CHEMICAL PATHOLOGY OF
PAEDIATRICS AND THE ELDERLY
BY DR.J.A.A. ONAKOYA
ALTERNATE TITLE IS
PAEDIATRICS ANDGERIATRICS
CLINICAL BIOCHEMISTRY
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OUTLINE
QUESTIONS:
WHAT DOES THIS TITLE MEAN?
WHY IS THIS DIFFERENT FROM THAT OF
‘’NORMAL’’ STUDY OF CHEMICAL
PATHOLOGY?
• WHO ARE THE PAEDIATRICS AND THE
ELDERLY?
• REFERENCE VALUES IN PAEDIATRICS AND THE
ELDERLY.
• EXAMPLES OF DIFFERENT CASES.
• HOW TO INTERPRETE THE LAB. RESULTS OF
PAEDIATRICS AND THE ELDERLY.
• BENEFIT OF THIS TOPIC TO THE PATIENT/
HOSPITAL ETC.
• CASES FROM LAB REPORTS.
• SAMPLING CONSIDERATION IN THESE AGE
GROUPS.
• PAEDIATRICS: CLASSIFIED INTO 4 DIFFERENT AGE
GROUPS NAMELY...a]NEONATES, b] 0 to 1year,
c]1year to 5years, d]5years to 12years.
Examples of some disorders in Paediatrics:
• NEONATAL HYPOGLYCAEMIA IS ENCOUNTERED
IN PREMATURE INFANTS OR INFANTS OF
DIABETIC MOTHERS.
• JAUNDICE ---COMMON IN THE 1ST WEEK OF LIFE
AND IN TERM BABIES,AND RAPIDILY RESOLVES.
• JAUNDICE IN THE 1ST 24 HOURS OF LIFE IS
ALWAYS PATHOLOGICAL.
• PREMATURITY:
• THERE IS IMMATURE LUNGS DUE TO
PREMATURITY BECAUSE OF REDUCED
SURFACTANT,LEADING TO RESPIRATORY
DISTRESS[RDS].
• BABIES LESS THAN 32 WEEKS GESTATION ARE
UNABLE TO MAKE THEIR OWN PULMONARY
SURFACTANT[FOR ALVEOLAR EXPANSION].
OTHER PRACTICAL CONSIDERATIONS:
SAMPLING------1.SMALL VOLUME
2. PLASMA PREFERRED[LESS TIME FOR
COAGULATION USING SERUM.
• 3. AUTOANALYSER PREFERED BECAUSE OF THE
SMALL VOLUME
• HYPERBILIRUBINAEMIA CAN OCCUR AND CAN
INTERFERE WITH CREATININE MEASUREMENT.
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• HAEMOLYSIS WHICH CAN OCCUR, INCREASES
POTASSIUM IONS.
• THE ELDERLY:
• THE ELDERLY FALLS IN THE AGE GROUP FROM 65
YEARS AND ABOVE.
• THE REFERENCE VALUES OF THE ELDERLY IS DIFFERENT
FROM NORMAL ADULTS.
• THESE ARE SOME OF THE EXAMPLES OF CASES IN THE
• ELDERLY[FORMERLY CALLED GERIATICS]
• DISEASED STATES IN THE ELDERLY
• NUTRITION IN THE THE ELDERLY
• HEALTH MAINTENANCE OF THE ELDERLY
• EXAMPLES OF CASES FROM LAB REPORTS.
• SPECIMEN/ SAMPLE COLLECTION FROM
NEONATES AND CHILDREN:
a. TO BE TAKEN WITH CARE
b. MINIMAL
c. AMOUNT OF BLOOD USUALLY IF POSSIBLE
CAPILLARY BLOOD---HEEL PRICK[LATERAL
SIDE OF THE HEEL] OR PRICK FROM THE
FINGERS.
• REFERENCE VALUES IN PAEDITRICS FOR
INTERPRETING RESULTS:
1. PLASMA BILIRUBIN AND TOTAL T4 NORMALLY
SHOW WIDE VARIATION IN CONCENTRATION
IN THE FIRST FEW HOURS AFTER BIRTH.
2. IN THE FIRST FEW MONTHS AFTER BIRTH
BECAUSE OF THE NATURE OF THE DIET, THIS
INFLUENCES THE REFERENCE VALUES FOR
PLASMA Ca , PO4, aminoacids,etc.
3.VARIATION IN THE ACTIVITY OR CONCENTRATION
WITH DIFFERENT LEVELS OF OSTEOBLASTIC
ACTIVITY OR DIFFERENCE STAGES OF GENITAL
DEVELOPMENT E.G.
ALKALINE PO4 ACTIVITY, GONATROPHIN AND
GONADAL STEROID CONCENTRATION.
4. MOST OF THE WORK ON PAEDIATRIC S IN
CHEMICAL PATHOLOGY IS CONCERNED WITH
INVESTIGATION AND MANAGEMENT OF LOW
BIRTH WEIGHT OR PREMATURE INFANTS WITH
NO CLEAR REFERENCE VALUES.
SCREENING ELDERLY PATIENTS
EXAMINATION
ABNORMALITIES COMMONLY DETECTED
SIDEROOM TESTS:
URINE
GLYCOSURIA, PROTEINURIA
FAECES
GIT BLOOD LOSS e.g.Ca colon, rectum
haemorrhoids
MEASUREMENTS ON BLOOD SAMPLES:
Albumin, total bilirubin
POOR NUTRITION
CREATININE,UREA
RENAL DX, POST RENAL URAEMIA
GLUCOSE
DM
POTASSIUM
HYPOKALAEMIA[DUE TO DIURETIC
THERAPY]
CALCIUM[PHOSPHATE AND ALKALINE
PHOSPHATASE]
HYPOCALCAEMIA[OSTEOMALACIA]
THYROID FUNCTION TESTS
HYPO OR HYPERTHYROIDISM
C- REACTIVE PROTEIN [OR ERYTHROCYTE
SEDIMENTATION RATE]
NON- SPECIFIC INDICATOR OF THE
PRESENCE OF ORGANIC DISEASE
• It is proposed that by the year 2050, more than
20% of the World Population will be over 65years
of age.As such , more Clinical Biochemical
resources and focus will be directed towards the
Elderly Population and their related Problems.
• WHAT ARE THESE PROBLEMS:Many Body Organs
begin to have a gradual decline in function but
the Body is able to manage these changes
because of the Body Functional reserve, so that
there is no clinical consequences.
• THE PROBLEM IS HOW THE CLINICAL
PATHOLOGIST DIFFERENTIATE BETWEEN THE
BIOCHEMICAL AND PHYSIOLOGICAL THAT
OCCUR AS A RESULT OF AGEING PROCESS,
AND FACTORS THAT INDICATE THE PRESENCE
OF DISEASE.
• THE REFEERENCE VALUES TABLE ‘’NORMAL’’
POPULATION , NOT FOR PAEDIATRICS OR THE
ELDERLY POPULATION.
• SOME DISEASES ARE MORE COMMON IN THE
ELDERLY THAN IN THE YOUNGER
POPULATION.SOME ELDERLY PERSONS HAVE
INCREASED LEVELS IN THEIR BIOCHEMICAL
PARAMETERS BUT THEY ARE NOT ANY DISEASED
STATES.IT IS IMPORTANT THIS GROUP OF PEOPLE
HAVE REGULAR MEDICAL ASSESSMENT ,SO THAT
THEIR PREVIOUS BIOCHEMICAL STATUS OR
VALUES CAN BE USED AS THEIR INDIVIDUAL
REFERENCE VALUE.
• SOME OF THE DISEASED STATES THAT OCCUR IN
THE ELDERLY ARE:
• THROID DISEASE
• DIABETES MELLITUS
• RENAL DISEASE
• PITUITARY DISEASE
• IMPAIRED GONADAL FUNCTION
• BONE DISEASE
• NUTRITIONAL DEFICINCIES
SOME EXAMPLES OF LAB. RESULTS
/CASE HISTORIES
IN PAEDIATRICS AND THE ELDERLY
• A CASE OF MAN OF 75YEARS WHO PRESENTED
WITH: IN A CONFUSED STATE, LOOKING ILL AND
WITH LOSS OF WEIGHT AT THE MEDICAL
EMERGENCY.WHAT DO YOU DO?
ASSESS THE PATIENT... EXAMINATION OF THE
PATIENT,BP,PULSE RATE,TEST FOR BLOOD
GLUCOSE,ETC. BIOCHEMICAL RESULTS MIGHT BE
ABNORMAL BECAUSE OF HIS PRESENTING STATE
AND NOT BECAUSE HE IS AGEING.
• AN ELDERLY WOMAN MAY HAVE SOME
BIOCHEMIAL RESULTS HER MEDICAL
ASSESSMENT AS BEING “ABNORMAL”BUT NOT
ABNORMAL BECAUSE OF AGE STATUS....E.G.
• UREA
• CREATININE CLEARANCE
• POTASSIUM
• THYRIOD INDEX
QUESTION TIME
• ANY QUESTIONS?
•THANK YOU
FOR YOUR
ATTENTION