Mass spectrometry and clinical chemistry

Abstract

Over the last ten to fifteen years there has been an enormous increase in the sophistication of the analytical instruments used in the clinical chemistry laboratory. That the majority of these instruments is designed for the automated and rapid analysis of body fluids reflects a trend in modern clinical chemistry to invest large amounts of money into capital equipment in order to process large numbers of samples in the least labour-intensive way. Provision of such a service is. however, only one aspect of clinical chemistry. Another responsibility is to provide to smaller patient groups, laboratory services of a more investigative nature which, because of their complexity and limited numbers, do not lend themselves to automation. Also. the discipline and its members should be involved in research into the physiological chemistry of health and disease, and into the application of new methods of analyses to investigate these processes. These responsibilities also require the investment of capital for instrumentation and of time for the investigations. However, since the returns on these investments are different from, and less pecuniary than, those from the automated instrumentation. they are often more difficult to justify. especially in times of fiscal constraint. An example of this type of investment is the use of analytical mass spectrometry in the clinical laboratory. The purpose of this review is to show how this technique has already been successfully adapted to problems in clinical chemistry. On the broader front, it describes one example of how clinical chemistry can carry out the innovative and investigative work alluded to above, which is so crucial to its long-term survival as a scientific discipline. The review will be divided into three sections. The first will describe the types and modes of usage of mass-spectrometer systems that are currently employed in clinical laboratories. The second will review the recent applications of these instruments to clinical chemistry problems. A final. shorter section. will deal with aspects of mass