AUTOMATION

in CLINICAL
CHEMISTRY
PRESENTED BY: YVETTE JOYCE R. CRUZ, RMT, MSMLS
DRIVING FORCES TOWARD MORE AUTOMATION

• Fast turn-around-time
• Ease of use
• Precision, sensitivity, and specificity
• “Walk-away” capabilities and minimal operator intervention
• Convenience for the patients (POC analyzers)
• Higher volume of testing
• Faster turn-around-time
 MODULAR ANALYZERS

• Chemistry and immunoassays are incorporated to a single

analyzer
SIEMENS DIMENSION VISTA 500
ROCHE MODULAR ANALYTICS
ABOTT ARCHITECT ci8200
BECKMAN COULTER SYNCHRON LXi 725
STEPS IN
AUTOMATED
ANALYSIS
• Specimen Preparation and Identification
• Specimen Measurement and Delivery
• Reagent Systems and Delivery
• Chemical Reaction Phase
• Mixing
• Separation
• Incubation
• Reaction Time
• Measurement Phase
• Signal Processing and Data Handling
Specimen Preparation and
Identification

• Pre-analytical specimen preparation has been and remains a

manual process.
• ALTERNATIVES:
➢ Use of ROBOTICS, or front-end automation
➢ Analyze the whole blood sample
➢ Use a plasma separator tube and perform primary tube
sampling with heparin plasma
Specimen Preparation and
Identification

• The sample must be properly identified, and its location in the

analyzer must be monitored throughout the test.
• MEANS:
➢ Manual labelling (simplest way)
➢ Bar code (sophisticated approach) – contains patient
demographics and may also include test requests
Specimen Measurement and Delivery

Carousel or rectangular Trays or racks move

Cups and tubes hold
racks serves as specimen automatically in one-
standards, controls, and
containers for disposable position steps at
patient specimens to be
sample cups or primary preselected speeds
pipetted into the reaction
tubes in the loading or (which determines the
chambers of the
pipetting zone of the no. of specimens to be
analyzers
analyzers. analyzed per hour)

For convenience, the The instrument’s

instrument has the microprocessor holds the
capability to identify the no. of samples in memory
last slot that contains a and aspirates only in
specimen and terminates positions containing
analysis after. samples.
• VITROS analyzer –
sample cup trays are
quadrants that hold 10
samples each in cups
with conical bottoms
• Roche/Hitachi
analyzers – use five-
position racks to hold
samples
• Modular analyzer –
up to 60 at one time
Specimen
Measurement
and Delivery
• Aliquot is measured through
aspiration of sample into a
probe, and dispensed into
the reaction vessels
• Probe and tubing are cleaned
after each dispensing to
minimize carryover, unless
disposable probes or tips are
used
Reagent Systems and Delivery
• LIQUID: available in bulk volume containers or unit doses
• DRY: Bottled as lyophilized powder, requiring reconstitution
or multi-layered dry chemistry slide
• PRESERVATION: refrigeration, reconstitution of dry tablet, or
combination of two stable components
• Dispensed via tubing from bulk containers, syringes that
pipette reagents into reaction containers, piston-driven
pumps connected by tubing, or pressurized reagent bottles
MULTILAYERED DRY
CHEMISTRY SLIDE FOR
VITROS ANALYZER
• Multiple layers on the slide are
backed by a clear polyester
support. The coating itself is
sandwiched in a plastic mount.
• THREE LAYERS
1. A spreading layer – accepts
the sample
2. One or more central layers
– can alter the aliquot
3. Indicator layer – where
analyte of interest may be
quantified
Chemical Reaction Phase

• MIXING: reagents and sample

• Coiled tubing (CFA)
• Rapid start-stop of rotation or bubbling of air (centrifugal)
• Mixing paddles (wet chemistry analyzers)
• SEPARATION: separating undesirable substances from sample
• INCUBATION; heating bath (water or air) to maintain required
temperature of reaction time
• REACTION TIME: depends on rate of transport through system
and timed reagent additions
Measurement Phase

Systems for measurement include

• Ion-selective electrodes
• Visible and UV light spectrophotometry (most common)
• Fluorescence polarization (Abbott AxSYM),
chemiluminescence, bioluminescence
• Gamma counters
• Luminometers
Signal Processing and Data Handling

• Accurate calibration is essential to obtain accurate information

• Multiple instruments that measure the same constituent in a lab
should be calibrated so that results are compatible
• Automated instruments, once calibrated, provide long term
stability of standard curve; require only monitoring
• Some of the instruments are self-calibrating
• Advanced automated instruments have a method of reporting
printed results and communicating to LIS
• Computerized monitoring is available for many parameters
 • Instruments evaluated should be
rated according to previously
identified needs
• Cost of the price of instruments
SELECTION and consumables
OF • Calculate the total cost per test for
each instrument that is considered
AUTOMATED • The ability to use reagents
produced by more than one
ANALYZERS supplier (open vs closed reagent
systems)
• Labor component
• Instrument’s analytic capability
TOTAL
LABORATORY
AUTOMATION
PRE-ANALYTIC PHASE (Sample
Processing)
• Automated process replaces manual handling
• Key components
✓Conveyance system
✓Bar-coded specimen
✓Computer software package to control specimen movement
✓Coordination of robots with instruments as work cells
✓Automated sorting, centrifugation, uncapping, sample
archiving, aliquoting
ANALYTIC PHASE (Chemical Analysis)

• Ever-smaller microsampling
• Expanded onboard and total test menus
• Accelerated reaction times
• Higher-resolution optics
• Improved flow through electrodes
• Enhanced user-friendly interactive software for quality control,
maintenance, and diagnostics
• Ergonomic and physical design improvements
POST-ANALYTIC PHASE (Data
Management)
• Bi-directional communication between analyzers and host
computer
• Integration of work station managers into communication
system
• Automated management of quality control data
• User-defined perimeters for many values
• Need for a “gap-filler” between instrument and laboratory
information system
 • Analyzers will continue to perform more
cost effectively and efficiently
• More integration and miniaturization of
components
• Sophisticated portable analyzers
FUTURE • Expanded test menus (inclusion of more
immunoassays and PCR-based assays)
TRENDS IN • Spectral mapping, or multiple wavelength
monitoring, with high-resolution
AUTOMATION photometers in analyzers
• More system and workflow integration for
robotics and data management
• Incorporation of AI
• Technologic advances in chip technology
and biosensors
 END OF
DISCUSSION