BIOM3001 / BIOM3901

Biomedical Science/Biomedical Studies

Clinical Biochemistry
Module Handbook
Academic session 2012
Module Leader: Dr Graham Basten
Basic Module Description
Base school
Credit value
Subject authority board

Allied Health
15
BMS&MS

fee band
credit level

Module leader

Dr Graham Basten

2
6

Basic Design Information

Total Hours/Activity
for Students

Lecture

Lab

20

Self Directed

Total

92 (4hr per week)

120

Module Requisites
Pre-requisite
-

Mandatory
Co-requisite
-

Core

Module Assessment
Semester 6

Total Duration

Unseen Exams
3 hours
Other Coursework Practical -

% Final Module Mark

70%
30%

Welcome, Aims and Objectives

This module is concerned with the application of biochemistry and cell physiology to the
diagnosis and monitoring of disease and its treatment in man. It includes a study of the
analytical principles employed to obtain data, the monitoring of the quality of those data,
as well as the evaluation of the data in the context of the normal and pathological
biochemistry and physiology of man. Principles, problems, current trends and potential
future developments will be covered rather than a routine description of methods.
The overall aim of this module is that the student understands the use of the chemical
pathology laboratory in diagnosis and patient management. At the end of the module the
student will know and understand:
(i)
(ii)
(iii)
(iv)

Biochemical/physiological processes in disease and their relationship to

appropriate laboratory measurements for diagnosis/patient management.
Interpretation of clinical biochemical data in patient care.
The commonly encountered mistakes/difficulties in the use of the laboratory, and
consequently.
The central role of laboratory medicine in general and chemical pathology in
particular, in diagnosis and management.

Revision Strategy

Students may also contact the module Dr Graham Basten (GB), room H0.36a, e-mail:
gbasten@dmu.ac.uk or twitter: @grahambasten
This year we are lucky to be joined by Jessica Leads (JL), a qualified Biomedical
Scientist.
1. Twitter: The module has a twitter account @biom3001 lecture notes and material

will be posted here. Please feel free to use twitter to share anything interesting you
find on the subject, or tweet me a question, and use the bookboon and showme
resources. Previous students have also created material and shared this with
students.
2. Lecture Material: In class I demonstrate the learning outcomes, you should cross
reference your lecture notes with the module outcomes and the recommended
textbook.
3. Recommend Textbook: As well as the books in the handbook, I said in class to also
use my free book which contains much of the lecture materials, particularly the
drawings. You can get it here:
http://bookboon.com/uk/textbooks/biochemical/introduction-to-clinical-biochemistry
4. Mock Exams: You should practice the exam using past papers on DMU librarys
Examnet. On completion of your answer please email relevant section to Dr Basten
for feedback. This can be done at any time of the year.

5. Personal sessions: The lectures are the primary method of contact time for delivery
and support to students, to hold private sessions on the entire module content for
each student would be inappropriate. However, if you really are stuck please drop
me an email and Ill help out.
6. Showme: I have placed learning material on the website:
http://www.showme.com/search/?q=Graham%20Basten
Helpful Texts
http://bookboon.com/uk/textbooks/biochemical/introduction-to-clinical-biochemistry
Mayne PD (1994) Clinical chemistry in diagnosis and treatment (Sixth Edition, Arnold)
Crook MA (2006) Clinical Chemistry and Metabolic Medicine (Hodder Arnold)
Other texts and websites
Gaw A, Gowan RA, O'Reilly D, Stewart MJ and Shepherd J (1995) Clinical Biochemistryan illustrated coloured text (Churchill Livingstone)
Mayne PD and Day AP (1994) A Workbook of Clinical Chemistry
Calbreath D (1992) Clinical Chemistry: A Fundamental Textbook. Saunders
Tietz N (1987) Fundamentals of Clinical chemistry. 3rd Saunders
Varley H (1987) Practical Clinical Biochemistry. 4th Heinemann.
Baynes JW (2005) Medical Biochemistry (Elsevier)
Google Leeds Pathology
Student Key Skills which provide concise information on report writing, grammar and
generic writing skills are available from: www.skills.dmu.ac.uk
And: http://www.library.dmu.ac.uk/Support/Selfstudy/index.php?page=89
Journals
Clinical Chemistry
Clinica Chimica Acta
British Journal of Biomedical Science
Annals of Clinical Biochemistry
Free student membership to Institute of Biomedical Science with free IBMS journals
Register with MY NCBI Medline for e-mail alerts for Clin Chem
Module Syllabus
The major topics to be covered will be selected from:

Laboratory tests: Characteristics of ideal methods, sources of error, sample problems,

human variability, reference ranges, quality control, and internal and external quality
assessment, and biological standards.
Renal function and dysfunction, both glomerular and tubular, including aspects of
acid/base homeostasis.
Proteins: Types, roles and analysis in blood, CSF and urine.
Bone metabolism: Calcium and bone diseases i.e. osteoporosis.
Diagnostic enzymology: Principles, organ specificity using specific enzymes,
isoenzymes and pattern recognition. AMI, skeletal muscle, pancreas and liver will be
used as selected examples.
Tumour markers: Aspects of tissue specificity and tumour profile will be considered.
Drugs and poisons: Sources of medical cases, problems with specimens, analysis and
interpretation, a survey of methods and a study of representative groups of materials will
be included.
Neonatal biochemistry including fetal investigations. This will include a consideration of
laboratory approaches to investigation at the chemical, genetic and cellular levels.
Principles of clinical endocrinology with the adrenal gland used as an example.
Toxicology: Drugs and poisons
Module Grade and Assessment
This is in line with current DMU rules and regulations.
Lecture Summaries and Suggested Learning Outcomes
Examples of lectures are highlighted below. Please note they are in no particular order.
Please note you will only be examined on topics delivered in the lectures. To obtain the
best mark youll need to show additional reading around those topics.
Introduction to Chemical Pathology (GB)

Describe the organisation (present and future) of a clinical laboratory

Define the major subdivisions of clinical biochemistry
Describe commonly encountered problems

Learning outcomes: The student will understand the current structures, operation and
operational difficulties of a typical chemical pathology laboratory.

Applied Pathology (JL)

Discuss the objectives and effective use of the service

Discuss the handling of high risk and priority or emergency samples
Explain general sampling problems and define the important clinical terms
including haemolysis, lipaemia, xanthochromia, old sample, jaundice, and
neonate
Learning outcomes: The student will continue to build an understanding of the
operational difficulties of a typical chemical pathology laboratory.
Samples and sample problems (GB)

Explain the difference (and importance) between plasma and serum

Describe the commonly used preservatives

Learning outcomes: The student will continue to build an understanding of the

operational difficulties of a typical chemical pathology laboratory.
Variation & Reference Ranges (JL)
Discuss normality and abnormality including simple statistical concepts (e.g.
cluster analysis and data handling)
Discuss the construction of reference ranges
Important considerations in data interpretation e.g. age, stature, sex etc.
To describe action limits and discuss laboratory common sense
Learning outcomes. The student will understand and appreciate the principles
underlying the construction of effective reference ranges.
Method Evaluation/Quality Assurance (JL)

To consider within and between batch precision and overall method precision.
To explain statistical techniques for the comparison of analytical methods.

To explain the terms primary and secondary standards

To understand the reasons for quality assurance and quality control
Explain the reasons for internal and external QC
Define accuracy, precision, bias, daily patient mean and variability
To discuss short and long term requirements for QA, analytical goals, biological
variation, patient needs etc
To describe commonly used schemes
To illustrate the problems using Levy-Jennings plots, QC scores etc.
To explain laboratory accreditation and appropriate legislation

Learning outcomes. The student will understand the need for quality assurance and
analytical confidence in clinical laboratories.

Renal Function (GB)

To revise the functions of the kidney using U&Es

To understand the concepts of clearance and homeostasis
Define proteinuria - glomerular, tubular, mixed and overflow

To describe tests of glomerular and tubular function and clinical impact

Discuss the impact of nephrotoxicity
Discuss result interpretation using simple examples

Learning outcomes. The student will understand the role of the laboratory in the
assessment of renal function in both health and disease.
Acid-base status (GB)

To understand the terms 'pH', 'acidosis', 'alkalosis'

To revise briefly the physiology of acid/base homeostasis and compensatory
mechanisms
To know the Henderson Hasselbach equation
To illustrate these principle with clinical examples including Diabetic ketoacidosis,
lactic acidosis, COPD, pyloric stenosis, salicylate overdose

Learning outcome: The student will be able to interpret simple arterial blood gas
patterns.
Principles of Endocrinology (JL)

To review the mechanisms controlling hormone secretion

Describe the circadian rhythm of hormone excretion wrt cortisol and ACTH
Discuss the use of stimulation and suppression tests
Define the terms primary and secondary hormone abnormalities
Define appropriate and inappropriate hormone secretion
Abnormalities of the HPA Axis

The differential laboratory diagnosis of Cushings Syndrome and Addisons

disease.
Clinical examples of the above

Learning outcomes. The student will understand the principles of clinical endocrinology
and the interpretation of adrenal function tests.
Proteins (JL)

To describe the major classes of blood, plasma and serum proteins and their
functions

The determination/detection of proteins by electrophoresis, dye binding methods

and the use of monoclonal and polyclonal antibodies
Introduce the quantitation of proteins in diagnosis with reference to CSF
To describe and discuss the relationship between albumin and globulins in
various disease states with particular reference to liver disease, infection and
myelomatosis
Bence Jones

Learning outcomes. The student will understand the role of plasma proteins in health
and disease.

Bone Diseases (GB)

The biochemical and clinical characteristics and underlying pathophysiology of

common bone diseases will be described. E.g. osteoporosis and osteomalacia.
The methods used in the diagnosis of these diseases will be discussed.
The role of PTH and Vitamin D in calcium homeostasis
Parathyroid diseases primary, secondary and tertiary.

Learning outcome: The student will understand the mechanisms involved in calcium
homeostasis and the clinical biochemical characteristics of parathyroid disease.
Learning outcomes: The student will, with knowledge of calcium metabolism,
understand the pathophysiology and diagnosis of common bone diseases (e.g.
osteoprosis, osteomalacia, Pagets disease).
Tumour Markers (JL)

To understand the term 'tumour marker'

To know their use in the diagnosis and prognosis of neoplasia
To review the tissue specificity of tumour markers
An illustration of the principles of tumour marker use by the use of examples of
specific tumour markers in the diagnosis and monitoring of malignancy
(These will include breast and lung cancer)
Review of the laboratory tests used for the diagnosis of Phaeochromocytoma

Learning outcome: The student will understand the use of tumour markers in Clinical
Chemistry including diagnosis, staging and prognosis.
Liver Function

LFT
Describe bilirubin metabolism
Define the terms pre-, post- and hepatic jaundice
The use of the laboratory in the differential diagnosis of jaundice

Learning outcomes: The student will understand the laboratory diagnosis of jaundice,
including neonatal jaundice.
Diagnostic enzymology (GB)

Discuss general considerations including sample problems, units, reference

ranges etc.
Describe commonly used enzymes including transaminases, creatine kinase,
lactate dehydrogenase, amylase, alkaline phosphatase and gammaGT
Explain specificity, sensitivity and selectivity.
The use of isoenzymes in diagnosis, especially those of LDH, CK and alkaline
phosphatase
in myocardial infarction and liver disease
To discuss the use of activity versus enzyme mass determinations.

Learning outcomes: The student will understand the principles of clinical enzymology
and enzyme changes associated with liver disease and acute myocardial infarction.
Neonatal biochemistry (JL)

To consider neonatal reference ranges, genetic and non-genetic conditions.

To explain the term 'failure to thrive'.
To describe sequential approaches to diagnosis including modern biochemical,
cellular and molecular techniques.
To discuss the classification of genetic disorders.
To describe illustrative examples including PKU and Cystic Fibrosis

Learning outcomes: The student will have a good grounding in neonatal biochemistry
and understand the need for neonatal monitoring.
Drugs & Poisons (GB)

Introduction to therapeutic drug monitoring

Review of the drugs currently measured
Review the techniques currently used
A consideration of drugs and poisons screening
Reasons for screening
Quality control and sample considerations
Drug absorption and metabolism mechanisms
Strategies for screening for a wide range of drugs/poisons in one sample
Summary and revision of lectures I, II and III

Learning outcomes: The student will understand the need for drug monitoring and
analysis using relevant examples, criteria for the provision of an effective service
including quality control and analytical considerations and strategies for poisons
screening.

Practical Sessions

There will be two practical classes Urine Analysis and Studies on inherited disease and
pre-natal investigations. Details will be placed on blackboard.

LABORATORY SAFETY
1.

You must be aware of, and operate within, the general rules governing laboratory
safety. In particular students will:
(i)
(ii)
(iii)

not bring any items of food or drink with them into laboratories.
behave in a mature and responsible manner.
Be considerate towards other students and respect laboratory facilities.

2.

Laboratory coats must always be correctly fastened and disposable gloves

should be worn when appropriate. Eye protection must always be worn in
the laboratory during practical work.

3.

In particular, you must never pipette any solution by mouth and must always use
automatic pipettes or pipetting aids as directed.

4.

If directed to use a pipette controller, take care when fitting the end of a glass
pipette into the pipette controller not to apply excessive force, snap the pipette,
and drive the broken end into your hand. If in doubt about how to use or fit a
pipette controller, ask for a demonstration.

5.

Any human-based material used in the practical will have been tested for
hepatitis A and B antigens and for HIV, and shown to give negative results, but
handle all biological samples with care, and avoid their contact with eyes, skin
and mouth.

6.

Avoid contact with chemical reagents (e.g.diazo reagent, sulphanilic acid,

methanol, Ehrlich's reagent, chloroform, preservatives, fixatives, staining agents,
solvents, alkalis and acids) with eyes, skin or mouth.

7.

Wash your hands before leaving the laboratory.

NB. FAILURE TO OBEY THE OBEY INSTRUCTIONS WILL RESULT IN THE

STUDENT BEING ASKED TO LEAVE THE CLASSROOM. NO PRACTICAL REPORT
WILL BE ACCEPTED AND NO MARK GIVEN.

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