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Clinical Chemistry: Principles, Procedures, Correlations, 5th ed. Michael L. Bishop, Edward P. Fody, and Larry Schoeff. Baltimore, MD: Lippincott Williams & Wilkins, 2005, 756 pp., $76.95, hardcover. ISBN 0-7817-4611-6.

Express Laboratory, Pacific Laboratory Medicine Services, Royal North Shore Hospital, St. Leonards, Sydney, NSW, Australia 2065

Although this book covers most aspects of the field, it is more a textbook aimed at students rather than a comprehensive in-depth reference book. It is divided into four sections: Basic Principles and Practice in Clinical Chemistry, Critical Correlations and Analytical Procedures, Assessment of Organ Function, and Specialty Areas of Clinical Chemistry. Chapters include specific examples, case studies, or summary questions.

In the first section, covering basic laboratory principles, the frequent use of examples that are familiar in laboratories make the chapters most useful. The chapter on point-of-care (POC) testing could have benefited by additional material, particularly with regard to proficiency testing and POC applications. For example, one of the largest areas of POC testing is in measuring cardiac markers, especially in emergency departments. The National Academy of Clinical Biochemistry has indicated that if turnaround times cannot be met by the laboratory, POC testing should be used. This is not discussed in this chapter, although it is mentioned in the chapter on cardiac function. It is also somewhat surprising that only four pages were considered sufficient to describe the use of DNA technology in the clinical chemistry laboratory.

The second section covers the key analytes measured in the clinical chemistry laboratory. These are covered adequately, although to quote reference intervals for enzymes without a literature reference is not recommended. With traceability being a major requirement in many countries, there is no mention that IFCC-recommended methods for enzymes are available. The most comprehensive chapter in this section is on lipids and lipoproteins and provides an excellent summary of the metabolism of lipids and the analytical issues.

It can be difficult to limit information when writing on organ function, but it has been done successfully in section three. The chapters concentrate on the laboratory diagnosis and assessment of organ function rather than describing disease states in detail. In each chapter, there is an introduction to the organ, often including structure and some anatomy, the function of the organ and disease states, and then the laboratory assessment. Several of these chapters have included specific textbooks for further reading, which is most useful.

The final section, on specialty areas, includes chapters on therapeutic drugs, toxicology, tumor markers, and vitamins, followed by very interesting chapters on geriatric and pediatric clinical chemistry. These last two are important specific areas of laboratory work that are often ignored. Geriatric medicine is one of the fastest growing areas of medicine. In the United States in 1994, 1 in 8 persons was 65 or older; by 2030, it is projected to be 1 in 5. Topics include changes in analyte values with age, the facts that the elderly are often on multiple medications and take limited exercise, and the need for these to be considered when interpreting results. The chapter on pediatric clinical chemistry notes that some of the greatest changes in metabolic regulation and analyte concentrations occur in the first few months of life. In addition, in pediatric treatment, drug doses are much more critical because not only is body weight important, but drug metabolism is often different from that in adults: "children should not be regarded as small adults". The single major issue in pediatric clinical chemistry is the ability to draw sufficient blood for testing and that this small volume may not suit all instrumentation.

At the end of the book are various appendices that contains useful tabulated information such as SI units, unit conversions, and pharmacokinetic parameters for many commonly prescribes drugs. These are followed by a very comprehensive glossary of terms used in clinical chemistry.

If there is a criticism of this book, it is that it is very specific for the American reader, with all contributors being from the United States apart from two Canadians. Several chapters use non-SI units; for example, in Chapter 12, Lipids and Lipoproteins, the units are in mg/dL, whereas the internationally accepted units are mmol/L. Similarly, there are several references to CLIA, which is important in the United States, but other systems of accreditation, such as ISO15189 are more widely accepted elsewhere.

In summary, this is a practical book that students will find particularly useful, but it also has a place in the laboratory.

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This Article Extract Full Text (PDF) Submit an electronic Letter to the Editor about this paper Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bais, R. Search for Related Content PubMed Articles by Bais, R.