Part II: Course Syllabus
Table of Contents
Item Page
Instructor Information 2-1
Course Information 2-2
Course Objectives 2-4
Learning Resources 2-22
Course Requirements & Grading 2-28
Instructor Information
DR. ESSAM HUSAIN JIFFRI (Course Co-ordinator)
Telephone: Office: 6401000 Ex. 21137
Mobile: 0505613915
E-mail:
Office Location: 1st floor, Room No. 542/1
Office Hour: Sat: 10:00 – 12:00 PM
Wed:10:00 – 12:00 PM
DR. HAMED KHOUJA
- Telephone: Office: 6401000 Ex. 22079 /20209
Mobile: 0504605257
- E-mail:
- Office Location: 2nd floor, Room No. 512/2
- Office Hour: Sun 9:00 – 11:00 AM
Tue 9:00 – 11:00 AM
DR. ADEEL G. CHAUDARY
Telephone: Office: 64O1000 Ex. 22135
Mobile: 0505689076
E-mail:
Office Location: 2nd, Room No.552/2
Office Hour: Sat: 12:00 – 2:00 PM
Mon: 12:00 – 2:00 PM
Course Information
COURSE NAME: Clinical Chemistry-1
COURSE NUMBER: MLT 301
COURSE MEETING TIMES:
Lecture hours: 3 hours/week for 14 weeks (Total 42 hours)
Practical hours: 2 hours/week for 14 weeks (Total 28 hours)
Tutorial hours: 1 hour/week for 14 weeks (Total 14 hours)
LECTURE
Three/Week / PRACTICALSTwo/Week / TUTORIALS
One/Week
MALE / Sat 08:00-09:00 a.m /
Sat 02:00–04:00 p.m (Group A)
/ Sat 01:00 – 02:00p.m(Group A)
Tue 01:00-02:00 p.m /
Wed 08:00–09:0 a.m /
Wed 02:00–04:00 p.m (Group B)
/ Wed 01:00–02:00 p.m(Group B)
FEMALE / Sun 08:00 – 09:00 a.m /
Sat 10:00–12:00 a.m (Group A)
/ Sat 01:00 – 02:00 p.m(Group A)
Mon 01:00 – 02:00 p.m /
Mon 10:00–12:00 a.m (Group B)
/ Sun 01:00 – 02:00 p.m(Group B)
Wed 09:00 – 10:00 a.m /
COURSE MEETING PLACES:
Male students: 3rd year classroom in the medical center,
Building number 5,
First floor,
Faculty of applied medical sciences,
Male section
Female students: 3rd year classroom in the medical center,
Building number 4,
Ground floor,
Faculty of applied medical sciences,
Female section
COURSE WEBSITE ADDRESS:
COURSE PREREQUISITES AND REQUIREMENTS:
A successful completion of Biochemistry (MLT 201) with a final cumulative grade of above 60% is the pre-requisite for Clinical Chemistry-1 (MLT 301).
ENTRY LEVEL SKILLS:
The student should display basic reading, writing, and mathematical skills
DESCRIPTION OF THE COURSE:
This course will be a detailed study of the chemical and instrumental analyses of human biological material of clinical significance. The student will be introduced to commonly used clinical chemistry techniques. This course discusses the clinical aspects of Lab Math, Sources of errors, carbohydrates, Amino-acidopathes, proteins, Vitamins, Trace Elements, enzymes, electrolytes. This course will integrate the following topics into the laboratory and lecture sessions: laboratory mathematics, quality assurance, specimen collection and processing, sources of biological variation, and evaluation techniques.
Course Objectives
GENERAL OBJECTIVES:
Upon completion of this course the student will be able to:
Achieve the objectives designated by a bullet under each lecture, group of lectures or practical sessions.
OBJECTIVES OF LECTURE TOPICS:
The course consists of lectures, practical classes, demonstrations and tutorials. The following is a listing of lecture topics and number of lectures for each topic:
LECTURE TOPICS / NUMBER OF LECTURES1- Course Scope / 3
2- Basic & Lab Math / 3
3- Source & Types of Errors & QC / 3
4- Carbohydrates / 6
5- Proteins / 6
6- Trace Elements / 3
7- Vitamins / 3
8- Enzymology / 6
9- Electrolytes & Ca, Mg, P / 9
TOTAL / 42
1. BASIC SCOPE &LAB MATH
(Six lectures)
Objectives:
To make sure that the student is able to:
1. realize, understand and deal with numerical values in the clinical lab in the best possible way to reflect accuracy and precision of the given value (significant figures, decimals, scientific notation, rounding off numbers)
2. recognize, understand and interpret SI units as applies to mass, volume, lengths, area & concentrations
3. carry out conversions of single units within the SI system
4. carry out conversions of combined units within the SI system
5. recognize, understand and interpret commonly used conventional units such as mg/dL; ng/mL, pg/mL
6. knowing the formula weight of substances, or appropriate conversion factor, be able to convert from conventional to SI units.
7. knowing the formula weight of substances, or appropriate conversion factor, be able to convert from SI units to conventional units
8. calculate the concentration of solutions in various terms such as g/L; mol/L, mg/L.
9. calculate molarity and normality of solutions.
10. express the amount of substances in terms of respective percentages (i.e; % w/v; % v/v, % w/w).
11. work out single, multiple, serial and parallel dilutions.
12. calculate the concentration of analytes in the neat sample which was diluted by a specific dilution factor.
13. calculate the final concentration of solution which was diluted by a specific dilution factor.
14. work out how to prepare various solutions from stock solutions
15. work out how to prepare various reagents from various compounds and substances
16. knowing the specific gravity and % acids; work out how to prepare weaker concentrations of acids from concentrated stock solutions
17. calculates the mean, SD & cv
18. calculates % deviation
2. SOURCES & TYPES OF ERRORS
(Six lectures)
Objectives
The student must be able to;
1- describe the discipline of clinical chemistry.
2- explain the importance of clinical chemistry in lab medicine.
3- describe the function of the clinical chemistry lab.
4- describe the type of results obtained in the clinical labs.
5- describe the characteristics of quantitative results.
6- describe and perform calibration of pipettes used in the lab by gravimetric procedures.
7- describes the basic quality control and quality assurance requirements for the lab.
8- describe reliability, accuracy and precision of results.
9- describe sensitivity and specificity of procedures.
10- describe the types of analytical errors in the lab.
11- describe the effects of these errors on the result of tests.
12- describe the three stages of quality assurance in the lab.
13- explain the preanalytical factors that may lead to errors in the analysis.
14- explain the analytical factors that may lead to errors in the analysis.
15- explain the postanalytical factors that may lead to errors in the reported results.
16- describe limits of accuracy of the reported result in terms of ;
a. reported values
b. decimal places
c. procedure limitations
d. instrument limitations
e. clinical significance
f. assay range
g. clinical range
h. extent of linearity
i. reagents
j. calibrators
k. temperature
l. humidity
m. vibration
n. air current
o. interference
p. cross-reactivity
q. sensitivity limits
r. specificity
s. reagent blank
17- describe how to spot errors in the lab.
18- describe how to eliminate or minimize the size and frequency of errors.
19- outline ways to improve accuracy, precision of results.
20- outline possible steps to improve the sensitivity and specificity of methods in the lab.
21- recognize the need for continuous development and modifications of existing systems in the lab and outside the lab.
22- describe the major precautions that must be observed in the lab to ensure the reliability of the reported results.
3. CARBOHYDRATE METABOLISM
(Six lectures)
Objectives
Upon completion of this chapter, the student will be able to:
1- Identify the primary biological function of carbohydrate in humans.
2- Describe, in general terms, the metabolism of carbohydrates in humans.
3- Compare and contrast the four types of utilization of glucose: glycogenesis, gluconeogenesis, glycolysis, glycogenolysis.
4- Outline the formation of other constituents, such as glycogen, galactose, fructose, pyruvic acid, lactic acid, from glucose.
5- Discuss the importance of the anaerobic and aerobic pathways and the pentose phosphate shunt in the metabolism of glucose.
6- Identify and explain the role of the following hormones in glucose metabolism;
a. Insulin
b. Glucagone
c. Epinephrine
d. Thyroxine
e. Adrenocorticotropic,
f. Cortisol
g. Hormones (ACTH)
h. Growth hormone
7- Discus the symptomatology of hypo- and hyperglycemia in humans.
8- Characterized the following types of diabetes mellitus: type 1, type 2, and gestational diabetes mellitus.
9- Discuss the major acute and chronic complications associated with diabetes mellitus.
10-Differentiate diabetic ketoacidosis (DKA); hyperglycemic, hyperosmolar, nonketotic coma (HHNC); and lactic acidosis using arterial pH and PCO2 values with blood ketone (acetoacetic acid) results.
11-Describe the action of insulin.
12- Describe how the following laboratory tests are used
the evaluation of hypo- or hyperglycemia;
a. Blood glucose
b. Glycated hemoglobin (hemoglobin A1c)
c. Ketones
13-Discuss the role of self-monitoring devices for diabetes in the measurement of blood glucose.
14- For Oral Glucose Tolerance and two Hour Post Prandial Testing;
a. describe proper patient preparation, including dose and administration of glucose.
b. describe specimen collection procedures, including time
of collection.
15- describe actual patterns of serum glucose levels in the
following conditions:
normal
malabsorption
diabetmellitus
hypoglycemia
hyperinsulinism
16- Outline the current classification scheme for diabetes, including
possible etiologies.
17- Compare and contrast anticoagulants/preservatives for blood
specimens for glucose analysis.
18- For each test listed below describe the rationale,
clinical usefulness, specimen requirements, patient
preparation, procedure, principle(s), measurement used to
calculate activity, limitations, and reference range(s):
a - Glucose Enzymatic: glucose oxidase
b - Galactose
c - Glycosylated Hemoglobin = Hemoglobin A1c
19- Compare methods for glycated hemoglobin analysis in regard
to product measured and frequency of use in the
clinical laboratories.
20- Discus laboratory tests used to evaluate the presence
of ketoacidosis and microalbuminurea.
4. AMINO ACIDOPATHIES
(Three lectures)
Objectives:
Students are given the fundamental concepts of metabolic disorders and their pathways. Accumulation and subsequent overflow of precursors due to the deficiency or inactivity of a certain metabolite (amino-acid containing protein or enzyme) are considered the basis of these disorders. Detection of these metabolites in blood and their overflow into the urine is clinically significant.
Discuss the metabolic disorders are rare however some of them are more common than others and these include:
· Phenylketonuria: Inherited autosomal recessive disorder where early detection of accumulating metabolite is crucial for better prognosis
· Alkaptonuria
· Tyrosinuria: TypeI and Type II
· Maple Syrup Urine Disease
· Homocystineuria
· Cystinuria
The topics covered include various methods of detection, screening tests and reference methods. Also criteria for blood and urine sample collection is discussed
5. PROTEINS
(Three lectures)
Objectives:
The students are required to know the clinical significance of proteins and to differentiate between various fractions of proteins depending upon their functions. As laboratory technologists the students must know different methods of detection and their underlying principles.
The topics covered include:
· Structures of proteins, amphoteric property, concepts of catabolism and anabolism
· General functions of proteins
· Hyperproteinemia and hypoproteinemia
· Methods of detecting total serum proteins
· Protein electrophoresis and densitometery
Protein sub fractions covered in detail in this chapter include:
a. Pre-albumin
b. Albumin
c. Alpha-1 globulins
d. Alpha-2 globulins
e. Beta globulins
f. Gamma globulins
Sub fractions are also covered in details including alpha-1 acid glycoproteins, alpha-1 antitrypsis, alpha feto proteins, hepatoglobins, ceruloplasmin etc along with their functions, clinical significance, methods of detection, pathophysiology.
Specific methods of detection for protein sub fractions include: radial immunodiffusion, immuno electrophoresis, ELISA, nephlometry.
Clinical significance of Albumin and globulin ratio is covered along with it’s affect on total hyper and hypoproteinemia.
Other diseases that have profound affect upon specific protein sub-fractions are analyzed along with their densitometric patterns e.g. liver cirrhosis, inflammation, alpha-1 antitrypsin deficiency, monoclonal increase.
Certain globulinemias are clinically significant and have direct affect on serum and urinary proteins and some of the disorders covered are Multiple Myeloma, Franklin’s disease, Waldenstorms’ macroglobulinemia.
6. VITAMINS
(Three lectures)
Objectives:
Students are made aware of the importance of vitamins as essential component of daily nutrition. Important vitamins are covered that includes: Vitamin-A, C, D, K and B complex. Their trivial names, reference ranges, dietary source and functions are covered.
Topics including clinical symptoms due to their deficiency or overdose are also explained followed by various methods of detection which include:
· In-vivo and in-vitro bioassays
· Microbiological assays
· Vitamin loading tests
· Flourometric and Colorimetric analysis
· HPLC
· RIA & ELISA
· Amperometry
· Erythrocyte fragility test
· Prothrombin and partial thrombin test
· Activity coefficient test
To understand the advantages and disadvantages of each of the above method is describes and the students are made well aware of the reference methods and screening methods used.
7. TRACE ELEMENTS
(Three lectures)
Objectives:
To understand what these trace elements are? And to appreciate their presence in the human body.
To understand the nutritional value and functional importance of essential, moderately essential and non-essential trace elements.
To understand the nutritional value and functional importance of ultra-tracelements
Trace elements covered in this chapter include:
· Iron: normal ranges, proteins carriers, clinical significance, methods of detection, transferring and ferritin, Iron saturation and binding capacity. Iron picture in various types of anemias
· Copper: clinical significance, functions and transporting enzyme (ceruloplamsin), method of detection, types of sample and interfering substances
· Zinc: function, clinical significance, method of detection, types of sample and interfering substances
Ultra-trace elements covered in this chapter include:
· Selenium: Function in association with vitamin-E and glutathione peroxidase, clinical significance, methods of detection, types of sample and normal range
· Manganese: function and clinical deficiency, type of sample required
· Cobalt: absorption in relation to vitamin B12 and intrinsic factor.
8. ENZYMOLOGY
(Six lectures)
Objectives:
Upon completion of this chapter, the student will be able to:
1- Explain the different factors affecting serum enzyme:
• Rate of entry of enzymes into blood