Chemical Pathology (sometimes referred to as Medical Biochemistry or Clinical Biochemistry) is a fundamental diagnostic, prognostic and monitoring keystone of modern medicine, having developed as a specific laboratory based specialty within Pathology since World War II.
All physiological processes are dependent on biochemical reactions, and all disease processes will be dependent on or reflect changes within these reactions. The majority of biochemical tests within the normal hospital setting require samples of body fluids or cells which are then subject to analysis. Due to the reductive nature of biochemistry within disease processes the repertoire of tests far exceeds any other Pathology specialty.
As well as providing laboratory based services, Chemical Pathologists are increasingly engaged in direct clinical care of highly specialised services which include lipidology & cardiovascular risk, diabetes, nutrition & obesity, inherited metabolic disease, metabolic bone and renal stone diseases. Since 2003, these roles have been formally recognised through the development of sub-specialisation training in Metabolic Medicine, which identifies the expanding clinical need for these services. Trainees wishing to include this subspecialist traing require two years of core medical training before entry to the specialty.
Trainees in chemical pathology tend to have varied interests:
- As a modern laboratory is highly automated, some are interested in IT and informatics,
- others have come from a background in diabetes and endocrinology,
- some enjoy laboratory work and may wish to develop this further by taking some time out of clinical work to do laboratory-based research,
- and others enjoy the challenge of managing a large and busy department with staff from several disciplines including clinical scientists and biomedical scientists.
Notable Achievements in Wales
- Wales has an international reputation for research in the porphyrias and in complement biology.
- Cardiff provides a UK-wide lab and clinical services for porphyria.
- Based in Cardiff are the regional Toxicology services and the Lipid Unit which includes the largest LDL apheresis service in the UK.
- A full metabolic Medicine Training Scheme is available in Wales which benefits from the new national service for Lysosomal storage disorders based in Cardiff.
Future of the Specialty/Developments in Wales
Services for genetic testing and cascade screening for familial hypercholesterolaemia have recently received funding in Wales along with the Lysosomal storage disease service. As a result the profile of the specialty is gaining ground and expansion of clinical and laboratory services is likely to continue as trainees are now qualifying with the dual CCT in Chemical Pathology (RCPath) and Metabolic Medicine (RCP).
Further information can be found in the training section of the Royal College of Pathologists website.