`The University of Texas at El Paso
College of Health Sciences & School of Nursing
Clinical Laboratory Science Program
CLSC 3155 – Clinical Chemistry I Lab
Spring 2013
The University of Texas at El Paso
College of Health Sciences & School of Nursing
Clinical Laboratory Science Program
Clinical Chemistry II Lab CLSC 3164
This course aligns with Healthy People 2020
Instructor: Elizabeth Camacho, B.S., M.T. (ASCP) Molecular Diagnostics Certificate
Office:
College of Health Sciences (CHSSON) 417
e-mail: [email protected]
Phone: 747-8596
Fax:
747-8224 or 747:7207
Laboratory Schedule: (Thursday 1-4 PM) at CHSSON 137
OFFICE HOURS: Thursday 10:00 to 12:00 a.m.
If you are unable to see me at this time, you may arrange an appointment at another time. You may schedule
meetings by Blackboard, telephone, or in person after lecture/laboratory session. Please use office hours to clarify
lecture objectives, special interests or career goals at the earliest convenience for both parties. The best time to
reach me by phone is during posted office hours. If I am unable to answer your call, please leave a detailed message
and I’ll return your call as soon as possible.
COURSE DESCRIPTION
The Clinical Chemistry Laboratory course is designed to develop and refine skills in performing
Clinical Chemistry testing by applying the theory learned in lecture. Clinical chemistry is a rapidly
changing area in laboratory medicine because of the variety of automated instrumentation available.
It is essential, therefore, that the basic principles as well as the techniques used in clinical chemistry
be mastered by the laboratorian. These include the basic theory of chemical determinations, use and
care of laboratory equipment and apparatus, application of quantitative measurement, proper
preparation of reagents, recognition of problems when they arise, proper collection and handling of
specimens, reporting of results, and the use of quality assurance protocol in the performance of any
procedure in the laboratory. The uses and general principles of selected tests and methodologies in
the clinical chemistry laboratory will be discussed, as the student performs the test. There will be
additional focus on laboratory mathematics and how it is applied to obtain the results achieved.
COURSE GOAL:
This course is designed to provide the student with basic clinical chemistry foundations to promote
and facilitate the understanding of this complex science. The student will learn to competently
perform basic procedures and correctly interpret the findings given adequate clinical data. This
course will provide the student with the knowledge to accurately distinguish between normal and
abnormal results and identify various testing procedures to evaluate the patient results in light of
clinical evidence.
COURSE OBJECTIVES:
A. Cognitive
Upon completion of this course, the student will:
1. Analyze how the identification of critical values impact clinical decision making.
2. List five components of Occupational Safety and Health Administration Act (OSHA) –
mandated Chemical Hygiene Plan.
3. Define & provide examples of the principles of safety, governmental regulations and
standards to laboratory practice to include (a) universal precautions policy and its purpose,
(b) appropriate procedures for the handling, (c) disposal, (d) decontamination and spill
control of biohazards.
4. State the purpose of information contained in a material safety data sheet. Provide one
example.
5. Describe the methods used for water purification and the specifications, uses, storage and
handling procedures used for different grades of reagent water.
6. Describe the proper way to use a pipette: volumetric, serologic, micropipette, transfer, etc.
7. Describe the proper operation, maintenance, and quality control of balances, centrifuges,
water baths, spectrophotometer, and heating blocks in the clinical laboratory.
8. Define “latex allergies,” and explain the precautions that should be taken to protect
patients and hospital workers from an adverse latex exposure.
9. How does the relationship between percent transmittance (%) and absorbance (A), affects
the color of a solution?
10. Illustrate an identify the following parts of a spectrophotometer: source of radiant energy,
entrance slit, wavelength selector, exit slit, cuvette /cuvette holder, detector and readout
device. Explain how it works.
11. Explain advantages and disadvantages of photometrioc monochromators & detectors.
12. Identify the ractive site of an enzyme, and explain how an enzyme can act as a catalyst.
13. Describe two ways of calculating enzyme activity with the use of automated instruments.
14. Analyze the lag, linear, and substrate exhaustion phases of an enzymatic reaction with
respect to substrate concentration and reaction velocity.
15. Identify the types of inhibitors of an enzymatic reaction and explain how they work.
16. Explain the role of the liver in carbohydrate,metabolism, nitrogen metabolism, bile
pigment formation and metabolic end product excretion and detoxification.
17. Correlate pathological liver conditions with the serum biochemical alterations
18. Explain bone cycle, resorption and bone formation. Indicate how alkaline phosphatase,
osteocalcin and calcium procedures may help in the prevention and diagnosis of bone
disease. Recognize normal and abnormal (high, low and panic values) results.
19. Solve the requirements of the following table:
Bone Disorder
Similarities
Differences
Ostepenia
Osteomalacia
Osteoporosis
20. Crate a table and include the advantages and disadvantages, frequency indicated to monitor
disease progression , detection, diagnosis, and monitoring of the following tests: Troponin
CK, CKMB, LDH and myoglobin.
21. Differentiate the functions and biosynthesis of cholesterol and triglycerides. Include the
variables that affect their plasma concentration and provide their reference ranges.
22. Generate a lipoprotein table to include: chylomicron, VLDL, LDL, HDL, IDL, and Lp(a).
It should have the following categories: (1) structure, (function, (3) physical properties, and
(4) chemical properties.
23. Discuss the purposes of the mobile & stationary phase in chromatography.
24. Differentiate between a reference electrode and a detecting electrode in potenitometric
assays.
25. Describe how glucose and oxygen electrodes work in voltametric techniques
Describe normal glucose homeostasis. Include the difference between a normal individual
versus that in a person with diabetes.
26. Describe normal glucose homeostasis. Include the difference between a normal individual
versus that in a person with diabetes.
27. Differentiate type 1, type 2 intermediate and gestational diabetes.
28. Summarize the six types of hyperlipoproteinemias. Include electrophoretic patterns,
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reference ranges, specimen characteristics after 24H at 4° C, and clinical significance.
Describe two types of iron overload, their causes, and laboratory test that can diagnose
them.
Compare the following tests: serum iron, TIBC, serum ferritin and transferring saturation
Compare and contrast iron deficiency and lead poisoning.
Create a table to inclue the advantages and disadvantages of HPLC and hemoglobin
electrophoresis for the quantification & identification of hemoglobin fractions.
Compare the properties of the cathode and anode in electrophoresis.
Classify commonly used electrophoresis stains and support media according to the
substance being visualized.
Describe the characteristics and electrophoretic mobility of each of the following
hemoglobin variants: Hemoglobin A, A2, F, S and C.
Review how digestions of DNA by specific nucleases can be used to identify specific DNA
sequences
Create a table, include the similarities and differences of the following molecular tests Real
Time PCR, Dot Blot, Reverse Dot Blot, Restriction Endonuclease Digestion, Flow
Cytometry and DNA sequencing.
Differentiate the three types of kinetic processes used to characterize the disposition of
drugs in the body: first-order, zero order, and Michael’s Menten. Name 3 applications of
therapeutic drug monitoring
Explain the concepts between reference intervals & therapeutic ranges in the therapeutic
drug monitoring
List common causes for higher-than-expected or lower-than-expected drug concentration
values.
Discuss principle, specimen requirements, interferences and clinical significance of drugs of
abuse testing.
Cite 3 examples of patient data correlated with disease diagnosis to confirm results.
Justify a decision made to repeat a laboratory procedure. Include decisions and
recommendations based on results obtained.
Create a table of each laboratory procedure included in the tentative laboratory schedule.
The table should include principle of the procedure, specimen requirements, reference
ranges, limitations of the procedure and clinical significance.
B. Affective
To show the appropriate responsible behaviors, students will demonstrate:
1. A positive attitude by being prepared for lecture and laboratory sessions, completing assigned
tasks on time and displaying self-motivation.
2. Organization by utilizing time effectively, sequencing and prioritizing tasks for completion with
time constraints and maintaining a neat clean work.
3. Adherence to safety rules by: avoiding eating, drinking and chewing gum in the laboratory
premises
4. Attention to detail by diligently pursuing accuracy and documenting data accurately and legibly.
5. Problem solving ability by explaining purpose of each step in diagnosis, interpretation, procedure,
recognizing discrepancies in techniques or procedures and repeating necessary lab tests when
necessary.
6. Dependability by following directions, working independently after being given directions.
7. Stability and self-confidence by approaching and performing routine tasks confidently without
assistance and maintaining composure.
8. Appropriate interpersonal skills by cooperating and communicating effectively with classmates
and instructors and displaying courteous, considerate behavior and appropriate appearance.
9. Ethical behavior and integrity by respecting confidentiality of patient information, complying with
professional standards and code of ethics, adhering to safety policies and abiding by all rules and
regulations of the institution.
NO ONE WILL BE ALLOWED IN THE LABORATORY WITHOUT PROPER PERSONAL
PROTECTIVE COVERING. UNIVERSAL PRECAUTIONS WILL BE OBSERVED AT ALL
TIMES. AT THE INSTRUCTORS DISCRESSION, THE INSTRUCTOR MAY DISMISS A
STUDENT WO DOES NOT HAVE THE PROPER PERSONAL PROTECTION.
C. PsychomotorAfter the learning experiences are introduced, student will gradually and competently:
1. Perform quality control procedures on reagents, instruments, refrigerators and incubators.
2. Observe universal precautions when handling blood and body fluids specimens.
3. Dispose of biohazard materials (contaminated gloves, towels, plastic pipettes, etc.) in the
appropriate containers
4. Dispose of clean sharps (i.e. clean but broken laboratory glassware) in the glass only container
5. Dispose of contaminated sharps (i.e. bloody glassware) in the red sharps container
6. Dispose of clean towels, papers, etc. in the regular trash can.
7. Clean up and organize work area after each laboratory session
8. Perform all procedures introduced in this course within the appropriate standard deviation for the
procedure.
9. Perform simple dilutions using the proper techniques.
10. Perform enzymatic and colorimetric assays using a spectrophotometer.
11. Recognize the normal ranges or reference intervals for glucose, cholesterol, protein, BUN and
creatinine, etc.
a) List the normal ranges or reference intervals for the analytes shown in lab
b) Utilize the normal ranges or references to evaluate abnormal results
c) Evaluate the possibility of reporting the patients’ results
d) Recognize any discrepancy in results
e) Interpret results in a timely manner
12. Demonstrate and apply knowledge of quality control
a) Select appropriate controls for tests
b) Interpret the chart of the controls to identify problems
c) Formulate plan for corrections
d) Analyze and record all data obtained
13. Apply specimen rejection criteria
14. Assess the pre-analytical, analytical and post-analytical factors that affect patient’s results:
a) Identify sample integrity and factors that affect sample’s integrity
b) Recognize sources of error in the methods used
c) Prioritize and differentiate between stat and routine samples
15. Select reagents, perform procedures, interpret results, and evaluate the significance of tests
performed in the clinical chemistry lab.
16. Describe the procedure, correctly calibrate and operate equipment, interpret results, and evaluate
the significance of results for the following procedures: spectrophotometry, luminometry,
immunoelectrophoresis, electrophoresis, glucose determination, protein concentration,
cholesterol, and others.
COURSE POLICIES:
1) Required Textbook: Clinical Chemistry: Techniques, Principles, Correlations Correlation, 6th
edition. 2010. Bishop, M.L.
2) Attendance & Active Engagement (5%): The student is expected to attend all lab sessions in a
timely fashion, wear protective equipment, and actively participate. It is responsibility of the
student to notify the instructor of any absence and to provide legitimate documentation of absence
to abide to University regulations. The instructor reserves the right to drop a student due to
tardiness or absentees when in the judgment of the instructor, a student has been absent to a degree
as to impair his or her status relative to credit for the course. The instructor may drop the student
from the class with a W before the course drop deadline or with an F after the course drop
deadline.
3)Instructional Strategies: Students are required to read ahead of time the handouts and other
resources provided in Blackboard for the laboratory exercise in the tentative course schedule.
Students are required to come to lab with the required print materials under the corresponding
laboratory exercise in Blackboard. Students will keep those handouts in a laboratory binder for
reference during the exercise. Laboratory assignments must be written up and the procedures
performed within the standard deviation for the procedure and to the satisfaction of the instructor
for a pass/fail grade. If they receive a fail grade, the lab must be repeated until the student receives a
pass grade. The laboratory is competency based. The student must demonstrate their competency to
perform the lab procedure at the designated level before they can progress to the next lab. In a
competency based program you are either competent to perform the procedure or you are not. No
one progresses until they are competent. All competencies and repeats must be taken the day they
are assigned unless extenuating circumstances occur because THERE WILL BE NO MAKEUP
LABS. The student must take the initiative in this course and see that everything is learned and
completed. A written exam will also be given for a letter grade and MUST be passed with at least
the minimum passing grade of 75%.
4) Quiz & Test Policy : If you cannot attend a proficiency, test, quiz or final exam for a university
acceptable excuse, inform me as soon as possible and we will arrange a time according to my
schedule. 5% of final grade will be removed if the student misses any of the scheduled
assessments for a legitimate reason. (Make ups exams/quizzes, while they may cover the same
material may differ from the exam/quiz taken by the rest of the class in organization, format, or
specific item data.) Students should maintain a 75% or above average to continue in the program.
Student engagement in class activities will be taken into account for grade determination.
5) Academic Integrity: There is a zero tolerance level for academic dishonesty. Absolute honesty and
integrity are a critical aspect of your chosen profession. Confidentiality of patient information is
another. These must be strictly observed. Any student who commits an act of scholastic dishonesty
is subject to discipline. Scholastic dishonesty includes, but is not limited to, cheating, plagiarism,
collusion, the submission for credit of any work or material that are attributable on whole or in part
to another person, taking an examination for another person, any act designed to give unfair
advantage to a student or the attempt to commit such acts. Proven violations of the detailed
regulations, as printed in the Handbook of Operating Procedures (HOP), and available in the Office
of the Dean of Students, may result in sanctions ranging from disciplinary probation, to failing
grade on the work in question, to a failing grade in the course, to suspension or dismissal, among
others.
6). Schedule of Exams/Quizzes:
Quiz #1: Week 2
Quiz #2: Week 3
Quiz #3: Week 4
Quiz #4: Week 5
Quiz#5: Week 6
Quiz#6: Week 7
Midterm Exam: Week 8
Quiz# 7: Week 9
Quiz#8: Week 10
Quiz#9: Week 11
Quiz#10: Week 12
Quiz#11: Week 13
Quiz#12: Week 14
Final Exam: Week 15
8) Laboratory Course Grading Policy:
There will be twelve quizzes on the material covered in lab during the semester. NO quiz grade
will be dropped.
• No make up for quizzes is allowed.
• One or more assignments will be given during the semester. The assignments may include any
of the topics listed under the tentative schedule. Details about the nature of the proficiencies will
be given during the first week of laboratory.
• There will be a mid-term exam for chapters 18 though 25.
• There will be a comprehensive Final Exam in all the chapters that we covered in laboratory
during the final week. If you cannot abide by the criteria for a legitimate reason (death, illness,
etc.,) inform me as soon as possible, bring necessary documentation, and we will consider the
situation. No make ups will be offered.
• Grade distribution among course tasks: ___________
Attendance & Participation
15% (1 point per Lab session)
Written Mid-term exam
30%
12 Quizzes
20%
Assignment
5%
Final exam
30%
9) Grading Scale: 90 – 100 =A
80 – 89 =B
75 – 79 =C
70-74.9=D
69 or below =F
NOTE: Must have a grade above 75 to stay in the CLS program
10) Supplementary Information:
You are welcome to find information regarding Fall Semester
Important Dates posted under Academic Calendar in the university
website
CLINICAL CHEMISTRY II
TENTATIVE LABORATORY SCHEDULE
CHS&SON 137 (Thursday 1 - 4)
Week
Date
1
January 24
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Topic
Porphyrins and Hemoglobin Chapter 18
Safety, QC, QA
January 31 Introduction to Hormones and Pituitary Function
TBA
Chapter 19
Quiz 1
February 7 Adrenal Function –Chapter 20 TBA
Gonadal Function - Chapter 21
Quiz 2
February 14 The Tyroid Gland - Chapter 22 TBA
Quiz 3
February 21 Calcium Homeostasis and Hormonal Regulation - Chapter 23 TBA
Quiz 4
February 28 Liver function – Chapter 24 TBA
Quiz 5
March 7
Cardiac Function – Chapter 25 TBA
Quiz 6
March 14
Midterm Exam
Renal Function - Chapter 26 TBA
March 21
Spring Break
March 28
Pancreatic Function - Chapter 27 TBA
Quiz 7
April 4
Body Fluid Analysis –Chapter 28 TBA
Quiz 8
April 11
Therapeutic Drug Monitoring - Chapter 29 TBA
Quiz 9
April 18
Toxicology – Chapter 30 TBA
Quiz 10
April 25
Circulating Tumor Markers - Chapter 31 TBA
Nutritional Assessment - Chapter 32
Clinical Chemistry and the Geriatric Patient – Chapter 33
Clinical Chemistry and the Pediatric Patient – Chapter 34
Quiz 11
May 2
Circulating Tumor Markers - Chapter 31 TBA
Nutritional Assessment - Chapter 32
Clinical Chemistry and the Geriatric Patient – Chapter 33
Clinical Chemistry and the Pediatric Patient – Chapter 34
Quiz 12
May 9
Final Exam
Last but not least… Enjoy your journey as a Medical Laboratory
Scientist!