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The growing importance of clinical chemistry and laboratory medicine

P
1 July, 2006  

Päivi Laitinen
PhD EurClinChem MHSc
Oulu University Hospital
Finland
E: paivi.h.laitinen@ppshp.fi
Secretary
International Federation of Clinical Chemistry
W: www.ifcc.org

The function of clinical chemistry and laboratory medicine is to perform qualitative and quantitative analyses on body fluids such as blood, urine, spinal fluid, faeces, tissue and other materials. The tests must be performed accurately for the results to be useful to the physician in the diagnosis and treatment of the disease. To serve this purpose, individuals interested in clinical chemistry began to form national societies; the first scientific societies of clinical chemistry were formed at the end of 1940s, when the first journals with the term clinical chemistry in their title also appeared. The International Association of Clinical Biochemists was formed in 1952 but, a year later, changed its name to the International Federation of Clinical Chemistry (IFCC).

The initial objectives of the IFCC were to “advance knowledge and promote the interests of biochemistry in its clinical (medical) aspects”. Today, the IFCC carries out most of its activities through the following divisions:

  • The Congress and Conference Division (CCD) is responsible for the general administration and management of all IFCC congresses, conferences and symposia. The CCD can obtain IFCC auspices for the congresses not organised by the IFCC.
  • The Education and Management Division (EMD) has a broad mission in facilitating the development of managerial skills, supporting educational activities in laboratory medicine and offering critiques, advice and expertise on issues and problems related to laboratory management, teaching and education. The divisional activities are currently carried out by five committees, three working groups and special projects.
  • The Communication and Publication Division (CPD) is responsible for all the publication activities of the IFCC. CPD coordinates the internet activities of the IFCC, primarily through the IFCC website. CPD also publishes the e-journal of the IFCC on the web, IFCC recommendations and documents in formal collaboration with the journal Clinical Chemistry and Laboratory Medicine and other international journals in the field.
  • The mission of the Scientific Division (SD) is to advance the science of clinical chemistry and to apply it to the practice of clinical laboratory medicine. According to the statutes of the IFCC, the federation exists to advance the science and practice of clinical chemistry and to further its application in the provision of health services and the practice of medicine. During the first decades the main efforts of this committee were directed toward analytical nomenclature, reference materials and methods, and quality control.

Standardisation and reference materials
The important scientific work of the IFCC lies in the areas of standardisation and reference materials. Several projects were conducted by the SD to further promote the concept of reference systems (eg, reference measurement procedure, reference material, reference laboratories and reference intervals). This concept is the basis for the implementation of global traceability of laboratory tests pursued by the Joint Committee of Traceability in Laboratory Medicine, in collaboration with the Bureau International des Poids et Mesures (BIPM) and the International Laboratory Accreditation Cooperation (ILAC). Another important collaborator is the Clinical and Laboratory Standards Institute. More than 200 certified reference materials and approximately 150 reference measurement procedures useful for the establishment of traceability are accessible on the BIPM website (see www.bipm.fr).

The Joint Committee for Guides in Metrology (JCGM) was founded in the 1990s in collaboration with the BIPM, ILAC, the International Electrochemical Commission, the International Organisation for Standards, the International Union of Pure and Applied Physics and l’Organisation Internationale de Métrologie Légale. The objectives of the JCGM are to maintain and develop the International Vocabulary of Basic and General Terms in Metrology and the Guide to the Expression of Uncertainty in Measurement. Both are pertinent for appropriate reporting of test results.

The most recent certified reference materials include the prothrombin G20210A mutation, myoglobin, Troponin I, Lp(a) and a new batch for Apo B. These were finalised in 2005 in collaboration with the Institute for Reference Materials and Measurements, the National Institute of Standards and Technology and the World Health Organization. The IFCC has approved the recommendations on most enzyme measurement procedures, which have now been adopted at 37°C. To implement these fundamentals in the clinical field, continuing discussions with medical associations, such as the International Diabetes Federation, the American Diabetes Association, the European Association of Diabetes Societies, the Japanese Diabetes Society, the American College of Cardiology and the European Society of Cardiology, have been held. The Global Campaign for Diabetes Mellitus (EMD Task Force) is an excellent example, in which patients, clinicians and laboratory professionals are working together.

A fully integrated medical discipline
The main objective of laboratory medicine has been to provide meaningful, accurate results for risk assessment, diagnosis of conditions, follow-up and monitoring of the treatment of patients. Laboratory medicine is an important and essential part of the diagnostic process. It has to provide reliable data to satisfy the quality requirements and expectations of clinicians. For this purpose many guidelines for quality management have been published focusing on process optimisation and economic aspects.

Today, the importance of clinical chemistry and laboratory medicine is growing in clinical medicine. Laboratory diagnostics is considered to be an integrated medical discipline, in which evidence-based test requesting, the clinical usefulness of tests and the interpretation of laboratory reports will be essential. In addition, the increasing number of clinical tests and the complexity and the increasing amount of data, especially in bioinformatics, need to be interpreted to clinicians and patients by the laboratory professionals. The interdisciplinary clinical consulting process will also bring laboratory nearer to the patient.

In the future clinical chemistry and laboratory medicine will have the important responsibility of  continuously evaluating the validity and clinical utility of new diagnostic tests linking them with clinical outcome. To achieve this, globally harmonised analytical measurement procedures are essential, with internationally recognised reference materials.