Ateneo - UPO

The course aims to train the student so that he can acquire general knowledge, also of a methodological nature, in Clinical Biochemistry. The course deals with the alterations affecting the main organs and tissues, which can be investigated through the analysis of biological fluids, deepening the knowledge also regarding the prevention and monitoring of pathologies.

Title: Laboratory Medicine; Authors: I. Antonozzi and E. Gulletta; Publisher: Piccin
Title: Laboratory Medicine; Author: G.Federici; Publisher: McGraw Hill
Slides.

Provide the necessary knowledge for the correct use of analytical instruments and for the application of both traditional and advanced analytical techniques in the field of Clinical Biochemistry and Clinical Enzymology.

knowledge in Organic Chemistry and Biochemistry.

Frontal lessons.

Oral exam: 5 questions will be asked referring to the main macro-areas addressed during the course, plus an optional question on flow cytometry.

Introduction to the course
Course program
How to carry out the final exam
What is clinical biochemistry about?
Laboratory role
Requesting an exam
Patient preparation
Methods of sampling/collection of the main biological fluids (urine, CSF, peritoneal-pleural-pericardial fluids, amniotic fluid, synovial fluid, gastric juice, seminal fluid, venous-arterial-capillary blood)
Importance of the right biological matrix
Blood sample collection: anticoagulant substances and coagulation accelerators.
Main exogenous and endogenous interferents of biochemical analyses: drugs, haemolysis, hyperlipemia, hyperbilirubinemia, paraproteins.
Pre-analytical variability: transport, acceptance, centrifugation, conservation of biological samples
Analytical variability: precision, accuracy, analytical sensitivity, analytical specificity.
Quality control: intra-laboratory control, EQA, control charts.
Reference values.
Diagnostic sensitivity and diagnostic specificity.
ROC curves.
Main analytical methods
Colorimeters, photometers.
Main analytical methods
Spectrophotometers.
Lambert-Beer law.
Calibration curves.
End-point enzymatic and non-enzymatic, kinetic, fixed-time kinetic spectrophotometric methods.
Solid phase electrophoresis and capillary electrophoresis, immunofixation.
Immune system and immunological methods: without labeling (precipitation, direct and indirect agglutination), with labeling (RIA, EIA, ELISA).
Blood count: red blood cells and hemoglobin, peripheral blood smear and MGG staining, microcytic, normocytic and macrocytic anemias, white blood cells, platelets.
Complete urinalysis: physical, chemical, urine sediment examination under light microscope. Glucidic metabolism. Biochemical characteristics of carbohydrates.
Carbohydrate metabolism: diabetes T1D, T2D, IGT, pregnancy diabetes, endocrinopathies causing hyperglycemia.
Criteria for making the diagnosis of diabetes.
Basic tests, in-depth tests and monotherapy of therapy: blood sugar, OGTT, glycemic profile, insulinemia, anti-pancreatic Abs research, anti-insulin Abs, HbA1c, Fructosamine.
Protein metabolism: amino acids, proteins.
Protein function.
Main proteins of diagnostic interest identifiable by electrophoretic analysis: pre-albumin, albumin, alpha1-antitrypsin, alphafetoprotein, alpha2-haptoglobin, alpha2-macroglobulin, transferrin, immunoglobulins.
Monoclonal components: MGUS and MM.
Analysis of normal and pathological electrophoretic tracings.
PT dosage (Biuret method), Albumin dosage (Bromcresol purple method).
Liver function: basics of anatomy and physiology.
Production, role and dosage of total, direct or conjugated and indirect or unconjugated bilirubin

Classification of jaundices. Main enzymes of hepatic production.
Enzymes in general: classification (EC), Michaelis-Menten theory, active site, cofactors and inhibitors, dosage (enzyme kinetics).
The isoenzymes. Main enzymes of diagnostic interest: LDH and its isoenzymes, ALP and its isoenzymes, GOT, GPT, GGT.
Main enzymes of diagnostic interest: CK and its isoenzymes, total amylase and pancreatic isoenzyme, lipase, cholinesterase, N. of dibucaine.
Iron metabolism: intestinal absorption, iron homeostasis.
General characteristics of ferritin, hemosiderin, transferrin, lactoferrin. Iron deficiency anemia. Iron storage disease.
Martial picture: dosage of iron, transferrin, ferritin, TIBC.
Tumor markers: tumor genesis, classification of tumor markers, dosage methods.
Diagnostic sensitivity and specificity, PPV, VPN.
Clinical use of tumor markers: when to dose them (screening, follow-up).
Guidelines for requesting tumor markers. Tissue specificity criteria.
PSA, Ca15.3, MCA.
Tumor markers:TPA, CYFRA-21-1, NSE, CEA, Tg, Calcitonin, CA125, CA19.9, AFP, other markers of neoplastic progression (B-HCG, urinary hydroxyproline, ferritin, beta-2-microglobulin).
Alterations of lipid metabolism.
Lipids: fatty acids, triglycerides, phospholipids, sterols (cholesterol, cholecalciferol, steroid hormones).
Lipotroproteins: chylomicrons, IDL, VLDL, LDL, HDL.
Methods for determining lipoprotein complexes (ultracentrifugation, electrophoresis).
Exogenous and endogenous pathway of lipid metabolism.
Receptor-mediated endocytosis of LDL.
Scavenger receptors: pathogenesis of atherosclerosis.
HDL: the reverse transport of cholesterol.
The apoliproteins.
Guidelines for reporting plasma lipid and lipoprotein levels.
Dyslipidemias.
Markers of myocardial damage.
Differential diagnosis of severe or prolonged chest pain, definition of ischemic heart disease, coronary risk factors, pathogenesis of atherosclerosis, AMI, unstable angina. The ideal biochemical marker. Total CPK, CK-MB catalytic activity and mass, Myoglobin, Troponins I and T, hs-Troponin.
Heart failure: natriuretic peptides. ANP, BNP, CNP, DNP, Urodilatin. Synthesis of BNP (pre-proBNP, proBNP, NT-proBNP). Dosage and choice of analytical method.
Renal function: the nephron. Urine production.
Ultrafiltration, reabsorption, secretion.
Acute and chronic renal failure.
The laboratory in the evaluation of renal insufficiency: urea (BUN) and urea nitrogen, creatinine.
Adaptation of mammals to terrestrial life: mechanisms of maintenance of water homeostasis and acid-base balance.
Regulation of acid-base balance: the role of diuretic hormone (ADH).
The electrolytes. Sodium: role, regulation, analytical methods. Aldosterone. Potassium: role, regulation, analytical methods. The chlorine.
Flow cytometry

The student will have to:
- know how to apply traditional and advanced analytical techniques and correctly interpret the information obtained from clinical laboratory data;
- have acquired the general knowledge and diagnostic methodologies of Clinical Biochemistry and Clinical Enzymolog