Clinical Biochemistry in Clinical Medicine - Literature review Example

Biochemical Data Name: Unit: Course: Supervisor: Date of submission: Introduction Clinical biochemistry plays a crucial role in clinical medicine; it is in clinical biochemistry that biochemical methods are applied to study pathological processes by acquiring the biochemical data (Sox et al, 2006, p. 489). According to Barth, Butler and Hammond (2003, p. 4) the core function of clinical biochemistry is to provide required biochemical information for management of patients. Such biochemical information is the data that is used by clinicians in making medical decisions affecting populations or patients. Biochemical data comprises of over a third of data that is found in the hospital laboratories. The biochemical data mainly comprises of the serum, plasma or whole blood samples, urine and sometimes it may include data on fluids such as gastric aspirate, pleural fluid and cerebrospinal fluid (William & Bangert 2008, p. 791). This paper discusses the uses of biochemical data, acquisition and interpretation. Uses of Biochemical Data In day to day life, clinicians are in need of information that is critical in the management of the patients. As a result they have to liaise with the laboratory staff to acquire and use biochemical data. In the field of medicine, extensive investigations are carried in relation to different diseases that may arise from metabolic issues such as diabetes mellitus or diseases resulting from biochemical changes renal failure (Lott, Notte, Gretch, Koff 2000, p. 47). Therefore the investigations and analysis have to rely to biochemical data. This implies that the principle application of the biochemical data is in diagnosis, prognosis, monitoring, screening and treatment. Diagnosis For treatment to be carried out, diagnosis acts as an initial step to treatment. Diagnosis is mainly a combination of investigations which clinicians use in order to understand the possible disease one is suffering from. Therefore, it is based on both the patients’ history and biochemical tests (Lott, Notte, Gretch, Koff 2000, p. 51). After the patient’s history is obtained, the conclusion of the clinician is based on assumption and hence to refute or confirm the assumptions of the diagnosis, biochemical data is obtained from the patient in order initiate treatment based on findings of the biochemical tests that are accurate. Prognosis Prognosis is very important aspect of preventive and curative care; it is a forecast of a likely medical outcome (Skendzel, Barnett and Platt 2005, p.204). The information that is obtained in the process of diagnoses can serve as important data for prognosis. Biochemical data that is obtained from an individual is analysed to predict likely medical complications in future or determine the right time for carrying out medical check and follow up treatments. For example, series of plasma creatinine concentration check up in patients with renal diseases leads to accumulation of biochemical data that can be used by clinicians to determine the right time for dialysis (Lott, Notte, Gretch, Koff 2000, p. 61). The biochemical data can also be used to point to likelihood of developing a specific medical condition. Therefore, biochemical data is used by clinicians for prognosis purpose which is an important aspect in management and treatment of patients. Monitoring In the clinical medicine, follow up of the patient plays a crucial role in determining whether treatment is effective or not. To make an effective follow up clinicians use biochemical data to determine the progress of the treatment. This is made possible in cases where there is an analyte that can be relied on. For instance, for patients with diabetes mellitus, clinicians can monitor their progress by analysing glycated haemoglobin which is biochemical data obtained from the patient being monitored. In the course of the monitoring, the biochemical data is also used to detect possible complications arising from treatment. For example, in the treatment of diuretics, biochemical data on hypokalaemia is a pointer to possible complications. Biochemical data can also be used to screen for possibilities of toxicities arising from the drugs the patient is on (Lott, Notte, Gretch, Koff 2000, p. 58). Screening Biochemical data is used in clinical medicine to find out the incidence of condition, i.e. determining whether a given medical problem is present sub-clinically in a healthy population. For example in USA and UK babies are screened for phenylketonuria (PKU) (Gupta 2004, p.511). The screening is normally necessary for identifying conditions that need to be controlled in a population. The biochemical data for screening can be acquired selectively depending on the medical condition being investigated. Treatment The central aim for the acquiring and analysis of the biochemical data is to help clinicians in the medical management of patients. Treatment is normally depended on prognosis, diagnosis, monitoring and screening information. For instance, in carrying out blood transfusion, biochemical investigations are carried out to determine whether the blood is contaminated and detect the possibility of blood agglutinations that may arse due to biological variations among individuals. Acquiring Biochemical Data Biochemical data is normally from analytes collected from body fluids depending on the test being carried. The collection of the analytes is normally carried by laboratory technicians. In acquiring the data a test request is made by a physician or health authorities. The analytes which are specimen for analysis are then collected and taken to laboratory putting into consideration the specified clinical and laboratory procedures necessary for ensuring that results are true reflection of the specimen taken (Harold, 2009 p.1079). Factors Affecting Biochemical Test Results Biochemical test results are depended on many factors. The factors can be technical or biological. The technical (analytical) relate to the methods applied in the collection of the specimen that may have negative effect on the test results. The technical factors also include the timing of collection, storage and subsequent subjection of the specimen to actual lab tests (Skendzel, Barnett, Platt 2005, p. 205). Some specimens if not handled well may end up giving the wrong results. Therefore, the specimen need to be collected and taken to laboratory for testing following the specified procedure if the data are to remain valuable. In addition, the data should be well labelled, i.e. with the necessary information for the patient. The information is crucial for the identification and subsequent analysis and interpretation of results. Biological factors affect the value of the biochemical data due variations resulting from body changes. According to Barth, Butler and Hammond (2003, p. 4) analytes are affected by many variables which may include time, posture and the day of collection. Therefore, for value to be maintained, standardisation of the conditions under which the sample is to be obtained is necessary. For instance, there can be biological variation in analytes concerning daily measurement of blood glucose and plasma calcium concentration. The biological variations can be due to metabolic changes, type of food taken and or physical activity. Other biological factors that should be considered is condition of the patient, for example, in taking specimen of blood haemolysis should be avoided as other analytes from the patient can be affected by haemolysis (Skendzel, Barnett, Platt 2005, p. 205). According to Harold (2009, 1079) failure to follow the right procedures and putting into consideration the different factors that ought to be undertaken are main sources of errors. The sources of errors are categorised as: Pre analytical: These are errors that occur outside the laboratory. They include taking the wrong specimen, improper labelling of the specimen or poor handling of the specimen. Analytical: These errors occur inside the laboratory and can result due error from instrument being used or from the laboratory technician/ staff. Post analytical: These errors arise when correct result is obtained but entered wrongly in the patient’s records. The errors can be avoided by incorporation of technology such as data handling software, personal scrutiny or application of quality control procedures that are put in place. Interpretation of results On obtaining the biochemical results, clinicians are tasked with interpretation of the results in order to determine what a patient is suffering from and the right treatment to be taken. In the interpretation, the clinicians have to consider whether the results are normal, or abnormal (Siest et al, 2005, p.117). Normal results In statistical terms, normal refers to value distribution from repeated measurement from same quantity. The Gaussian Curve is normally applied to determine a value distribution. Therefore ‘normal’ is depended on establishing the range for given variable in an individual who is healthy (Siest et al, 2005, p.117). This means that for results to be termed normal there must be a representative sample that forms the basis of comparison. Most biological values will depict even distribution as it is in Gaussian Curve, with the majority of people in a population having a value which approximately equals to the mean of the whole population. Therefore, biochemical results that are approximately to the representative sample are considered normal. Normal is relative term and to avoid the problems that may arise from the use of the term, Interval Reference (RI) has been adopted by clinicians and laboratory staff as a reference point for biochemical data interpretation (Wu et al 2009, p.107). Abnormal results Some results from analytes normally show significant biological variations. In using the RI, results that are greater in difference from the given limits of RI indicate a greater possibility that the results are indication of pathological process and could be considered abnormal. However, it is worth noting that presence of abnormal results is not a definite indicator of pathological problem as there are some individual variations (Wu et al 2009, p.107). Conclusion Biochemical data plays an important role in the clinical medicine. The biochemical data is specifically used for diagnosis, monitoring, prognosis and screening purposes. The value of biochemical data depends on following the right procedure in the collection and transportation of the analytes in the right conditions. The results relating to the biochemical testing are normally affected by biological and analytical variations. The biochemical results are normally interpreted in order to determine their utility on basis of being normal or abnormal. References Barth, J.H. Butler, G.E, Hammond, P. 2003. Biochemical Investigations in Laboratory Medicine. Journal of Clinical Pathology, 1 (1), pp. 2-7. Gupta, R.C. 2004. Practical biochemistry: Biochemical investigation in clinical medicine. J Clin Chem Clin Biochem; 26 (1), pp. 509-519. Harold, V. 2009. Acquiring of biochemical data. Clin Chem, 21:1077-1087. Lott, A., Nolte. F., Gretch. F., Koff, R. 2000. Laboratory Guidelines for screening, diagnosis and monitoring.Laboratory Medicine Practice Guidelines, 12 (1), pp. 45-63. Siest, G., Henry, J., Schiele, F. and Young, D.S. 2005. Interpretation of Clinical Laboratory Tests: Reference Values and Their Biological Variation. Foster City, CA: Biomedical Publications. William, J. M., Bangert, S.K 2008. Clinical Biochemistry: Metabolic and clinical aspects. Elsevier Health Sciences, pp. 789-793. Skendzel L. P, Barnett RN, Platt. R., 2005. Medically useful criteria for analytic performance of laboratory tests. Journal of Clinical Pathology. 83 (1):200- 205. Sox, C. M, Koepsell, T.D., Doctor, J.N., Christakis, D.A., 2006. Clinical biochemistry principle and practice. Journal of Clinical Chemistry 160 (1), pp. 487–92. Wu, A. H, Apple, F.S, Gibler, W.B., Jesse, R.L., Warshaw, M.M. 2009. Clinical Biochemistry Standards of Laboratory Practice: Clin Chem 45 (1), pp.104– 121. Read More