabolism, Diabetes, and Hypoglycemia

7.1 Carbohydrates: An Introduction

7.2 Regulation of Blood Glucose Concentration

7.3 Diabetes Mellitus: Basic Concepts

7.4 Monogenic Diabetes Mellitus

7.5 Type 1 Diabetes Mellitus

7.6 Type 2 Diabetes Mellitus

7.7 Metabolic Syndrome or Syndrome X

7.8 Complications of Diabetes

7.9 Secondary Causes of Diabetes Mellitus

7.10 Diagnostic Criteria for Diabetes

7.11 Hypoglycemia

7.12 Laboratory Methods

7.13 Glucose Meters


Chapter 8. Cardiac Markers

8.1 Myocardial Infarction

8.2 Overview of Cardiac Markers

8.3 Myoglobin

8.4 Creatine Kinase Isoenzyme: CK-MB

8.5 Troponin I and Troponin T

8.6 High-Sensitive Cardiac Troponin Assays

8.7 Less Commonly Used Cardiac Markers

8.8 B-Type Natriuretic Peptides (BNP)

8.9 C-Reactive Protein

8.10 Myeloperoxidase


Chapter 9. Endocrinology

9.1 Introduction to Various Endocrine Glands

9.2 Hypothalamus

9.3 Pituitary Gland

9.4 Thyroid Gland

9.5 Thyroid Function Tests

9.6 Hypothyroidism

9.7 Hyperthyroidism

9.8 Disorders of Parathyroid Glands

9.9 Adrenal Glands

9.10 Cushing’s Syndrome

9.11 Conn’s Syndrome

9.12 Hypoadrenalism Including Addison’s Disease

9.13 Dysfunctions of Gonads

9.14 Pancreatic Endocrine Disorders

9.15 Multiple Endocrine Neoplasias

9.16 Endocrine Testings: Suppression and Stimulation Tests


Chapter 10. Liver Diseases and Liver Function Tests

10.1 Liver Physiology

10.2 Liver Function Tests and Interpretations

10.3 Jaundice: An Introduction

10.4 Congenital Hyperbilirubinemia

10.5 Hemolytic (Prehepatic) Jaundice

10.6 Hepatocellular Jaundice

10.7 Chronic Liver Disease

10.8 Cholestatic Jaundice

10.9 Alcohol- and Drug-Induced Liver Disease

10.10 Liver Disease in Pregnancy

10.11 Liver Disease in Neonates and Children

10.12 Macro Liver Enzymes

10.13 Laboratory Measurement of Bilirubin and Other Tests


Chapter 11. Renal Function Tests

11.1 Basic Functions of Kidneys

11.2 Glomerular Filtration Rate

11.3 Creatinine Clearances

11.4 Chronic Kidney Disease

11.5 Cystatin C

11.6 Urea (Blood Urea Nitrogen) and Uric Acid

11.7 Protein in Urine and Proteinuria

11.8 Other Renal Diseases

11.9 Laboratory Measurements of Creatinine and Related Tests

11.10 Urine Dipstick Analysis


Chapter 12. Inborn Errors of Metabolism

12.1 Overview of Inborn Errors of Metabolism

12.2 Amino Acid Disorders

12.3 Carbohydrate Metabolism Disorders

12.4 Urea Cycle Disorders

12.5 Organic Acid Disorders (Organic Aciduria)

12.6 Fatty Acid Oxidation Disorders

12.7 Mitochondrial Disorders

12.8 Peroxisomal Disorders

12.9 Lysosomal Storage Disorders

12.10 Purine or Pyrimidine Metabolic Disorders

12.11 Disorders of Porphyrin Metabolism

12.12 Newborn Screening and Evaluation


Chapter 13. Tumor Markers

13.1 Introduction to Tumor Markers

13.2 Clinical Uses of Tumor Markers and Common Tumor Markers

13.3 Prostate-Specific Antigen (PSA)

13.4 False Positive and Unexpected PSA Results

13.5 Cancer Antigen 125 (Carbohydrate Antigen 125: CA-125)

13.6 False Positive CA-125

13.7 Alpha-Fetal Protein

13.8 False Positive AFP

13.9 Carcinoembryonic Antigen (CEA)

13.10 False Positive CEA

13.11 Cancer Antigen-19-9

13.12 β2-Microglobulin

13.13 Human Chorionic Gonadotropin (hCG)

13.14 Causes and Evaluation of Persistent Low Levels of hCG

13.15 False Positive hCG


Chapter 14. Therapeutic Drug Monitoring

14.1 What is Therapeutic Drug Monitoring?

14.2 Drugs That Require Therapeutic Drug Monitoring

14.3 Free Versus Total Drug Monitoring

14.4 Therapeutic Drug Monitoring Benefits

14.5 Basic Pharmacokinetics

14.6 Effect of Gender and Pregnancy on Drug Metabolism and Disposition

14.7 Effect of Age on Drug Metabolism and Disposition

14.8 Drug Metabolism and Disposition in Uremia

14.9 Drug Metabolism and Disposition in Liver Disease

14.10 Effect of Cardiovascular Disease on Drug Metabolism and Disposition

14.11 Thyroid Dysfunction and Drug Metabolism

14.12 Effect of Food, Alcohol Consumption, and Smoking on Drug Disposition

14.13 Monitoring of Various Drug Classes: General Considerations

14.14 Monitoring of Anticonvulsants

14.15 Monitoring of Cardioactive Drugs

14.16 Monitoring of Anti-Asthmatic Drugs

14.17 Monitoring of Antidepressants

14.18 Monitoring of Immunosuppressants

14.19 Monitoring of Selected Antibiotics

14.20 Monitoring of Antineoplastic Drugs

14.21 Monitoring of Antiretrovirals


Chapter 15. Interferences in Therapeutic Drug Monitoring

15.1 Methodologies Used in Therapeutic Drug Monitoring and Issues of Interferences

15.2 Effect of Endogenous Factors on Therapeutic Drug Monitoring

15.3 Effect of Collecting Specimen in Gel-Separator Tube on Therapeutic Drug Monitoring Results

15.4 Digoxin Immunoassays: So Much Interference

15.5 Interferences in Analysis of Antiepileptics

15.6 Interferences in Analysis of Tricyclic Antidepressants

15.7 Interferences in Analysis of Immunosuppressants

15.8 Interferences in Analysis of Antibiotics


Chapter 16. Drugs of Abuse Testing

16.1 Commonly Abused Drugs in the United States

16.2 Medical vs. Workplace Drug Testing

16.3 SAMHSA vs. Non-SAMHSA Drugs

16.4 Detection Window of Various Drugs in Urine

16.5 Metabolism of Abused Drugs/Target of Immunoassay Antibodies

16.6 Immunoassays vs. GC/MS Cut-Off Concentrations

16.7 False Positive Immunoassay Test Results with Various Abused Drugs

16.8 False Negative Test Results

16.9 Derivatization in GC/MS Confirmation Testing

16.10 Analytical True Positive Due to Use of Prescription Drugs and Other Factors

16.11 Issues of Adulterated Urine Specimens in Workplace Drug Testing

16.12 Miscellaneous Issues in Drugs of Abuse Testing


Chapter 17. Challenges in Drugs of Abuse Testing: Magic Mushrooms, Peyote Cactus, and Designer Drugs

17.1 Negative Toxicology Report

17.2 Magic Mushroom Abuse

17.3 Peyote Cactus Abuse

17.4 Rave Party Drugs and Date Rape Drugs (Including Designer Drugs)

17.5 Abuse of Amphetamine-Like Designer Drugs (Including Bath Salts)

17.6 Abuse of Synthetic Marijuana (Spice and K2)

17.7 Designer Drugs that are Opioid Analogs


Chapter 18. Testing for Ethyl Alcohol (Alcohol) and Other Volatiles

18.1 Alcohol Use and Abuse

18.2 Health Benefits of Moderate Drinking

18.3 Health Hazards of Heavy Drinking

18.4 Metabolism of Ethyl Alcohol: Effect of Gender and Genetic Factors

18.5 Relation between Whole Blood Alcohol and Serum Alcohol and Legal Limit of Driving

18.6 Analysis of Alcohol in Body Fluids: Limitations and Pitfalls

18.7 Biomarkers of Alcohol Abuse

18.8 Methanol Abuse

18.9 Abuse of Ethylene Glycol and Other Alcohols


Chapter 19. Common Poisonings Including Heavy Metal Poisoning

19.1 Poisoning from Analgesics

19.2 Methyl Salicylate Poisoning

19.3 Carbon Monoxide Poisoning

19.4 Cyanide Poisoning

19.5 Overdose with Tricyclic Antidepressants

19.6 Benzodiazepine and Opiate Overdose

19.7 Alcohol Poisoning

19.8 Poisoning from Organophosphorus and Carbamate Insecticides

19.9 Lead Poisoning

19.10 Mercury Poisoning

19.11 Arsenic Poisoning

19.12 Poisoning from Other Metals/SOURCES


Chapter 20. Pharmacogenomics

20.1 Introduction to Pharmacogenomics

20.2 Polymorphism of Enzymes Responsible for Drug Metabolism

20.3 Polymorphism of Transporter Proteins and Receptors

20.4 Pharmacogenomics and Warfarin Therapy

20.5 Pharmacogenomics of Selected Anticancer Drugs

20.6 Pharmacogenomics of Selected Opioid Drugs

20.7 Pharmacogenomics of Selected Psychoactive Drugs

20.8 Pharmacogenomics of Miscellaneous Other Drugs

20.9 Methods for Pharmacogenomics Testing


Chapter 21. Hemoglobinopathy

21.1 Hemoglobin Structure and Synthesis

21.2 Introduction to Hemoglobinopathies

21.3 Alpha-Thalassemia

21.4 Beta-Thalassemia

21.5 Delta-Thalassemia

21.6 Sickle Cell Disease

21.7 Hereditary Persistence of Fetal Hemoglobin

21.8 Other Hemoglobin Variants

21.9 Laboratory Investigation of Hemoglobin Disorders

21.10 Diagnostic Tips for Thalassemia, Sickle Cell Disease, and Other Hemoglobinopathies

21.11 Apparent Hemoglobinopathy After Blood Transfusion


Chapter 22. Protein Electrophoresis and Immunofixation

22.1 Monoclonal Gammopathy

22.2 Serum Protein Electrophoresis

22.3 Urine Electrophoresis

22.4 Immunofixation Studies

22.5 Capillary Zone Electrophoresis

22.6 Free Light Chain Assay

22.7 Paraprotein Interferences in Clinical Laboratory Tests

22.8 Cerebrospinal Fluid Electrophoresis


Chapter 23. Human Immunodeficiency Virus (HIV) and Hepatitis Testing

23.1 Human Immunodeficiency Virus (HIV) Testing

23.2 Window Period in HIV Infection

23.3 Standard HIV Testing

23.4 Rapid HIV Antibody Testing

23.5 Confirmatory HIV Test

23.6 HIV Viral Load Test and Related Assays

23.7 Introduction to Hepatitis Testing

23.8 Testing for Hepatitis B

23.9 Testing for Hepatitis C

23.10 Immunization and False Positive HIV and Hepatitis Testing

23.11 Testing for Epstein–Barr Virus (EBV)


Chapter 24. Autoimmunity, Complement, and Immunodeficiency

24.1 Introduction to the Immune System and Complement

24.2 Pathways of Complement Activation

24.3 Immunodeficiency

24.4 Major Histocompatibility Complex (MHC)

24.5 Human Leukocyte Antigen Testing

24.6 Transplant Rejection

24.7 Autoimmune Serology

24.8 Hypersensitivity Reaction-Mediated Diseases


Chapter 25. Effect of Herbal Supplements on Clinical Laboratory Test Results

25.1 Use of Herbal Remedies in the United States

25.2 How Herbal Remedies Affect Clinical Laboratory Test Results

25.3 Liver Damage as Reflected by Abnormal Liver Function Test After Using Certain Herbals

25.4 Kidney Damage and Herbal Supplements

25.5 Kelp and Thyroid Function

25.6 Miscellaneous Abnormal Test Results Due to Use of Certain Herbals

25.7 Drug–Herb Interactions Involving St. John’s Wort and Warfarin–Herb Interactions

25.8 Herbs Adulterated with Western Drugs and Contaminated with Heavy Metals



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About the Author

Amitava Dasgupta

Amitava Dasgupta received his PhD degree in Chemistry from Stanford University and his fellowship training in Clinical Chemistry from the Laboratory Medicine Department of the University of Washington School of Medicine at Seattle. He is a tenured Full Professor of Pathology and Laboratory Medicine at the University of Texas Health Sciences Center located at the Texas Medical Center at Houston. Dr. Dasgupta has published 210 scientific papers, written many invited review articles, and has edited, co-edited or written 15 books. He is on the Editorial Board of five major medical journals including American Journal of Clinical Pathology, Archives of Pathology and Laboratory Medicine, Therapeutic Drug Monitoring, Clinica Chimica Acta and Journal of Clinical Laboratory Analysis.

Affiliations and Expertise

Professor, Pathology and Laboratory Medicine, The University of Texas, McGovern Medical School, , Houston, TX, USA

Amer Wahed

Amer Wahed is a graduate of Medicine, training initially in Internal Medicine at Royal Postgraduate Medical School, London, England. He subsequently trained in Anatomic and Clinical Pathology from the University of Texas-Houston Medical School. After working for several years in a private setting, he joined the Department of Pathology and Laboratory Medicine at the University of Texas-Houston Health Sciences Center. Currently he is an Assistant Professor of Pathology and Laboratory Medicine and Associate Director of Clinical Chemistry and Immunology at Memorial-Hermann Hospital at the Texas Medical Center. He is also the Associate Director of the Pathology Residency Program at the University of Texas-Houston Medical School. Dr. Wahed has a strong interest in teaching and is actively involved in the education of medical students, graduate students, residents, and fellows. He has been recognized for his teaching contributions through awards from his department, as well as the Office of the Dean. He is also active in mentoring pathology residents in research and has published multiple papers in peer-reviewed journals.

Affiliations and Expertise

Associate Professor of Pathology and Laboratory Medicine, University of Texas, McGovern School of Medicine, Houston, TX, USA