Clinical Biochemistry

Data

Official data in SubjectManager for the following academic year: 2024-2025

Topic

The aim of clinical biochemistry is to improve the ability of medical students to integrate information provided by the clinical laboratory with other clinical diagnostic disciplines and thus, to form an accurate diagnosis. We will give you a guideline how to request and interpret laboratory tests to diagnose, evaluate the prognosis and monitor the therapy of the patients. The subject Clinical Biochemistry requires and builds upon your existing knowledge in biochemistry, pathophysioogy and pathology. We will teach you how to select from a variety of laboratory parameters, provide you with a strategy on how and when to order these tests, and help you to develop a molecular approach to medicine. Clinical biochemistry includes classic subfields such as clinical chemistry, hematology, hemostaseology, immunology. While basic knowledge of the most common analytical methods are important to learn about, special emphasize will be directed toward the preanalytical (sample ordering, patient and sample preparation) and post-analytical (interpretation of the data) processes.

Lectures

• 1. Role of clinical laboratory in the current healthcare system. Informative value of laboratory tests - Miseta Attila János
• 2. Disorders of water, Na+ and K+ balance - Miseta Attila János
• 3. Disorders of calcium and magnesium metabolism, laboratory diagnostics of musculoskeletal diseases - Kőszegi Tamás Antal
• 4. Iron, porphyrin and hemoglobin metabolism - Nagy Tamás
• 5. Laboratory assessment of the heart and cardiovascular disorders - Kovács Gábor László (Labormed)
• 6. Diseases of the liver - Miseta Attila János
• 7. Laboratory assessment of the pancreas and the gastro-intestinal tract - Nagy Tamás
• 8. Disorders of the carbohydrate metabolism - Kőszegi Tamás Antal
• 9. Laboratory assesssment of the lipid metabolism, lipid disorders - Kovács Gábor László (Labormed)
• 10. Renal diseases - Czéh Boldizsár
• 11. Assessment of the hypothalamic-pituitary endocrine system and the thyroid function - Kovács Gábor László (Labormed)
• 12. Toxicology and therapeutic drug monitoring - Vassné Lakatos Ágnes
• 13. Tumors and tumor markers - Miseta Attila János
• 14. Molecular biology assays in the clinical laboratory - Gombos Katalin

Practices

• 1. Requesting a lab test - Patient preparation, sampling, sampling error and sample handling. - Péterfalvi Ágnes
• 2. The most frequently used analytical methods. - Péterfalvi Ágnes
• 3. Hematology - analysis of the blood cells and interpretation of the results. - Kiss Gabriella (Labormed)
• 4. Hematology - analysis of the blood cells and interpretation of the results. - Kiss Gabriella (Labormed)
• 5. Assessment of the acid/base balance. - Nagy Tamás
• 6. Basic bedside laboratory tests (POCT). - Nagy Tamás
• 7. Plasma proteins: analytical options and interpretation of the results. - Tőkés-Füzesi Margit
• 8. Laboratory tests of liquor and other body fluids. - Tőkés-Füzesi Margit
• 9. Urine analysis - Bedside and chemical (quantitative) urine tests and their interpretation. - Czéh Boldizsár
• 10. Urine analysis - Bedside and chemical (quantitative) urine tests and their interpretation. - Czéh Boldizsár
• 11. Laboratory monitoring of blood coagulation. Functional tests. - Réger Barbara
• 12. Laboratory monitoring of blood coagulation. Functional tests. - Réger Barbara
• 13. Screening for endocrin disorders in te laboratory. Preanalytical considerations. Laboratory assessment of the adrenal glands and the gonads. - Lányi Éva
• 14. Molecular biology assays in the clinical laboratory. - Gombos Katalin

Seminars

Reading material

Obligatory literature

Literature developed by the Department

Notes

Recommended literature

W.J. Marshall, S.K. Bangert: Clinical Chemistry, 7th ed., Mosby Co, 2012, ISBN 9780723437048

G.J. Beckett, S.W. Walker, P. Rae, P. Ashby: Lecture Notes on Clinical Biochemistry, 8th ed., Wiley-Blackwell Co., 2013. ISBN 978-1-4443-9475-7

A. Gaw, M.J. Murphy, R.A. Cowan, D.St.J. O'Reilly, M.J. Stewart, J. Shepherd: Clinical Biochemistry, An Illustrated Colour Text, 4th ed., Churchill Livingstone Elsevier 2008

Conditions for acceptance of the semester

Attending the lectures and practices is obligatory. Absences up to 25% are accepted.

Mid-term exams

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Making up for missed classes

Attending the practices is obligatory. If someone misses a practice for any reason, he/she is asked to attend the practice in question given to another group.

Exam topics/questions

Questions for the oral examination

1. Purpose of laboratory test requests (screening, diagnosis, differential-diagnosis, validation, monitoring).

2. Patient preparation before sampling. Proper method to carry out blood (venous, capillary) and urine collection. Type of tubes.

3. Reference values and ranges, specificity, sensitivity and predictive value of laboratory tests.

4. Interpretation of laboratory results. Biological and analytical factors influencing the results.

5. Bedside/point of care tests (POCT) and their informational value.

6. Disorders of water and sodium homeostasis.

7. Disorders of potassium balance.

8. Laboratory findings in metabolic type changes of the acid/base balance.

9. Laboratory findings in respiratory type changes of the acid/base balance.

10. Laboratory approaches for the detection of disorders in calcium, magnesium and phosphate homeostasis.

11. Clinical biochemistry of osteoporosis. Laboratory tests to assess joint and bone disorders.

12. Laboratory analysis of plasma proteins.

13. Laboratory analysis of plasma enzymes.

14. Disturbances of non-immunoglobulin plasma proteins.

15. Disorders of immunoglobulins and paraproteins.

16. Assessment of acute phase proteins, diagnosis and monitoring of sepsis.

17. Laboratory findings in inflammatory disorders.

18. Laboratory diagnosis of malignant hematologic disorders; complete blood count and flow cytometry

19. Laboratory diagnostic approaches in anemias.

20. Hemoglobinopathies: disorders of the porphyrin metabolism.

21. Laboratory findings in the disorders of iron metabolism.

22. Blood coagulation: cellular components (platelets, endothelial cells) and their laboratory analysis.

23. Blood coagulation: functional tests (PT, APTT, TT, fibrinogen, D-dimer).

24. Laboratory monitoring of anti-coagulant therapies.

25. Current analytical protocol to detect acute myocardial infarction; international recommendations.

26. Laboratory monitoring the therapy of myocardial infarction. Laboratory approaches in chronic heart failure (BNP, proBNP, electrolytes).

27. Laboratory diagnostics of the striated muscle diseases.

28. Diagnostic criteria of diabetes mellitus (WHO criteria). Laboratory monitoring of patients with diabetic history.

29. Clinical biochemistry of hypoglycemia and hyperglycemia.

30. Lipids and lipoproteins in the blood plasma.

31. Laboratory tests that predict hepatic disorders.

32. Laboratory diagnostics of alcoholic liver damage. Laboratory tests to assess liver fibrosis.

33. Disorders of bilirubin metabolism.

34. Laboratory diagnosis of acute pancreatitis.

35. Laboratory diagnosis of chronic pancreatitis.

36. Laboratory diagnosis and monitoring of malignant and inflammatory bowel diseases.

37. Laboratory diagnosis of acute renal diseases.

38. Laboratory diagnosis and monitoring of chronic renal diseases.

39. Laboratory findings in proteinuria and hematuria.

40. Laboratory assessment of increased serum uric acid levels.

41. Laboratory tests of the cerebrospinal fluid and other body fluids.

42. Pre-analytical considerations of the hormone tests.

43. Clinical biochemistry of the hypothalamus, hypophysis.

44. Laboratory assessment of the thyroid function.

45. Clinical biochemistry of the disorders of adrenal medulla/cortex.

46. Clinical biochemistry of the disorders of the human reproductive system.

47. The most important non-specific laboratory tests that suggest the presence of malignant diseases.

48. Tumor markers and their informational value in the clinical laboratory practice.

49. Molecular biology applications in the practice of clinical laboratories.

50. Therapeutic drug monitoring (TDM).

51. Toxicology tests in the clinical laboratory.

Questions for evaluating laboratory results

1. Normal results

2. Oral or s.c. anti-coagulated patient

3. Respiratory acidosis

4. Metabolic acidosis

5. Acute myocardial infarct

6. Hyperlipidemia

7. Acute renal failure

8. Chronic renal disease (dialyzed patient)

9. Acute liver disease

10. Liver failure

11. Bile obstruction

12. Acute pancreatitis

13. Myeloma multiplex

14. Leukemia (blood cell count)

15. Leukemia (blood smear)

16. Diabetes

17. Iron deficiency anemia

18. Hypo/hyperthyreosis

19. Adrenal crisis

20. Acute inflammation

21. Sepsis

22. DIC

23. Malignancy (tumormarkers)

Examiners

• Czéh Boldizsár
• Kőszegi Tamás Antal
• Kovács Gábor László (Labormed)
• Miseta Attila János
• Nagy Tamás
• Péterfalvi Ágnes

Instructor / tutor of practices and seminars

• Gombos Katalin
• Nagy Tamás
• Péterfalvi Ágnes
• Szirmay Balázs Gábor