Clinical Chemistry Fundamentals and Laboratory Techniques

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Clinical Chemistry
Fundamentals and Laboratory Techniques

Author

Donna Larson, EdD, MT (ASCP), DLM

Vice President for Academic and Student Affairs
Clatsop Community College
Astoria, Oregon

Consulting Editors

Joshua Hayden, PhD, DABCC

Assistant Professor of Pathology and Laboratory Medicine
Weill Cornell Medical College
Director, Toxicology and Therapeutic Drug Monitoring
Assistant Director, Central Laboratory
New York Presbyterian Hospital-Cornell Campus
New York, New York

Hari Nair, PhD, DABCC

Technical Director
Boston Heart Diagnostics
Framingham, Massachusetts

ELSEVIER
ELSEVIER
325 1 Riverporr Lane
St. Louis, Missouri 63043

CLINICAL CHEMISTRY: FUNDAMENTALS AND

LABORATORY TECHNIQUES ISBN: 978- 1 -4 5 57-42 1 4 - 1

Copyright© 2017 by Elsevier, Inc. All rights reserved.

No part of this publication may b e reproduced or rransmirred i n any form or b y any means, electronic or mechanical,
including photocopying, recording, or any information storage and retrieval system, without permission in writing
from the publisher. Details on how to seek permission, further information about the Publisher's permissions poli­
cies and our arrangements wirh organizations such as the Copyright Clearance Center and the Copyright Licensing
Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher (other than
as may be noted herein) .

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our
understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using
any information, methods, compounds, or experiments described herein. In using such information or methods
they should be mindful of their own safety and the safety of others, including parties for whom they have a profes­
sional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current
information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered,
to verify the recommended dose or formula, the method and duration of administration, and contraindications.
It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate
safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liabil­
ity for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise,
or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

Library of Congress Cataloging-in-Publication Data

Clinical chemistry : fundamentals and laboratory techniques I edited by Donna Larson ; consulting editors,
Larson, Donna, editor. I Hayden, Joshua Uoshua A.) , editor. I Nair, Hari, editor.

Joshua Hayden, Hari Nair.

Clinical chemistry (Larson)

Includes bibliographical references and index.

St. Louis, Missouri : Elsevier/Saunders, [20 1 7] 1

LCCN 20 1 5 0440741 ISBN 978 1 4 5 5742 1 4 1 (paperback : alk. paper)

I MESH: Clinical Chemistry Tests.
LCC RB40 I NLM QY 90 I DOC 6 1 6. 07/5 6--dc23 LC record
available at http :/ /lccn.loc.gov/20 1 5044074

Executive Content Strategist: Kellie White

Content Development Manager: Jean Sims Fornango
Content Development Specialist: Beth LoGiudice, Spring Hollow Press
Publishing Services Manager: Catherine Jackson
Senior Project Manager: Daniel Fitzgerald
Designer: Margaret Reid

Working together

Printed in Canada
IJ!Jr- W\\"W
BookAid
[nl emational

clsc:v1cr
to grow libraries in
developing countries
<:om • www. hooka1J org
Last digit is the print number: 9 8 7 6 5 4 3 2
 To my mom and dad, Donald and Barbara Bedard (I wish they could have been here
to see this); to my husband, Earl, and my son, Adrian, for their love and support; to my
sister and her family for their warmth and love; to the Allards for their support during
my clinical year and college years; and to all the friends and colleagues I worked with at
Wentworth-Douglass Hospital (NH), 509th Strategic Hospital (NH), RAF Lakenheath
Regional Hospital (UK), Winston-Salem State University (NC), Mt Hood Community
College (OR), Portland Community College (OR), and Clatsop Community College (OR).
Donna Larson
I appreciate the opportunity Elsevier provided for me to A big thank you to Kellie White, Jean Sims Fornango, and
write the first edition of this clinical chemistry book for Beth LoGiudice for joining the team and seeing this proj­
medical laboratory technology students. The process was ect through to completion. The final product has been a
exciting, exhausting, challenging, and an educational expe­ long time coming. My Thursday mornings will never be
rience like no other. I would like to thank the contributors the same! Thanks also to Dan Fitzgerald and his team for
for their hard work to help make this book possible. putting everything together in a beautiful full-color book.
I would like to thank the Elsevier staff for the assistance, Everyone was understanding, patient, compassionate,
guidance, encouragement, and experience that they shared empathetic, and truly amazing.
with me throughout the development of the book. Thank
you to Ellen Wurm-Cutter, who helped me through the Donna Larson
proposal and beginning stages of manuscript development.

vi
Sheryl Berman, PhD Laura J. McCloskey, PhD
Division Dean of Health Professions Department of Pathology, Anatomy, and Cell Biology
Lane Community College Sidney Kimmel Medical College
Eugene, Oregon Thomas Jefferson University
Philadelphia, Pennsylvania
Jimmy L. Boyd, CLS (NCA), MS/MHS
Assistant Professor, Department Head M. Laura Parnas, PhD, DABCC, FACB
Medical Laboratory Technology Director of Clinical Science
Arkansas State University, Beebe Sutter Health Shared Laboratory
Beebe, Arkansas Livermore, California

Craig Foreback, PhD John W. Ridley, PhD, RN, MT (ASCP)

Senior Consultant Formerly, Director of Medical Laboratory Technology
Clear Medical Solutions, LLC West Central Technical College
Bradenton, Florida Waco, Georgia
Senior Lecturer Emeritus
University of Wisconsin School of Medicine Laird C. Sheldahl, PhD
and Public Health Instructor, Anatomy and Physiology, Biology
Madison, Wisconsin Mount Hood Community College
Gresham, Oregon
Danielle Fortuna, MD
Department of Pathology, Anatomy, and Douglas F. Stickle, PhD, DABCC, FACB
Cell Biology Department of Pathology, Anatomy, and Cell Biology
Sidney Kimmel Medical College Sidney Kimmel Medical College
Thomas Jefferson University Thomas Jefferson University
Philadelphia, Pennsylvania Philadelphia, Pennsylvania

Thomas Kampfrath, PhD, DABCC Zi-Xuan Wang, PhD

Clinical Biochemist Department of Pathology, Anatomy, and Cell Biology
Santa Clara Valley Medical Center Sidney Kimmel Medical College
Department of Pathology and Laboratory Medicine Thomas Jefferson University
San Jose, California Philadelphia, Pennsylvania

vii
This page intentionally left blank
Keith Bellinger, PBT (ASCP) Amy Gatautis, MBA, MT (ASCP), SC
Medical Technologist Program Director, Medical Laboratory Technology
The United States Department of Veterans Affairs New Cuyahoga Community College
Jersey Health Care System Cleveland, Ohio
East Orange, New Jersey
Assistant Professor, Phlebotomy Kristine Hayes, MAT, MLS (ASCP)
Rutgers-The State University of New Jersey MLT and Phlebotomy Program Coordinator
Newark, New Jersey Moberly Area Community College
Moberly, Missouri
Stephanie Bielas, PhD
Assistant Professor of Human Genetics Candy Hill, MEd, MT (ASCP)
University of Michigan CLT Program Coordinator
Ann Arbor, Michigan Jefferson State Community College
Birmingham, Alabama
Jimmy L. Boyd, CLS (NCA), MS/MHS
Assistant Professor, Department Head Lorri Huffard, PhD, MT (ASCP), SBB
Medical Laboratory Technology Dean, Science & Health Programs
Arkansas State University, Beebe Wytheville Community College
Beebe, Arkansas Wytheville, Virginia

Russell Cheadle, MS, MLS (ASCP) Phyllis Ingham, EdD, MEd, MT (ASCP)
Professor, Clinical Laboratory Technology Director Clinical Laboratory Technology Program
Macomb Community College West Georgia Technical College
Warren, Michigan Waco, Georgia

Cathy Crawford, BS, MT (ASCP) Stephen M. Johnson, MS, MT (ASCP)

Clinical Courses Instructor and MLT Teaching Assistant Program Director
Mount Aloysius College Saint Vincent Health Center School of Medical
Cresson, Pennsylvania Technology
Erie, Pennsylvania
Karen M. Escolas, EdD, MT (ASCP)
Chair, Department of Medical Laboratory Technology Haywood Joiner Jr., EdD, MT (ASCP)
Farmingdale State College, State University of New York Chair, Department of Allied Health
Farmingdale, New York Louisiana State University at Alexandria
Alexandria, Louisiana
Roger Fortin, MS, MBA, MLS (ASCP)
Program Director Stephanie Jordan, BS, MLS (ASCP), CM
Bunker Hill Community College Assistant Professor
Charlestown, Massachusetts Pierpont Community and Technical College
Fairmont, West Virginia
Trent Freeman, MA, BS, MLS (ASCP)
Education Coordinator Jeffrey Josifek, MS, MLS (ASCP), CLS (NCA)
Medical Education and Training Campus Department of Medical Laboratory Technology
The George Washington University Portland Community College
Fort Sam Houston, Texas Portland, Oregon
ix
 Reviewers

Minh Kosfeld, PhD, MLT (ASCP) Ryan Rowe, MLS (ASCP)

Assistant Professor Weber State University
Department of Biomedical Laboratory Science Ogden, Utah
Doisy College of Health Sciences
St. Louis University Mary Sadlowski, MT (ASCP)
St. Louis, Missouri Medical Technologist
Greater Baltimore Medical Center and Community
Marc L. Meyers, MBA, MT (ASCP) College of Baltimore County
PM Laboratory Coordinator Towson, Maryland
Centegra Clinical Laboratories
McHenry, Illinois Cheryl Selvage, MS, MT (ASCP)
Associate Professor
Constance Moore, MS, MT (ASCP) Lorain County Community College
Program Director, Laboratory Sciences Elyria, Ohio
Eastern Gateway Community College
Steubenville, Ohio Anita Marie Smith, MT (AMT), MBA
Laboratory Administrative Director
Richard C. Mroz Jr., DA, MS, BSMT, MT (ASCP) Moberly Regional Medical Center
MLT Program Director Moberly, Missouri
Fortis Institute
Fort Lauderdale, Florida Angela Sparkman, MEd, MT (ASCP)
Program Director, Assistant Professor of the Medical
Dawn Nelson, MA, MT (ASCP) Laboratory Technology Program
MLT Program Director Ivy Tech Community College
Florence-Darlington Technical College Sellersburg, Indiana
Florence, South Carolina
Andrea Thompson, BS, MLT (ASCP)
Kathleen C. Perlmutter, MBA, MT (ASCP) MLT Instructor
Phlebotomy Coordinator, MLT Faculty Barton Community College
Montgomery County Community College Great Bend, Kansas
Blue Bell, Pennsylvania
Dionne M. Thompson, MSE, MT (ASCP)
Jennifer D. Perry, MS, BSMT (ASCP) MLT Program Director/Instructor
Associate Professor and Chairperson Three Rivers College
Clinical Laboratory Sciences Department Poplar Bluff, Missouri
Marshall University
Huntington, West Virginia

Ellen F. Romani, AAS (MLT), MS

Department Chair
Medical Laboratory Technology/Phlebotomy/Therapeutic
Massage
Spartanburg Community College
Spartanburg, South Carolina
Clinical Chemistry: Fundamentals and Laboratory Techniques including the applications of Westgard rules for control
is a comprehensive, readable, and student-friendly text for charts and the calculation of the mean, mode, and standard
2-year medical laboratory technology programs. The text­ deviation, are explained and practiced in that chapter.
book has a full-color design along with detailed illustrations Part 2, Pathophysiology and Analytes, covers the dis­
and diagrams to help students with complex chemistry eases, broken down by body system, that are commonly
concepts. Pathophysiologic concepts are included to help diagnosed through chemical tests. Each chapter in this sec­
students understand the clinical relevance of clinical chem­ tion contains information about anatomy and physiology
istry assays. of a specific body system, disease mechanisms of common
conditions that require clinical chemistry testing, and how
Purpose and Organization laboratory results correlate with clinical disorders. This is a
key section of the book because MLT students usually do
As I look back at my journey in clinical laboratory science, not have room in their program for a separate pathophysiol­
I cannot help but marvel at how laboratory test methods ogy class, unlike other health science students, for whom it
rapidly changed over the course of the 20th century and is part of the program paradigm.
into the 2 1 st century. While researching my dissertation, Pathophysiologic mechanisms of diseases and the resul­
The Structure of Knowledge in Clinical Laboratory Science, I tant effects on clinical chemistry tests are discussed in each
was amazed to read articles in laboratory journals ( 1 940s) of the chapters. For example, it is easier to remember test
concerning how to build a better cage for laboratory ani­ results that are elevated after an acute myocardial infarction
mals. (Pregnancy tests during that time used rabbits to (MI) if it is known that the muscle is damaged and that
determine whether a woman was pregnant.) The radioim­ the dying cells release specific chemicals into the blood. If
munoassays that were popular in the 1 970s and into the blood is drawn at timed intervals after the MI, the person
1 980s were largely replaced by colorimetric immunoassays who understands the pathophysiologic mechanism behind
in the late 1 980s and 1 990s. Looking back, there was always the infarct will know what types of clinical chemistry results
new information in the expanding discipline of clinical lab­ to expect from each specimen.
oratory science. The more the knowledge base expands, the When diseases are discussed that do not use laboratory
more the students are asked to learn. This is especially true tests for diagnoses or when laboratory tests are used to
of medical laboratory technology (MLT) students. rule out other disorders, this information is given so that
MLT students have a mere 2 years to learn all the clinical students can understand the laboratory test ordering pat­
laboratory science (CLS) knowledge (with few prerequisite terns of health care providers. This information also helps
and general education courses) on which to build a solid students better understand reflex testing and how the algo­
knowledge foundation. Pieces from various disciplines are rithms are developed.
incorporated or embedded in their CLS . When writing this Part 3, Other Aspects of Clinical Chemistry, covers
book, I envisioned a clinical chemistry book that would therapeutic drug monitoring, toxicology, transplantation,
incorporate j ust-in-time learning concepts for which the and emergency preparedness. The clinical laboratory has a
material would be fortified with additional material when critical role in these areas, providing ongoing testing and
needed. Building on this approach, Part 1 , Laboratory Prin­ assistance.
ciples, covers laboratory principles, safety, quality assur­ To complement the organization, the book is writ­
ance, and other fundamentals of laboratory techniques. ten in the active voice to help students better understand
The concepts are essential for anyone working in a clini­ the material. Although this may be unconventional for a
cal laboratory, and this section provides a good reference textbook at this level, I believe it helps students to better
for beginning MLT students. For example, the students understand complex clinical chemistry concepts and mas­
do not take a statistics course, but statistical concepts and ter the material.
calculations are included in Chapter 7, Laboratory Qual­ Most individuals are visual learners. To that end, many
ity Management Systems. Quality management methods, figures, photographs, tables, and flowcharts are included

xi
 Preface

to help students better understand concepts. Many figures Review Questions

summarize complex and complicated processes or pathways
to provide better comprehension of the material by students. Multiple-choice review questions at the end of every chap­
ter provide students with a unique tool as they prepare for
classroom examinations and certification examinations. The
Key Features review questions give students a chance to quiz themselves
Cha pter Outl i n e on the chapter content, assess their knowledge of important
chapter topics, and evaluate which topics need follow-up
Each chapter starts with a chapter outline that shows the review.
main topics that are covered. It provides students and
instructors with a roadmap to the chapter and can be easily Critica l Th i n king Questions
referenced at any time.
The Critical Thinking Questions allow students and instruc­
Objectives tors to discuss the chapter topics in a broader way. Although
these questions have correct answers, they require more in­
The textbook format facilitates the learning process by pro­ depth thinking, analysis, evaluation, and reflection than
viding students and educators with detailed objectives that other questions in the chapter.
address the knowledge required to master each chapter's
content. The learning objectives are listed at the beginning Case Stud ies
of each chapter, giving students and instructors definitive
evaluation tools to use as the chapter's content is covered. Additional Case Studies round out each most chapters,
Objectives are provided at various cognitive mastery lev­ giving students another opportunity to apply the knowl­
els: comprehension, application, analysis, synthesis, and edge gained from the chapter. The scenarios are meant to
evaluation. stimulate interest and critical thinking and to encourage
discussion of chapter topics with other students.
Key Terms
Evolve Companion Website
Key terms are identified at the beginning of each chapter
and highlighted in the chapter, putting valuable terminol­ Clinical Chemistry comes with a companion website, found
ogy at students' fingertips. The key terms are also included on Evolve (evolve.elsevier.com/Larson) . This website con­
in the Glossary at the back of the book. tains helpful ancillaries for instructors and additional mate­
rials for students.
Case in Point
For the I n structor
A key clinical case study is provided at the beginning of every
appropriate chapter. The Case in Point feature provides appli­ The Evolve website has multiple features for the instructor:
cation of the student's knowledge for correlating the clinical • A test bank with multiple-choice questions and ratio­
side of test results. Students are asked to think about impor­ nales.
tant questions related to each scenario and to use fundamen­ • PowerPoint presentations for every chapter that can be
tal information from the chapter to determine the answers. used as is or as a template to prepare lectures.
• A detailed Answer Key with rationales for all in-text
Poi nts to Remember questions.
• The Image Collection that provides electronic files of all
A bulleted list of important concepts is included in the first part the chapter figures that can be downloaded into Power­
of the chapter, providing an overview of the chapter content. Point presentations.
This list gives students a simple study tool for easy reference.
For the Student
Summary
Additional content is available for the student:
A short summary at the end of the chapter highlights • High-definition animations to illustrate key physiologic
key information from the chapter. Students can revisit and pathophysiologic processes.
the various chapter topics in short form for review and • Extra Case Studies for certain chapters for more practical
reinforcement. application of textbook content.
Part 1 : Laboratory Principles 5 Molecular Diagnostics,97

Introduction, 98
Donna Larson
1 Laboratory Essentials, 1
Nucleic Acid Structure and Function, 98
Introduction, 3
Donna Larson
Laboratory Methods, 106
History of Clinical Laboratories, 3 Diagnostic Applications, 110
Types of Clinical Laboratories, 4

Laboratories, 8
Regulation and Accreditation of Clinical 6 Automation in the Laboratory,114

Laboratory Materials, 9 Introduction, 115

Donna Larson

Chemistry Review, 10 Goal of Automation, 115

Laboratory Mathematics, 14 History of Automated Analyzers, 115
Automating Clinical ChemistryTests, 117
2 Practical Laboratory Safety,25 Total Laboratory Automation, 119

Introduction, 26
Donna Larson

Safety Regulations, 26
7 Laboratory Quality Management Systems,124
John W. Ridley and Donna Larson
The Laboratory Safety Program, 29 Introduction, 126
Introduction to Quality, 126
3 Principles of Laboratory Instrumentation, 41 Facilities and Safety Overview, 128
Purchasing and Inventory, 130
Introduction, 43
Craig Foreback and Donna Larson
Process Control, 131
Properties of Light, 43 Assessment, 148
Spectrophotometry, 44 Personnel, 149
Fluorometry, 48 Customer Service, 149
Luminometry, 51 Occurrence Management, 149
Nephelometry andTurbidimetry, 51 Process Improvement, 149
Electrochemistry and Chemical Sensors, 52 Documents and Records, 151
Chromatography, 56 Organization, 152
Mass Spectrometry, 62
Electrophoresis, 67
Colligative Properties, 71
8 Enzymes,156

Point-of-CareTesting, 72 Introduction, 158

M. Laura Parnas and Thomas Kampfrath

Flow Cytometry, 74 The Nature of Enzymes, 158

Kinetics, 159
4 lmmunoassays,78 Enzyme Reaction Conditions, 162
lsoenzymes, 163
Introduction, 80
Donna Larson
Specific Enzymes, 163
Antibodies, Antigens, and Analytes, 80
lmmunochemical Methods, 82
Label Methods, 84
Part 2: Pathophysiology and Analytes

Particle Methods, 88
Light-Scattering Methods, 92
9 Clinical Chemistry and Disease,171

Introduction, 172
Donna Larson

Performance, 93
Factors Affecting Immunoassay Analytical
Definition of Disease, 172

xiii
 Contents

Pathology, 172
Disease Mechanisms, 175
17 Blood Vessel Diseases,289

Biochemistry of Disease, 175 Introduction, 291

Donna Larson

Lipids, 291
10 Cell Injury and Its Relationship to Lipoproteins, 293
Disease,179 Normal Lipoprotein Metabolism, 294
Abnormal Lipoprotein Metabolism, 296
Introduction, 180 Laboratory Procedures and Limitations, 299
Donna Larson

Overview of Cellular Injury, 180 Lipoproteins and Clinical Vascular Disease, 301
Causes of Cellular Injury, 181
Changes in Body Chemistry, 183
LaboratoryTests, 184
18 Heart Disease,306

Introduction, 307
Sheryl Berman

11 Inflammation,187 Heart Structure and Blood Flow, 307

Myocardial Infarction, 307
Introduction, 188 Congestive Heart Failure, 311
Donna Larson

Defense Mechanisms, 188 Congenital Heart Defects, 312

The Inflammation Process, 188 Endocarditis, Myocarditis, and Pericarditis, 314
Acute Inflammation, 195
Chronic Inflammation, 196
Laboratory Procedures and Limitations, 198
19 Respiratory Diseases,318

Introduction, 319
Donna Larson

12 Body Fluids and Electrolytes,204 Structure and Function of the Respiratory System, 320
Respiratory Diseases and Pathophysiology, 320
Introduction, 205
Donna Larson

Fluid Balance and Body Fluid Compartments, 205

Electrolytes, 206
20 Gastrointestinal Disease,334

Colligative Properties, 213 Introduction, 335

Sheryl Berman

Fluid Imbalances, 215 Gastrointestinal System, 335

Gastrointestinal FunctionTests, 342
13 Blood Gases and Acid-Base Balance,219

Introduction, 220
Donna Larson 21 Diseases of the Liver,346

Blood Gases, 220 Introduction, 347

Donna Larson

Acid-Base Theory, 224 Liver and BiliaryTract, 348

Acid-Base Disorders, 226 Liver Diseases, 350
Interpreting Blood Gas Analyses, 230
22 Pancreatic Diseases and Disorders,363
14 Blood Diseases,234
Introduction, 365
Donna Larson

Introduction, 236 Overview of the Pancreas, 365

Sheryl Berman

Hematopoiesis, 236 Pancreatitis, 366

White Blood Cells, 236 Diabetes, 368
Red Blood Cells, 240 Cystic Fibrosis, 375
Malabsorption and Maldigestion, 375
15 Proteins,251

Introduction, 252
Donna Larson 23 Endocrinology,379

Biochemistry of Proteins, 252 Introduction, 382

Jimmy L. Boyd and Donna Larson

Plasma Proteins, 255 Overview of the Endocrine System, 382

Proteins in Other Body Fluids, 264
Testing, 385
Anatomy, Pathophysiology, and Laboratory

16 Cancer and Tumor Markers,268

Introduction, 269
Donna Larson 24 Kidney and Urinary Tract Diseases,412

Cancer andTumor Markers, 269 Introduction, 413

Sheryl Berman

Clinical Correlations, 280 Kidney Anatomy, 414

 Contents

Normal Physiology, 416 32 Immune System Diseases,529

Disease States, 419 Sheryl Berman
Laboratory Procedures, 425 Introduction, 531
Normal Immune System, 531
25 Reproductive Diseases and Disorders,432 Disease States, 538
Donna Larson
Introduction, 433 Part 3: Other Aspects of Clinical Chemistry
Reproductive System Structure and Function, 433
Diseases and Disorders, 435 33 Therapeutic Drug Monitoring,552
Laboratory Procedures and Limitations, 442 Laird C. Sheldahl and Donna Larson
Introduction, 554
26 Pregnancy, 446 Drug Disposition, 554
Sheryl Berman Administration of Drugs, 558
Introduction, 448 Drug Levels, 560
Pregnancy, 448 Cardiovascular Drugs, 562
Complications of Pregnancy, 450 Antibiotics, 567
Fetal Complications, 453 Antiepileptic Drugs, 571
Laboratory Diagnosis of Fetal Abnormalities, 455 Psychoactive Drugs, 576
Bronchodilators, 579
27 Bone,Joint,and Skeletal Muscle Diseases,458 Immunosuppressant Drugs, 580
Donna Larson
Introduction, 459 34 Toxicology,584
Normal Anatomy and Physiology of Bones, 459 Laird C. Sheldahl and Donna Larson
Bone Diseases, 460 Introduction, 586
Normal Anatomy and Physiology of Joints, 466 Routes of Exposure, 587
Joint Diseases, 466 Dose-Response Relationship, 588
Normal Anatomy and Physiology of Muscles, 468 Acute and ChronicToxicity, 588
Muscle Diseases, 469 Specimen Collecting and Handling, 589
Conditions Caused by Pollutants, 590
28 Nervous System Diseases,474 Toxic Agents, 592
Donna Larson Household Products, 597
Introduction, 475 Toxic Metals, 599
Nervous System Anatomy and Physiology, 476 Drugs of Abuse, 602
Nervous System Diseases, 477
Cerebrospinal Fluid Analysis, 483 35 Transplantation,616

Douglas F. Stickle
Daniel/e Fortuna, Laura J. McCloskey, Zi-Xuan Wang,
29 Skin, Hair,and Nail Diseases,488
Donna Larson Introduction, 617
Introduction, 489 Overview ofTransplantation, 617
Skin Diseases, 489 Role of Medical Laboratories inTransplantation, 619
Effects of Systemic Disease on Skin, 491 Overview of the Immune System, 619
Hair Diseases, 492 Role of the Immune System inTransplantation, 622
Nail Diseases, 493 Immunosuppression, 624
Exceptional Cases inTransplantation, 628
30 Eye and Ear Diseases,497 Future ofTransplantation, 629
Donna Larson
Introduction, 497 36 Emergency Preparedness,634
Eyes, 498 Donna Larson
Ears, 501 Introduction, 636
Emergency Preparedness, 636
31 Nutritional and Metabolic Diseases,504 Emergency Response, 637
Donna Larson Laboratory Response Network, 654
Introduction, 507
General Concepts of Health and Disease, 507 Glossary,661
Cold Injuries, 507
Heat Illnesses, 508 Answer Key,683
Nutritional Conditions, 509
Metabolic Diseases, 518 Index,707
Inborn Errors of Metabolism, 520
This page intentionally left blank
 Laboratory Principles

CHAPTER OUTLI N E
I ntrod uction Chemistry Review
H i story of C l i n ical Laboratories Atomic Theory

Types of C l i n ical Laboratories

Chemical Bonds

I n patient Laboratories Factors Affecting Chemical Reactions

Outpatient C l i nics and Physicia ns' Office La boratories Acid, Bases, and Salts
Reference Laboratories Orga nic Chemistry

State and Federal La boratories Biochemistry

M i l itary Laboratories La boratory Mathematics

Reg u l ation and Accreditation of C l i n ical Laboratories

Mola rity

Reg u lation Molal ity

Accreditation Norma l ity

Di l utions
La boratory Materials
Conversions
Glasswa re and Plasticwa re
pH
Centrifuges
Beer's Law
Bala nces
Sta ndard Cu rves
Pi pettes
S u m mary
Reagents
Water

O BJ ECTIVES
At the completion of this chapter, the reader will be able to:
1. Describe the history of the clinical laboratory. 1 0. Describe the types of ba lances and their use i n the
2. List the typica l depa rtments of a clinica l laboratory. laboratory.
3. List the personnel employed in a clinica l la boratory. 1 1 . Compa re a n d contrast serologic a n d vo l u metric
4. List the characteristics of reference, federal, and m i l itary pi pettes.
la boratories. 1 2. Describe the various methods used to ca librate pi pettes.
5. Briefly describe The Joint Com mission and the Col lege of 1 3. Defi ne mola rity and mole and perform the calcu lations
American Pathologists and their roles i n clinical laboratory needed for prepa ring and worki ng with molar solutions.
oversig ht. 1 4. Defi ne molality and perform the ca lcu lations needed for
6. Describe the types of water and the uses for each. prepa ring and worki ng with molal solutions.
7. Com pa re and contrast the types of glasswa re and 1 5. Defi ne normal ity, equivalent weig ht, and m i l l iequ iva lent
plasticwa re. weight and perform the calcu lations needed for prepa ring
8. Describe the types of centrifuges used in the and worki ng with normal solutions.
laboratory. 1 6. Defi ne g/d L and mg/d L u n its and perform ca lculations
9. Describe the operating instructions and precautions for necessa ry to prepa re solutions of a desired g/d L and mg/d L
centrifuges. concentration.