Clinical Chemistry, Immunology and Laboratory Quality Control

Clinical Chemistry, Immunology and Laboratory Quality Control

A Comprehensive Review for Board Preparation, Certification and Clinical Practice

1st Edition - December 2, 2013

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  • Authors: Amitava Dasgupta, Amer Wahed
  • Hardcover ISBN: 9780124078215
  • eBook ISBN: 9780124079359

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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

  • Dedication


    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



    Color Plates

Product details

  • No. of pages: 504
  • Language: English
  • Copyright: © Elsevier 2014
  • Published: December 2, 2013
  • Imprint: Elsevier
  • Hardcover ISBN: 9780124078215
  • eBook ISBN: 9780124079359

About the Authors

Amitava Dasgupta

Amitava Dasgupta
Dr. Amitava Dasgupta received his Ph.D degree in Chemistry from Stanford University and received his medical training in Toxicology and Clinical Chemistry from the Laboratory Medicine Department of the University of Washington School Of Medicine at Seattle. He is board certified in both Toxicology and Clinical Chemistry by the American Board of Clinical Chemistry. 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. He is also the Director of Clinical Chemistry and Toxicology Laboratory of Memorial-Hermann Laboratory Services, the major clinical teaching hospital of the University of Texas. In addition, he is also the Medical Director of Memorial-TIRR Hospital laboratory services. Dr. Dasgupta has published over 235 scientific papers and edited, co-edited, authored or co-authored 20 books including books published by Elsevier. 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. He lectures both nationally and internationally on drug and alcohol testing and acts as an expert witness for the State of Texas for alcohol and drug related criminal prosecutions.

Affiliations and Expertise

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

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