Clinical Chemistry: Principles, Techniques, and Correlations

Cover Page
Title Page
Copyright Page
Disclaimer
Brief Contents
Contents
Dedication Page
Foreword
Preface
New to This Edition
Acknowledgments
Contributors
Ancillary Contributors
Reviewers
PART 1 Basic Principles and Practice in Clinical Chemistry
CHAPTER 1 Basic Principles and Practices of Clinical Chemistry
Kathryn Dugan and Elizabeth Warning
Units of Measure
Reagents
Chemicals
Reference Materials
Water Specifications
Solution Properties
Concentration
Colligative Properties
Redox Potential
Conductivity
pH and Buffers
Laboratory Equipment
Heating Units
Glassware and Plasticware
Desiccators and Desiccants
Balances
Centrifuges
Laboratory Mathematics and Calculations
Significant Figures
Logarithms
Concentration
Dilutions
Simple Dilutions
Serial Dilutions
Water of Hydration
Graphing and Beer’s Law
Specimen Collection and Handling
Types of Samples
Sample Processing
Sample Variables
Chain of Custody
Electronic and Paper Reporting of Results
CHAPTER 2 Laboratory Safety and Regulations
Brandy Greenhill
Laboratory Safety and Regulations
Occupational Safety and Health Act
Other Regulations and Guidelines
Safety Awareness for Clinical Laboratory Personnel
Safety Responsibility
Signage and Labeling
Safety Equipment
Chemical Fume Hoods and Biosafety Cabinets
Chemical Storage Equipment
PPE and Hygiene
Biologic Safety
General Considerations
Spills
Bloodborne Pathogens
Airborne Pathogens
Shipping
Chemical Safety
Hazard Communication
Safety Data Sheet
OSHA Laboratory Standard
Toxic Effects from Hazardous Substances
Storage and Handling of Chemicals
Radiation Safety
Environmental Protection
Personal Protection
Nonionizing Radiation
Fire Safety
The Chemistry of Fire
Classification of Fires
Types and Applications of Fire Extinguishers
Control of Other Hazards
Electrical Hazards
Compressed Gas Hazards
Cryogenic Materials Hazards
Mechanical Hazards
Ergonomic Hazards
Disposal of Hazardous Materials
Chemical Waste
Radioactive Waste
Biohazardous Waste
Accident Documentation and Investigation
CHAPTER 3 Quality Management in the Clinical Laboratory
Yun L. Trull, Michael W. Rogers, Cyndy B. Levtzow, Matthew P. A. Henderson, Christopher R. McCudden, and Monte S. Willis
Basic Concepts
Descriptive Statistics: Measures of Center, Spread, and Shape
Measurement of Precision
Descriptive Statistics of Groups of Paired Observations
Measurement of Bias
Inferential Statistics
Quality Control and Quality Improvement
QC Charts
Operation of a QC System
Multi-Rules Rule!
Proficiency Testing
Lean Six Sigma
Quality Assessment
Individual Quality Control Program (IQCP): An Option to Streamline QCP
Reference Range Studies
Establishing Reference Ranges
Determining Whether to Establish or Transfer and Verify Reference Ranges
Data Analysis to Establish a Reference Range
Data Analysis to Transfer and Verify a Reference Range
Method Evaluation
Regulatory Aspects of Method Evaluation
Allowable Analytical Error
Method Evaluation Acceptance Criteria
Diagnostic Efficiency
Measures of Diagnostic Efficiency
CHAPTER 4 Analytic Techniques
Karen K. Apolloni
Spectrophotometry
Beer’s Law
Spectrophotometric Instruments
Components of a Spectrophotometer
Spectrophotometer Quality Assurance
Atomic Absorption Spectrophotometry
Fluorometry
Fluorometry Instrumentation
Fluorescence Polarization
Advantages and Disadvantages of Fluorometry
Chemiluminescence
Turbidimetry
Nephelometry
Laser Applications
Electrochemistry
Galvanic and Electrolytic Cells
Half-Cells
Ion-Selective Electrodes
pH Electrodes
Gas-Sensing Electrodes
Enzyme Electrodes
Coulometric Titration
Anodic Stripping Voltammetry
Electrophoresis
Procedure
Support Materials
Treatment and Application of Sample
Detection and Quantitation
Electroendosmosis
Isoelectric Focusing
Immunofixation Electrophoresis
Capillary Electrophoresis
Two-Dimensional Electrophoresis
Osmometry
Freezing Point Osmometer
Newer Optical Techniques
Chromatography
Modes of Separation
Chromatographic Procedures
High-Performance Liquid Chromatography
Gas Chromatography
Mass Spectrometry
Sample Introduction and Ionization
Mass Spectrometer Analyzer
Detector
Applications of MS in the Clinical Laboratory
Small Molecule Analysis
Mass Spectrometry in Proteomics and Pathogen Identification
Mass Spectrometry at the Point of Care
CHAPTER 5 Clinical Chemistry Automation
Nikola A. Baumann and Brooke M. Katzman
History and Evolution of Automated Analyzers
Driving Forces and Benefits of Automation
Steps in Automated Analysis
Specimen Preparation and Identification
Specimen Measurement and Delivery
Reagent Systems and Delivery
Chemical Reaction Phase
Measurement Phase
Signal Processing and Data Handling
Additional Considerations for Automated Immunoassays
Immunoassay Basics
Turbidimetry and Nephelometry
Labeled Immunoassays
Total Laboratory Automation
Preanalytic Phase
Analytic Phase
Postanalytic Phase
Future Trends in Automation
PART 2 Analytic Procedures and Clinical Correlation
CHAPTER 6 Proteins and Heme Derivatives
Takara L. Blamires and Kristina Jackson Behan
Amino Acids
Overview
Basic Structure
Metabolism
Classification
Aminoacidopathies
Methods of Analysis
Proteins
Overview
Basic Structure
General Chemical Properties
Synthesis
Catabolism and Nitrogen Balance
Hormonal Regulation of Protein Metabolism
Classification
Plasma Proteins
Prealbumin
Albumin
Globulins
Other Proteins of Clinical Significance
Troponin
Natriuretic Peptides
Fibronectin
Cross-Linked C-Telopeptide
Cystatin C
Plasma Total Protein Abnormalities
Hypoproteinemia
Hyperproteinemia
Methods of Analysis
Sample Requirements
Total Protein
Albumin
Immunochemical Assays
Electrophoresis
Proteins in Other Body Fluids
Urine
Cerebrospinal Fluid
Hemoglobin
Synthesis and Degradation of Hemoglobin
Myoglobin
Heme
Synthesis of Heme
Disorders of Heme Biosynthesis
Clinical Application
Analytical Methods
CHAPTER 7 Nonprotein Nitrogen Compounds
Shawn H.W. Luby
Urea
Biochemistry
Clinical Application
Analytical Methods
Pathophysiology
Uric Acid
Biochemistry
Clinical Application
Analytical Methods
Pathophysiology
Creatinine/Creatine
Biochemistry
Clinical Application
Analytical Methods
Pathophysiology
Ammonia
Biochemistry
Clinical Application
Analytical Methods
Pathophysiology
CHAPTER 8 Enzymes
Donna J. Spannaus-Martin
General Properties and Definitions
Enzyme Classification and Nomenclature
Enzyme Kinetics
Enzyme Catalysis
Factors That Influence Enzymatic Reactions
Measurement of Enzyme Activity
Calculation of Enzyme Activity
Measurement of Enzyme Mass
Enzymes as Reagents
Enzymes of Clinical Significance
Creatine Kinase
Lactate Dehydrogenase
Aspartate Aminotransferase
Alanine Aminotransferase
Alkaline Phosphatase
Acid Phosphatase
γ-Glutamyltransferase
5′-Nucleotidase
Amylase
Lipase
Glucose-6-Phosphate Dehydrogenase
Macroenzymes
Drug-Metabolizing Enzymes
CHAPTER 9 Carbohydrates
Vicki S. Freeman
General Description of Carbohydrates
Classification of Carbohydrates
Stereoisomers
Monosaccharides, Disaccharides, and Polysaccharides
Chemical Properties of Carbohydrates
Glucose Metabolism
Fate of Glucose
Regulation of Carbohydrate Metabolism
Hyperglycemia
Diabetes Mellitus
Pathophysiology of Diabetes Mellitus
Criteria for Testing for Prediabetes and Diabetes
Criteria for the Diagnosis of Diabetes Mellitus
Criteria for the Testing and Diagnosis of GDM
Hypoglycemia
Genetic Defects in Carbohydrate Metabolism
Role of the Laboratory in Differential Diagnosis and Management of Patients with Glucose Metabolic Alterations
Methods of Glucose Measurement
Self-Monitoring of Blood Glucose
Glucose Tolerance and 2-Hour Postprandial Tests
Glycosylated Hemoglobin/HbA1c
Ketones
Albuminuria
Islet Autoantibody, Insulin Testing, and C-Peptide Testing
CHAPTER 10 Lipids and Lipoproteins
Kathleen M. Kenwright
Lipid Chemistry
Fatty Acids
Triglycerides
Phospholipids
Cholesterol
General Lipoprotein Structure
Chylomicrons
Very-Low-Density Lipoprotein
Intermediate-Density Lipoproteins
Low-Density Lipoproteins
Lipoprotein (a)
High-Density Lipoproteins
Lipoprotein X
Lipoprotein Physiology and Metabolism
Lipid Absorption
Exogenous Pathway
Endogenous Pathway
Reverse Cholesterol Transport Pathway
Lipid and Lipoprotein Population Distributions
National Cholesterol Education Program
Dyslipidemia and Children
National Heart, Lung, and Blood Institute
Diagnosis and Treatment of Lipid Disorders
Arteriosclerosis
Hyperlipoproteinemia
Hypercholesterolemia
PCSK9
Hypertriglyceridemia
Combined Hyperlipidemia
Lp(a) Elevation
Non-HDL Cholesterol
Hypobetalipoproteinemia
Hypoalphalipoproteinemia
Lipid and Lipoprotein Analyses
Lipid Measurement
Cholesterol Measurement
Triglyceride Measurement
Lipoprotein Methods
HDL Methods
LDL Methods
Apolipoprotein Methods
Phospholipid Measurement
Fatty Acid Measurement
Standardization of Lipid and Lipoprotein Assays
Precision
Accuracy
Matrix Interactions
CDC Cholesterol Reference Method Laboratory Network
Analytic Performance Goals
Quality Control
Specimen Collection
CHAPTER 11 Electrolytes
James March Mistler
Water
Osmolality
The Electrolytes
Sodium
Potassium
Chloride
Bicarbonate
Calcium
Magnesium
Phosphate
Lactate
Anion Gap
Electrolytes and Renal Function
CHAPTER 12 Blood Gases, pH, and Buffer Systems
Kyle B. Riding
Acid–Base Balance
Maintenance of H+
Buffer Systems: Regulation of H+ and the Henderson-Hasselbalch Equation
Regulation of Acid–Base Balance: Lungs and Kidneys (Transport of Carbon Dioxide)
Assessment of Acid–Base Homeostasis
The Bicarbonate Buffering System
Acid–Base Disorders: Acidosis and Alkalosis
Determining Patient Acid–Base Status
Oxygen and Gas Exchange
Oxygen and Carbon Dioxide
Oxygen Transport
Assessment of a Patient’s Oxygen Status
Hemoglobin–Oxygen Dissociation
Measurement
Blood Gas Analyzers: pH, pCO2, and pO2
Measurement of pO2
Measurement of pH and pCO2
Types of Sensors
Calibration
Correction for Temperature
Calculated Parameters
Spectrophotometric Determination of Oxygen Saturation (CO-Oximetry)
Quality Assurance
Preanalytic Considerations
Analytic Assessments: Quality Control and Proficiency Testing
PART 3 Endocrinology and Clinical Correlation
CHAPTER 13 Basic Endocrinology
Scott Moore
Hormone Classification
Amine
Peptide
Protein
Glycoprotein
Steroid
Fatty Acid
Introduction to Hormones
Growth Hormone (GH)
Adrenocorticotropic Hormone (ACTH) and the Adrenal Cortical Hormones
Follicle Stimulating Hormone and Luteinizing Hormone
Prolactin (PRL)
Androgens
Progesterone
Estrogens/Estradiol/Estriol
Catecholamines
Thyroid Hormone (T3, T4) and Thyroid Stimulating Hormone (TSH)
Posterior Pituitary Hormones
Calcitonin and Procalcitonin
Parathyroid Hormone (PTH)
Insulin
Glucagon
Gastrin and Secretin
Human Chorionic Gonadotropin (hCG)
Serotonin/5-hydroxyindolacetic Acid (5-HIAA)
Hormone Metabolism
Alcohol Consumption
Adrenal Steroid Hormone Synthesis
Mechanisms of Elimination
Hormone Transport
Solubility
Carrier Proteins
Micelles
Feedback Mechanisms
Negative Feedback Mechanisms
Positive Feedback Mechanisms
Primary, Secondary, and Tertiary Disorders
Other Factors That Affect Hormone Levels
Emotional Stress
Time of Day
Menstrual Cycle
Menopause
Food Intake/Diet
Drugs
CHAPTER 14 Thyroid Function
Yukari Nishizawa-Brennen
The Thyroid
Thyroid Anatomy and Development
Thyroid Hormone Synthesis
Protein Binding of Thyroid Hormone
Control of Thyroid Function
Actions of Thyroid Hormones
Tests for Thyroid Function
Thyroid-Stimulating Hormone
Thyroxine (T4)
Triiodothyronine (T3)
Free Thyroxine (FT4)
Free Triiodothyronine (FT3)
Thyroglobulin Antibody
Thyroperoxidase Antibody
Thyrotropin Receptor Antibody
Other Tools for Thyroid Evaluation
Nuclear Medicine Evaluation
Thyroid Ultrasound
Fine-Needle Aspiration
Disorders of the Thyroid
Hypothyroidism
Thyrotoxicosis
Hyperthyroidism
Toxic Adenoma and Multinodular Goiter
Drug-Induced Thyroid Dysfunction
Amiodarone-Induced Thyroid Disease
Subacute Thyroiditis
Nonthyroidal Illness
Thyroid Nodules
CHAPTER 15 Hypothalamic and Pituitary Function
Stephanie L. Jacobson
Embryology and Anatomy
Functional Aspects of the Hypothalamic–Hypophyseal Unit
Pituitary Tumors
Hypophysiotropic or Hypothalamic Hormones
Anterior Pituitary Hormones
Growth Hormone
Actions of GH
Testing
GH Excess
GH Deficiency
Prolactin
Prolactinoma
Other Causes of Hyperprolactinemia
Clinical Evaluation of Hyperprolactinemia
Management of Prolactinoma
Idiopathic Galactorrhea
Hypopituitarism
Etiology of Hypopituitarism
Treatment of Panhypopituitarism
Posterior Pituitary Hormones
Oxytocin
Arginine Vasopressin
CHAPTER 16 Adrenal Function
Stephanie L. Jacobson
Embryology and Anatomy
The Adrenal Cortex
Glucocorticoid Physiology
Cortex Steroidogenesis
Congenital Adrenal Hyperplasia
Primary Aldosteronism
Etiology
Diagnosis
Treatment
Adrenal Insufficiency
Symptoms
Diagnosis
Treatment
Isolated Hypoaldosteronism
Hypercortisolism (Cushing’s Syndrome)
Etiology
Diagnosis
Treatment
Adrenal Androgens
Androgen Excess
Diagnosis
Treatment
The Adrenal Medulla
Embryology
Biosynthesis, Storage, and Secretion of Catecholamines
Metabolism and Excretion of Catecholamines
Pheochromocytoma and Paraganglioma
Epidemiology
Clinical Presentation
Diagnosis
Result Interpretation
Treatment
Adrenal Incidentaloma
CHAPTER 17 Gonadal Function
Jane R. Semler
The Testes
Functional Anatomy of the Male Reproductive Tract
Physiology of the Testicles
Disorders of Sexual Development and Testicular Hypofunction
Diagnosis of Hypogonadism
Testosterone Replacement Therapy
Monitoring Testosterone Replacement Therapy
The Ovaries
Early Ovarian Development
Functional Anatomy of the Ovaries
Hormonal Production by the Ovaries
The Menstrual Cycle
Hormonal Control of Ovulation
Pubertal Development in the Female
Precocious Sexual Development
Menstrual Cycle Abnormalities
Evaluation of Female Infertility
Hirsutism
Estrogen Replacement Therapy
CHAPTER 18 Parathyroid Function
Rebbecca Silva
Parathyroid Glands
Parathyroid Hormone
Vitamin D
Effects of the Parathyroid Hormone
GI Regulation
Role of Kidneys
Bone Physiology
Parathyroid Disorders
Primary Hyperparathyroidism
Secondary Hyperparathyroidism
Secondary and Tertiary Hyperparathyroidism in Renal Failure
Familial Hypocalciuric Hypercalcemia
Hyperthyroidism
Addison’s Disease
Medications That Cause Hypercalcemia
Hypervitaminosis
Parathyroid Hormone–Related Protein
Hypoparathyroidism
Metabolic Bone Diseases
Rickets and Osteomalacia
Osteoporosis
PART 4 Organ Systems and Clinical Correlation
CHAPTER 19 Liver Function
Janelle M. Chiasera
Anatomy
Gross Anatomy
Microscopic Anatomy
Biochemical Functions
Excretory and Secretory Functions
Metabolism
Detoxification and Drug Metabolism
Liver Function Alterations During Disease
Jaundice
Cirrhosis
Tumors
Reye’s Syndrome
Drug- and Alcohol-Related Disorders
Assessment of Liver Function/Liver Function Tests
Bilirubin
Methods
Urobilinogen in Urine and Feces
Serum Bile Acids
Enzymes
Tests Measuring Hepatic Synthetic Ability
Tests Measuring Nitrogen Metabolism
Hepatitis
CHAPTER 20 Cardiac Function
Teresa A. Mortier
Pathophysiology of Atherosclerosis
Cardiac Ischemia, Angina, and Heart Attacks
Markers of Cardiac Damage
Initial Markers of Cardiac Damage
Cardiac Troponins
Myoglobin
Cardiac Injury
Cardiac Biomarkers in Heart Failure
Diagnosis and Risk Stratification of Heart Failure
Cardiac Troponins
Markers of Coronary Heart Disease Risk and Plaque Instability
C-Reactive Protein
Homocysteine
Markers of Pulmonary Embolism
Use of D-Dimer Detection in PE
Value of Assaying Troponin and BNP in Acute PE
Coronary Heart Disease
CHAPTER 21 Renal Function
Peter O’Brien
Renal Anatomy
Renal Physiology
Glomerular Filtration
Tubular Function
Elimination of Nonprotein Nitrogen Compounds
Water, Electrolyte, and Acid–Base Homeostasis
Endocrine Function
Analytic Procedures
Creatinine Clearance
Estimated GFR
Cystatin C
β2-Microglobulin
Myoglobin
Albuminuria
Neutrophil Gelatinase–Associated Lipocalin
NephroCheck
Urinalysis
Pathophysiology
Glomerular Diseases
Tubular Diseases
Urinary Tract Infection/Obstruction
Renal Calculi
Renal Failure
CHAPTER 22 Pancreatic Function
Gerald D. Redwine, John E. Lee Sang, and Amanda Rivera-Begeman
Physiology of Pancreatic Function
Diseases of the Pancreas
Tests of Pancreatic Function
Cholecystokinin (CCK) Test
Fecal Fat Analysis
Fecal Enzymes
Sweat Electrolyte Testing
Serum Enzymes
Tests of Gastric Secretion and Intestinal Function
PART 5 Specialty Areas of Clinical Chemistry
CHAPTER 23 Body Fluid Analysis
Kyle B. Riding
Cerebrospinal Fluid
Serous Fluids
Pleural Fluid
Pericardial Fluid
Peritoneal Fluid
Amniotic Fluid
Hemolytic Disease of the Fetus and Newborn
Neural Tube Defects
Fetal Lung Maturity
Phosphatidylglycerol
Lamellar Body Counts
Sweat
Synovial Fluid
CHAPTER 24 Pregnancy and Prenatal Testing
Heather L. Phillips and Michelle R. Campbell
Pregnancy
Conception and Embryonic Development
Fetal Development
Delivery
Transformation During Pregnancy
Plasma Volume Increase
Renin–Angiotensin–Aldosterone System
Natural Decreases in Analytes
Upregulation of Hormones and Steroids
Increased Glomerular Filtration Rate
Hyperventilation
Endocrine
Cholesterols
Immune System
Neuroactive Hormones
Analytes for Maternal and Fetal Health Assessment
Human Chorionic Gonadotropin
α-Fetoprotein (AFP)
Fetal Amniotic Fluid α-Fetoprotein
Unconjugated Estriol
Inhibin A
The Triple and Quadruple Screen Test
Acetylcholinesterase
Pregnancy Associated Plasma Protein A (PAPP-A)
Progesterone
Glucose
Fetal Fibronectin
Common Diseases Associated with the Developing Fetus
Neural Tube Defects
Down Syndrome
Trisomy 18
Isoimmunization
Preterm Delivery
Common Diseases Associated with the Mother and Pregnancy
Preeclampsia
Hyperemesis Gravidarum
Ectopic Pregnancy
Analyte Deficiency
Other Clinical Impairments
CHAPTER 25 Therapeutic Drug Monitoring
Jie Gao and Floyd Josephat
Pharmacokinetics
Routes of Administration
Drug Absorption
Drug Distribution
Free Versus Bound Drugs
Drug Metabolism
Drug Elimination
Elimination Example
Pharmacodynamics
Specimen Collection
Pharmacogenomics
Cardioactive Drugs
Digoxin
Quinidine
Procainamide and N-acetylprocainamide
Disopyramide
Antibiotics
Aminoglycosides
Gentamicin
Tobramycin
Amikacin
Vancomycin
Antiepileptic Drugs
Primidone
Phenobarbital
Phenytoin and Free Phenytoin
Valproic Acid
Carbamazepine
Ethosuximide
Felbamate
Gabapentin
Lamotrigine
Levetiracetam
Oxcarbazepine
Tiagabine
Topiramate
Zonisamide
Psychoactive Drugs
Lithium
Tricyclic Antidepressants
Clozapine
Olanzapine
Immunosuppressive Drugs
Cyclosporine
Tacrolimus
Sirolimus
Everolimus
Mycophenolic Acid
Antineoplastics
Methotrexate
Bronchodilators
Theophylline
CHAPTER 26 Toxicology
Christopher R. Swartz
Xenobiotics, Poisons, and Toxins
Routes of Exposure
Dose–Response Relationship
Acute and Chronic Toxicity
Analysis of Toxic Agents
Toxicology of Specific Agents
Alcohols
Carbon Monoxide
Caustic Agents
Cyanide
Metals and Metalloids
Pesticides
Toxicology of Therapeutic Drugs
Salicylates
Acetaminophen
Toxicology of Drugs of Abuse
Amphetamines
Sedatives–Hypnotics
Barbiturates
Benzodiazepines
Cannabinoids: Tetrahydrocannabinol (THC)
Cocaine
Opioids
Tricyclic Antidepressants
Methylenedioxymethamphetamine
Phencyclidine
Anabolic Steroids
CHAPTER 27 Trace Elements, Toxic Elements, and Vitamins
Michelle R. Campbell
Trace and Toxic Elements
Instrumentation and Methods
Aluminum
Arsenic
Cadmium
Chromium
Copper
Iron
Lead
Manganese
Mercury
Molybdenum
Selenium
Zinc
Vitamins
Overview
Fat-Soluble Vitamins
Water-Soluble Vitamins
CHAPTER 28 Tumor Markers
Carleen Van Siclen
Types of Tumor Markers
Applications of Tumor Marker Detection
Screening and Risk Assessment
Prognosis
Monitoring Effectiveness of Therapy and Disease Recurrence
Laboratory Considerations for Tumor Marker Measurement
Immunoassays
High-Performance Liquid Chromatography
Immunohistochemistry and Immunofluorescence
Enzyme Assays
Tumor Marker Tests
α-Fetoprotein
Cancer Antigen 125 (CA-125)
Carcinoembryonic Antigen (CEA)
Human Chorionic Gonadotropin (hCG)
Prostate-Specific Antigen (PSA)
Cancer Antigen 15-3 (CA 15-3)
Carbohydrate Antigen 19-9 (CA 19-9)
Immunoglobulin Free Light Chains
Human Epididymis Protein 4 (HE4)
Neuron-Specific Enolase (NSE)
CHAPTER 29 Point-of-Care Testing
Heather McNasby
Laboratory Regulations
Accreditation
POCT Complexity
Implementation
Establishing Need
POCT Implementation Protocol
Personnel Requirements
Quality Management
Accuracy Requirements
QC and Proficiency Testing
POC Applications
Informatics and POCT
CHAPTER 30 Newborn and Pediatric Clinical Chemistry
Khushbu Patel and Tracey G. Polsky
Developmental Changes from Neonate to Adult
Respiration and Circulation
Growth
Organ Development
Problems of Prematurity and Immaturity
Pediatric Sample Collection and Handling
Phlebotomy
Preanalytic Concerns
Choice of Analyzer
Point-of-Care Analysis in Pediatrics
Turnaround Time
Evaluation of POCT Devices
Device Limitations for Pediatric Use
Regulation of Blood Gases and pH in Neonates and Infants
Blood Gas and Acid–Base Measurement
Regulation of Electrolytes and Water: Renal Function
Disorders Affecting Electrolytes and Water Balance
Development of Liver Function
Physiologic Jaundice
Energy Metabolism
Diabetes
Nitrogen Metabolism
Nitrogenous End Products as Markers of Renal Function
Liver Function Tests
Calcium and Bone Metabolism in Pediatrics
Hypocalcemia and Hypercalcemia
Endocrine Function in Pediatrics
Hormone Secretion
Hypothalamic–Pituitary–Thyroid System
Hypothalamic–Pituitary–Adrenal Cortex System
Growth Factors
Endocrine Control of Sexual Maturation
Development of the Immune System
Basic Concepts of Immunity
Components of the Immune System
Neonatal and Infant Antibody Production
Immunity Disorders
Genetic Diseases
Cystic Fibrosis
Newborn Screening for Whole Populations
Diagnosis of Metabolic Disease in the Clinical Setting
Drug Metabolism and Pharmacokinetics
Therapeutic Drug Monitoring
Toxicologic Issues in Pediatric Clinical Chemistry
CHAPTER 31 Geriatric Clinical Chemistry
Laura M. Hickes and J. Marvin McBride
The Aging of America
Aging and Medical Science
General Physiologic Changes with Aging
Muscle
Bone
Gastrointestinal System
Kidney/Urinary System
Immune System
Endocrine System
Sex Hormones
Glucose Metabolism
Effects of Age on Laboratory Testing
Muscle
Bone
Gastrointestinal System
Urinary System
Immune System
Endocrine System
Sex Hormones
Glucose Metabolism
Establishing Reference Ranges for Older Adults
Preanalytical Variables Unique to Geriatric Patients
Diseases Prevalent in Older Adults
Age-Associated Changes in Drug Metabolism
Absorption
Distribution
Metabolism
Elimination
Atypical Presentations of Common Diseases
Geriatric Syndromes
The Impact of Exercise and Nutrition on Chemistry Results in the Geriatric Population
Appendix: Reference Ranges
Glossary
Index