Clin Lab Method C4 Chem - Odp

4.
BASIC CLINICAL CHEMISTERY

TESTS
1
Learning Objectives
At the end of this course, students will able be to:
• List major lab tests used to examine liver function
• Know what laboratory methods used for measurements of the
different metabolic products
• Explain which laboratory tests used to assess renal function
• Interpret what abnormal results mean
• Understand the function and disorders of carbohydrate
• How diabetic Miletus is diagnosed in the laboratory
• Define what plasma protein is and
• Explain the clinical significance of each plasma protein
• differentiate the different type of body fluids and
• Tell major lab tests for body fluids and their interpretation
2
Outlines
4.1. Liver Function Tests
4.1.1. Physiologic Function Of Liver
4.1.2. Laboratory Diagnosis Of Liver Function
4.1.3. Clinical Condition Of Liver Function Test
4.2. Renal Function test
4.2.1. Overview of Renal function
4.2.2. Laboratory Diagnosis of Renal Function
4.2.3. Clinical Significance of Individual Tests
4.3. Carbohydrate Metabolism Disorders
4.3.1. Function of Carbohydrate
4.3.2. Type of Carbohydrate Disorders
4.3.3. Diagnosis of Diabetic Miletus
4.4. Plasma Protein
4.4.1. Overview of Plasma Protein
4.4.2. Plasma Proteins of Clinical Significant
4.5. Body Fluid Analysis
4.5.1. Type of Body Fluids
4.5.2. Laboratory Diagnosis of Body Fluids (CSF)
3
4.1. Liver Function Test
• The liver is a large bi-lobed

complex organ receiving a large Right lobe Left lobe
amount of blood and nutrients
from the gastrointestinal system;
• It converts nutrients from the diet
into usable or storage form.
• The lobules are the functional
units of the liver.
• Each lobule is traversed by a bile
duct, a branch of the portal vein,
and the hepatic artery, collectively
called the portal triad.
Gall bladder Bile duct
Pancreas 4
Liver Function Test cont’d…
Physiological Functions of the Liver
 Carbohydrate metabolism
 Protein metabolism
 Lipid metabolism
 Conjugation, detoxification and excretion
 Vitamin storage
 Digestion and formation of bile
 Enzymes
 Bilirubin metabolism
• The liver filters and processes blood as it circulates through the
body. It metabolises nutrients, detoxifies harmful substances,
makes blood clotting proteins and performs many other vital
functions.
Excretory Functions
• Bile, Bilirubin esters, Bile Acid (salt or conjugates), Cholesterol, Excreted waste
products 5
BILIRUBIN
• Bilirubin is formed from the lysis of red cells (haem component) in
the RE Sytem.
• Unconjugated bilirubin is transported to the liver loosely bound to
albumin, is water insoluble and therefore cannot be excreted in urine.
• Within the liver it is conjugated to bilirubin glucoronide and
subsequently secreted into bile and the gut respectively.
• Intestinal flora breaks it down into urobilinogen, some of which is
reabsorbed and either excreted via the kidney into urine or excreted
by the liver into the GIT.
• Conjugated bilirubin is water soluble and appears in urine.
• The remainder is excreted in the stool as Urobilin giving stool its
brown colour.
6
Metabolism of Bilirubin
7
Clinical Correlations
**Urobilinogen = UBG; *Total Bili = (conjugated + unconjugated)
Jaundice Clinical Serum Serum Urine Urine

Type Condition Conjugated Total Bilirubin (UBG)**
Bilirubin Bilirubin *
None Normal Normal level Normal Neg Normal
level <1 mg/dL
Pre-hepatic Hemolytic Normal or Increase Neg Increase
anemia Sl Increase
Hepatic Hepatitis Increase Increase Positive Normal or
increase
Post-hepatic Obstruct-ion Increase Increase Positive Normal or
of bile duct none.
8
Laboratory Tests for Liver Function
 Test Type includes:
• Total and direct bilirubin
• Total protein (Albumin, globulin)
• Liver Inflammatory Enzymes AST, ALT, ALP, GGT
 Specimen: Serum is always preferable
 Test Methods:
• Photometric or Calorimetric analysis
Measuring Bilirubin in Serum or Plasma
• Bilirubin in serum or plasma is commonly measured by
photometric methods based upon the diazo reaction
• Conjugated bilirubin + diazotized sulfanilic acid → azobilirubin +
alkaline tartrate (green to blue-green color)
• Measured with photometer at 555 - 600 nm depending on
specific reagent used
9
ALBUMIN
• Albumin synthesis is an important function of the liver.
• With progressive liver disease serum albumin levels fall, reflecting decreased
synthesis.
• Albumin levels are dependant on a number of other factors such as the nutritional
status, catabolism, hormonal factors, and urinary and gastrointestinal losses.
• Albumin concentration does correlate with the prognosis in chronic liver disease.
10
Liver function tests: ALT and AST
• The cells in the liver contain proteins called enzymes that drive different
chemical reactions.
• When liver cells are damaged or destroyed, the enzymes in the cells leak out
into the blood, where they can be measured by blood tests.
• Liver function tests check the blood for two main liver enzymes:
1. Aspartate aminotransferase (AST). The AST enzyme is also found in muscles
and many other tissues besides the liver.
2. Alanine aminotransferase (ALT). ALT is almost exclusively found in the liver.
• AST and ALT are an excellent marker of hepatocellular injury.
• They participate in gluconeogenesis by catalysing the transfer of amino
groups from aspartic acid or alanine to ketoglutaric acid to produce
oxaloacetic acid and pyruvic acid respectively.
• If ALT and AST are found together in elevated amounts in the blood, liver
damage is most likely present.
11
Liver function tests: Alkaline phosphatase and GGT
• Another liver's key functions is the production of bile (helps digest fat.
• Bile flows through the liver in a system of small tubes (ducts), and is
eventually stored in the gall bladder, under the liver.
• When bile flow is slow or blocked, blood levels of certain liver enzymes may
rise:
1.Alkaline phosphatase (ALP)
2.Gamma-glutamyl transpeptidase (GGT)
• GGT enzyme is found in hepatocytes and biliary epithelial cells.
• If alkaline phosphatase and GGT are elevated, a problem with bile flow is
most likely present.
• Bile flow problems can be due to a problem in the liver, the gall bladder or
the tubes connecting them.
• Raised GGT levels may be seen in pancreatic disease, myocardial infarction,
renal failure, chronic obstructive pulmonary disease, diabetes, and
alcoholism
12
Causes of hyperbilirubinaemia
A) Unconjugated
1. Increased bilirubin production.
• Haemolysis, Ineffective erythropoiesis, Blood transfusion,
Resorption of haematomas.
2. Decreased hepatic uptake.
• Gilbert’s syndrome, Drugs—for example, rifampicin.
3. Decreased conjugation.
• Gilbert’s syndrome, Criggler-Najjar syndrome, Physiological
jaundice of the newborn.
B) Conjugated
1. Dubin-Johnson syndrome.
2. Rotor’s syndrome
13
Common causes of raised transaminases
• Alcohol.
• Medications: non-steroidal anti-inflammatory drugs,
antibiotics, antiepileptic drugs, anti-tuberculous drugs, herbal
medications.
• Non-alcoholic steatohepatosis.
• Chronic hepatitis B and C.
• Autoimmune diseases.
• Congestive cardiac failure and ischaemic hepatitis.
• α1-Antitrypsin deficiency.
• Endocrine disease: hypothyroidism, Addison’s disease.
• Diseases of striate muscle.
• Glycogen storage diseases
14
Common causes of raised ALP
A) Physiological
• Women in the 3rd trimester of pregnancy, Adolescents, Benign,
familial (due to increased intestinal ALP).
B) Pathological
• Bile duct obstruction, Primary biliary cirrhosis, Primary
sclerosing cholangitis, Drug induced cholestasis, Adult bile
ductopenia, Metastatic liver disease, Bone disease.
Causes of raised gammaglutamyl transferase
• Hepatobiliary disease, Pancreatic disease, Alcoholism, Chronic
obstructive pulmonary disease, Renal failure, Diabetes,
Myocardial infarction, Drugs—for example, carbamazepine,
phenytoin, and barbiturates
15
4.2. Renal Function Test
Review of the Urinary System
1. Kidney
• Structure
– Bean shaped paired organs
– Outer layer = cortex; composed primarily of glomeruli,
and tubules
– Inner layer = medulla; composed primarily of the loop
of Henle and collecting ducts
– Renal pelvis: collects urine into the ureters
2. Ureters: urine flows from renal pelvis into the ureters, then
into the bladder
3. Bladder: urine stored here until voided
4. Urethra: urine voided through urethra to outside of body
16
Major Structures of Urinary System
• Kidney (Bean shaped)

• Ureters
• Bladder
• Urethra
17
Renal Function Test cont’d…
Kidney Functions
1. Filtration of small molecules
2. Reabsorption of essential substances
3. Secretion into urine from blood stream
4. Excretion
5. Hormonal regulation: erythropoietin, ADH, aldosterone
6. Homeostasis
Renal Threshold:
• Defined as the plasma concentration of a substance that when
exceeded, the kidney tubules will not reabsorb any more into the
bloodstream, resulting in the substance being excreted into the urine
Example: glucose ~160-180 mg/dl
18
Creatinine Formation and Excretion
– Spontaneously derived from creatine in muscle
• High energy ATP storage and use in muscle
– Produced at a constant rate day to day
– Excreted into urine through glomerular filtration; not significantly
reabsorbed or secreted by tubules
Uric Acid Formation and Excretion
1. End product of purine (adenine and guanine) metabolism by the
liver
2. Purines are precursors of the nucleic acids ATP and GTP (adenosine
tiphosphate and guanosine triphosphate)
3. Readily filtered by the glomerulus, but then undergoes a complex
cycle of reabsorption and secretion by the tubules.
 Not a good test for GFR
19
Renal function tests:

• metabolic pathways, methods of analysis, calculations,
interpretations and correlation of results
Protein  amino acids  ammonia  urea
1. BUN/ urea
2. Creatinine
Muscle breakdown product
3. Uric Acid
Nucleic acid catabolism
4. Creatinine Clearance
20
Clinical Significance of Urea:

• Azotemia - an elevated concentration of urea in the blood.
• Uremia or Uremic syndrome- a very high plasma urea concentration
accompanied by renal failure
– Fatal if not treated
– Treatment can be dialysis and/or transplantation.
• Conditions causing elevations of plasma urea are classified according to cause
into three main categories: Pre renal, Renal, Post renal.
Clinical Significance of BUN:

1.Serum/plasma urea levels will vary depending upon
- Diet, Liver function, Kidney function, State of hydration
2.Increased urea (BUN)
a. Increased protein intake  increased synthesis b. Decreased
kidney function decreased excretion
c. Dehydration
21
Clinical Significance of Creatinine

1. Endogenous substance
2. Amount produced is relatively constant and proportional to
muscle mass
3. Amount excreted into urine is constant from day to day
4. Filtered almost entirely by the glomerulus; not significantly
secreted or reabsorbed by tubules
5. Show little or no response to dietary changes
Clinical Significance of Uric Acid
1.Increased uric acid (hyperuricemia)
A. Gout: at plasma pH uric acid is readily insoluble and at
concentrations >6.4 mg/dl the plasma is saturated resulting in
crystal deposition in tissues and joints
22
B. Increased catabolism of nucleic acids

1) Patients on chemotherapy for proliferative disease such
as leukemia, lymphoma, multiple myeloma, polycythemia
2) Must monitor uric acid levels to avoid nephrotoxicity
3) Allopurinol treatment is used to interrupt the uric acid
synthesis pathway in these patients, avoiding
nephrotoxicity
C. Renal disease: Filtration and secretion are impaired
2.Decreased uric acid (hypouricemia)
A.Severe liver disease
B.Defective tubular reabsorption (Fanconi’s syndrome)
C.Over treatment with allopurinol
23
BUN/Creatinine Ratio
• Calculation often used by clinicians to differentiate between
pre-renal and post-renal cause of azotemia:
• Azotemia is condition of increased NPN compounds in the
bloodstream most often due to increased urea (BUN) and
creatinine (the major NPN compounds clinically significant in
evaluation of kidney disease)
calculated = Serum BUN (mg/dl)
Serum creatinine (mg/dl)
• Normal Ratio between 10 and 20 (majority b/n 12 and 16)
24
Differentiation of azotemia
1. Increased ratio with increased BUN, normal creatinine
• Tend to be caused by pre-renal conditions: Congestive Heart
Failure; Shock, hemorrhage; Dehydration; Increased protein
metabolism; Increased protein catabolism
2. Increased ratio with dysproportionate increased BUN, slightly
increased creatinine
• Tend to be caused by post-renal conditions that obstruct urine
flow: Stone, Tumor, Sever infection
25
3. Increased ratio with increased BUN, increased creatinine

• Tend to be caused by - renal conditions that decrease kidney
function: Acute renal failure, Chronic renal failure,
Glomerulonephritis, Tubular necrosis
4. Decreased ratio with decreased BUN
• Tend to be caused by conditions of decreased urea
production: Low protein diet, Liver disease
26
4.3. Carbohydrate Metabolism Disorders
• Carbohydrate is important constitute of living cells and the
main source of energy
4.3.1. Source and Function of CHO (Glucose)
1. Energy source 1g= 4kcal/17kj (glucose CO2 +H2O + ATP)
2. Cell structure (plants-cellulose & animals- chitin)
3. Recognition markers eg. A,B,O blood types
4. Structural component of nucleic acids
5. Part of plasma membrane
Source of Glucose
 Mainly from daily intake of CHO
 Breakdown of stored glycogen Glycogenolysis
 From breakdown of non-CHO Gluconeogenesis
• In normal physiology, blood glucose level is monitored by INSULIN
(B cell of Islet of Langrhams of the pancreas) and GLUCAGON
27
Carbohydrate Metabolism Disorders
4.3.2. Type of Carbohydrate Disorders
1. Hyperglycemia high blood glucose level
Effects: Immediate effects
Long term effect
2. Hypoglycemia low blood glucose level
3. A normal or decreased plasma glucose concentration often
with excretion of a non glucose - reducing sugar in the urine
(inborn errors of CHO metabolism)
What is Diabetes Mellitus (DM):

• It is a group of disorders in CHO metabolism characterized by
raised plasma glucose level (hyperglycemia) resulting from
defects in insulin production, secretion &/or action.
28
Carbohydrate Metabolism Disorders cont’d…
Classification of Diabetes mellitus
1. Type I (IDDM) (Juvenile diabetes)
2. Type II (NIDDM)
3. Gestational diabetes mellitus (GDM)
4. Malnutrition related (MRDM)
Type I or IDDM
• It is a sever form characterized by absolute insulin deficiency
• Cell mediated destruction or degeneration of β cells of the islets of pancreas,
causing an absolute deficiency of insulin secretion
• Accounts 5-10 % diagnosed cases of diabetes
• Usually diagnosed at < 18 years old
• Thinner body, inability to gain weight
Type II- NIDDH
• Accounted for 90 - 95% of the diagnosed cases of diabetes
• Onset is usually after 40 years of age
• Strong association with obesity
• Best controlled by weight loss, diet, drug therapy
29
• Type II is Caused by :
 Insulin resistance -decreased ability of insulin to act on the
peripheral tissues
 Resistance of tissue cells to the action of insulin
 β- cells dysfunction
Gestational diabetes mellitus
• Onset of diabetes during pregnancy and Causes is similar to type II
• Hyperglycemia usually decreases after delivery
• Higher risk of mother developing type II after pregnancy
Complications of Diabetes mellitus
 Keto-acidosis
 Neuropathy
 Retinopathy
 Angiopathy
 Nephropathy and Infection
30
4.3.3. Diagnosis of Diabetes mellitus
Diagnostic criteria
1. History
2. Classic symptoms of diabetes
3. Blood glucose: Demonstration of significant hyperglycemia
Classic symptoms of Diabetes includes
Polyuria  Frequent urination
Polydipsia  Excessive thirsty
Polyphagia  Excessive hunger/ desire to eat
Unexplained weight loss  Excess Glucose is excreted as urine than stored as fat
Laboratory Tests of DM
• Glucose Assay Methods:
1.Oxidation-reduction [Redox ]
2.Condensation
3.Enzymatic
31
Samples for Glucose Assay
I. Serum and plasma are common specimens for quantitative analysis
II. Whole blood capillary is used for rapid testing (10 sec)
Specimen collection time options for blood glucose measurements
Random blood sugar (RBS) 80-120 mg/dl
Fasting blood sugar (FBS) 70-110 mg/dl
Two- hours post prandial (2h.pp)  100-140 mg/dl
2h OGTT: Patient is given75g sugar load and their RBS is measured after 2Hr
DM Is Diagnosed By Demonstrating Any Of The Following

1.If FBS of >= 126mg/dl in two separate occasions
2.2H OGTT >= 200(8H FAST, 75G LOAD, TEST AFTER 2H)
3.IF RBS of >= 200 Plus Classic Symptoms of DM
4.IF HbA1c OF >6.5%
IF FBS of 110-125 mg/dl Impaired Fasting Glucose
IF OGTT of 140-199 mg/dl Impaired Glucose Tolerance
32
4.4. Plasma Protein
• There are several different type of proteins present in the blood, and
collectively known as plasma proteins. They include
 Albumin,
 Alpha 1 –Fetoprotein,
 C-reactive protein,
 complements, fibrinogen and immunoglobulin.
• Most of plasma proteins are synthesized and catabolized in the liver.
• In certain occasions alteration of plasma protein occur, due to:
1. Change in volume of plasma water
2. Change in concentration of protein
 The relative hypoproteinemia Hemodilution.
 The relative hyperproteinemia Hemoconcentration.
33
Plasma Protein cont’d…
4.4.2. Plasma proteins with Clinical significance
1. Albumin
• Is the most abundant plasma protein & main extra vascular body fluids
• Accounts approximately one-half of the plasma protein mass.
• Has high net negative charge at physiological pH highly soluble in water
Function of Albumin
I. Maintaining the colloidal osmotic pressure in both the vascular and extra
vascular space with continuous equilibration in between
II. Binding and transportation of large number of compounds, including free
fatty acids, phospholipids, metallic ions, amino acids, drugs, hormones
and bilirubin.
Clinical significance of Albumin
 An increase level of albumin
Acute dehydration
 Decreased level of albumin seen in
Edema and Ascitis, Urinary loss, Gastrointestinal loss, Inflammatory
conditions,, Hepatic disease, Protein energy malnutrition 34
2. Alpha 1 –fetoprotein [AFP]:
• One of the first α –globulin appear in mammalian sera during
development of the embryo.
• Dominant serum protein in early embryonic life
• synthesized primarily by the fetal yolk sac and liver.
• contains approximately 4% carbohydrate
Clinical Significance:
High AFP levels seen in:
1. Open neural tube or abdominal wall defect in fetus.
2. Multiple fetuses, fetal demise, feto-maternal bleeding,
3. Hepatocellular and germ cell carcinomas in childhood and adults
35
3. C-reactive protein
• The first APPs to become elevated in inflammatory diseases and is synthesized
primarily by liver.
• CRP activates the classic complement path way and initiates opsonization,
phagocytosis, and lysis of invading organisms such as bacteria and viruses.
• CRP can recognize potentially toxic autogenous substances released from
damaged tissue, to bind them, and then detoxify or clear them from the
blood.
CRP is clinically useful for
• Screening for organic disease
• Assessment of the activity of inflammatory diseases
• Detection of inter-current infection in systemic lupus erythematosus (SLE), in
leukemia, or after surgery
• Management of neonatal septicemia and meningitis
CRP levels usually rise after
• myocardial infraction, stress, trauma, infection, inflammation, surgery, or
neoplastic proliferation. 36
4.5. Body Fluid Analysis
4.5.1. Overview Of Different Body Fluids
1. CEREBROSPINAL FLUID (CSF)
Composition and formation
• CSF is the third major fluid of the body with Adult total volume 140-170 ml
and Neonate total volume 10-60 ml
• Subarachnoid space - area that lies between the arachnoid membrane and pia
mater.
• CSF is formed by the choroid plexus cells and ependymal cells occupies this
space.
• Blood Brain Barrier - restricts entry of macromolecules such as blood cells,
large proteins, lipids. Therefore, the composition of CSF does not resemble
plasma.
Functions
1. To supply nutrients to the nervous tissue
2. To remove metabolic wastes
3. Serves as a mechanical barrier to cushion the brain and spinal cord against
trauma
37
Body Fluid Analysis cont’d…
Indications
• CSF analysis is performed to diagnose meningitis, intracranial
hemorrhage (CVA), leukemias, malignancies, and central
nervous system disorders.
Specimen Collection
Routinely via lumbar puncture under sterile conditions
CSF Physical Characteristics /Appearance and Gross Exam's
• Normally crystal clear and colorless
• Descriptive terms used  clear, hazy, cloudy, turbid, bloody,
xanthochromic.
• These terms should also be quantitated as slight, moderate,
marked, or grossly.
38
A. Xanthochromic : term used only for CSF to describe a

yellowing discoloration of the supernatant caused by:
 Usually an indication of the presence of old/lysed RBC (Hgb 
BIL)
 Elevated serum bilirubin
 Carotene pigment, merthiolate contamination and increased
proteins
B. Clotted: Clot formation is abnormal and indicates increased
fibrinogen due to traumatic tap or diseases causing damage to
the blood brain barrier resulting in increased protein
(meningitis, Froin's syndrome, and blockage of CSF circulation)
C. Pellicle formation: A web-like pellicle formation in a
refrigerated specimen is associated with tubercular meningitis
D. Milky: Due to increased lipids 39
2. SEROUS FLUIDS
• Serous fluid is the small amount of fluid that lies between the membranes
lining the body cavities (parietal) and those covering the organs within
the cavities (visceral).
• There are three types of serous fluids
I. Peritoneal fluid (Ascitic fluid) - from the abdominal cavity
 Paracentesis
II. Pleural fluid (thoracic fluid) - lung  Thoracentesis
III. Pericardial fluid - heart  Pericardiocentesis
Transudates Vs. Exudates
• Abnormal build up of serous fluid is called an effusion.
• Classifying a cause can be aided by determining if it is a transudates or
exudates Diagnosis and treatment depend on this.
Indications
 infections, hemorrhages, malignancies, other disorders 40
3. SYNOVIAL FLUID
• Secreted by the cells of the synovial membrane
• Very viscous fluid containing
a. Hyaluronic acid
b. Mucopolysaccharides
c. Small amount of plasma protein
Functions
 Supplies nutrients to the cartilage
 Acts as a lubricant
Indications
 infections, hemorrhage, degenerative disorders (arthritis),
inflammatory disease (SLE) 41
4. SEMINAL FLUID
Composition
1. Spermatozoa sperm cells
2. Seminal Vesicles Fluid— a viscous fluid that provides Fructose
and other nutrients to maintain the spermatozoa. Provides the
major volume of the seminal fluid.
3. Prostate fluid — a milky fluid that contains Acid Phosphatase
and other enzymes that act on the fluid from the seminal
vesicles resulting in coagulation and liquification of the semen.
Indications / Reasons for Testing
 Infertility
 Post-vasectomy
 Identification of a fluid as semen (forensic medicine)
 Artificial insemination programs – sperm donors 42
5. AMNIOTIC FLUID
Composition and Formation
• Found in membranous sac surrounding fetus and formed by
 Metabolism of fetal cells
 Transfer of water across placental membrane
 Fetal urine (later stages of development)
Function
• Provides cushion to protect fetus
Indications
suspected chromosomal abnormalities, metabolic
disorders, neural tube defects, HDN, gestational age,
infections, fetal maturity
43
4.5.2. Laboratory Procedures of body fluid analysis
Laboratory Analysis of CSF (are always considered STAT!)
1. Hematology
• Cell counts – both WBC and RBC are always performed
WBC Normal
 Adult = up to 5 mononuclear cells /μl
 Newborn = up to 30 mononuclear cells /μl
 Children (1 - 4 yrs) = up to 20 mononuclear cells /μl
 0 RBC/μl should be seen in normal CSF specimens,
regardless of patient’s age.
Method of cell count:
• Manual WBC and RBC counter using hemocytometer
• Counting using CBC Analyzer is not recommended.
44
2. Chemistry
• There are few clinically significant CSF chemistry tests since
the blood - brain barrier causes selective filtration from the
plasma.
• Abnormal values result from alterations in the permeability of
the blood - brain barrier.
A. CSF protein
• Majority of CSF protein is of the albumin fraction
• Significance of elevated/ increased protein
 Damage to blood/brain barrier as seen in meningitis and
hemorrhagic conditions
 Production of Immunoglobulin within the CNS
 Degeneration of neural tissue
45
B. CSF glucose
• Perform this test STAT since cells and organisms will utilize glucose
causing levels to decrease rapidly.
• Normally the CSF glucose will be 60-70 % of the patient's plasma
glucose value.
• Significant Decreased CSF glucose are seen in
 Bacterial or fungal meningitis
 Hypoglycemia
 Brain tumors
 Leukemia
• An increase CSF glucose is always a result of increase plasma levels.
C. Other Chemistry tests
1) CSF lactate 2) CSF glutamine 3) CSF lactate dehydrogenase (LDH or LD)
46
3. Microbiology – CSF
A. Gram stain  for Gram (+) and Gram (-) bacteria
B. Culture (sensitive test)  for Aerobic and Anaerobic bacteria
C. Acid-fast or fluorescent antibody stains  for TB
D. India-ink preparation  Cr. neoformans
4. Serology
I.VDRL – tertiary syphilis (neuro syphilis), T. pallidum
II.Latex agglutination
III.ELISA
5. Cytology
• An unstained slide of the CSF sediment may also be prepared and
sent to the cytology department.
• Special stains (eg. PAS) will be used to identify various cells
(especially malignant cells and inclusions).
47
THANK YOU
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4.

BASIC CLINICAL CHEMISTERY

• The liver is a large bi-lobed

Jaundice Clinical Serum Serum Urine Urine

• Kidney (Bean shaped)

Renal function tests:

Clinical Significance of Urea:

Clinical Significance of BUN:

Clinical Significance of Creatinine

B. Increased catabolism of nucleic acids

3. Increased ratio with increased BUN, increased creatinine

What is Diabetes Mellitus (DM):

DM Is Diagnosed By Demonstrating Any Of The Following

A. Xanthochromic : term used only for CSF to describe a

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