UNIVERSIDAD DE ZAMBOANGA
BATCH 2024
AUBF
Adapted from: REFERENCE BOOKS
COURSE OUTLINE: LECTURE/LABORATORY
1. Urinalysis Automation
a. Semi-Automated Urine
Chemistry Analyzers
b. Fully Automated Urine Chemistry
Analyzers
c. Automated Microscopy
d. Automated Urinalysis System
2. Body Fluid Analysis Automation
Urinalysis Automation
Introduction
- Urinalysis is a valuable tool used to
diagnose and monitor renal and urinary
tract illnesses. Typically, it is a moderate-
to high-sample volume test for a general
chemistry lab, representing up to 30% of
all samples received. Routine urinalysis
consists of macroscopic examination,
chemical analysis, and microscopic urine
sediment examination.
- According to studies, the laboratory
staff's accuracy in timing and
interpreting the color reactions during
urine testing is the key factor. Timing
precision is necessary for accurate color
measurements. Urinalysis automation
ultimately aims to increase efficiency
and standardize urinalysis results
reporting while also enhancing
repeatability and color discrimination.
NOTE:
Automated urinalysis offers the benefits of
convenience, efficiency, and increased
sensitivity for detecting renal and urinary
tract abnormalities. The true value may lie in
the ability to efficiently screen and report
urine samples that lack pathologic findings.
 Subjectivity related to visual distinction
between the developments of automated
systems has made it easier to see colors.
Readers for reagent strips that measure
light reflection spectrophotometrically,
or "reflectance photometry”
NOTE:
Reflectance photometry uses the principle
that light reflection from the test pads
decreases in proportion to the intensity of
color produced by the concentration of the
test substance.
 The instruments are user-friendly and
include visual and audio prompts for
operation. The various manufacturers’
instruments include different features
and principles for testing which will be
discuss more by the other presentors.
Online is one more benefit of automation.
bar coding, manual, and computer
capability with LIS interface Marking
abnormal results, storing patient and
control results, entering color, clarity,
and microscopic results to be included
on the printed report, and carrying out
the bare minimum of calibration,
cleaning, and as well as upkeep.
Automated Instruments
 Semiautomated chemistry analyzers
o Instruments that are semi-
automated nevertheless require
an operator to mix the specimens,
dipping of test strips, and entry of
microscopic data.
 Fully automated chemistry analyzers
o The urine tubes are placed on a
rack or a carousel and
automatically passed through the
equipment in a fully automated
chemistry analyzer.
 Automated urine cell analyzers
o To categorize urine sediment,
automated urine cell analyzers
mix, aspirate, dilute, and stain
urine particles.
 Completely automated systems
o Complete urinalysis, including
the physical, chemical, and
microscopic components, is
carried out using automated
urine systems of a standard urine
test.
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Semi- Automated Urine Chemistry
Analyzers
 Test for chemical component of urine
o Read and interpret the reagent
strip results consistently
 Instrument and the reagent strips used
for the following test that performed:
1. Leukocyte
2. Nitrite
3. Protein
4. Blood
5. Glucose
6. Ketone
7. Bilirubin
8. Urobilinogen
9. pH
10. SG
11. Color
12. Creatinine
13. Protein to creatinine ratio
 Semi-automated analyzers are well
suited for small- and medium-volume
laboratories
 Are self-calibrating and some instrument
perform auto-checks
o For a semi-automated
instrument, the reagent strips are
manually dipped and placed on
the strip reader, the reaction pads
are read at the correct time, and
the strip is moved to the waste
container
o The results are displayed,
printed, or transmitted to an LIS
o Positive results are flagged to
indicate a patient sample that
requires additional confirmation
testing or microscopic evaluation
 The semi-automated instrument
requires the operator to:
1. Dip the reagent strip into a well-
mixed urine sample
2. Blot the strip to remove excess
urine
3. Place the strip onto the reagent
strip platform
4. Press the analyser/ enter button
 Results are printed out, and abnormal
results are flagged automatically.
 As the strip moves through the
instrument, reflectance readings are
taken at the correct time intervals.
 Some manufacturers’ test strips have a
color compensation pad that adjusts
results for urine color.
 This feature allows the instrument to
subtract the urine color from the color
developed on the reaction pad, providing
an accurate result for each pad despite
the interference.
 The strips are then moved to the waste
container.
 Results are stored in the analyzer,
printed, or sent to the LIS
 Daily maintenance is minimal and
includes cleaning the reagent strip
platform and emptying the reagent strip
waste container.
Fully Automated Chemistry Analyzers
 Fully automated urine chemistry
analyzers can also determine the
physical characteristics of urine—color,
clarity, and specific gravity (SG)—
however, the methods used vary.
o To perform urine color
assessment, some manufacturers
include an additional pad on the
reagent strip to determine urine
color by reflectance photometry;
others use spectrophotometry at
multiple wavelengths to assign
color.
 Light transmittance or light scatter is
used to determine urine clarity. Despite
the universal availability of an SG
reagent strip test, most fully automated
chemistry analyzers use refractive index
because of its greater accuracy.
 A microprocessor collates all results—
color, clarity, SG, and chemistry tests—
which are subsequently sent to data
storage and can be printed on a report
form or sent electronically to an LIS.
NOTE:
When using a fully automated urine
chemistry analyzer, the user simply places
labeled tubes of urine into a sample rack or
carousel. Testing is initiated by pressing a
button on the instrument display or
automatically with placement of a sample
rack. From this point on, the instrument
controls movement of the specimen rack,
identifies each sample, mixes it, aspirates
urine using a sample probe, and dispenses it
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 onto a reagent strip. At the appropriate read
time, each reaction is read using the
appropriate wavelengths of light for that
specific test.
Clinitek Atlas
- Is a fully automated benchtop
instrument designed for high-volume
urine testing using proven technology in
dry-pad urine chemistry analysis. Also,
Automated Urine Chemistry Analyzer
combines dry-pad urine chemistry
technology and a cassette test format to
help ensure maximum productivity and
standardized testing with other.
- Operating with a throughput of up to 240
samples/hour, it helps streamline
workflow, simplify testing, and deliver
consistent, high-quality results.
- It can detect for early kidney disease
Urisys 2400 urine analyzer
- The new URISYS 2400 System has been
designed for high throughput
laboratories with 100–1000 urines per
day. Its fully automated operation meets
today’s demands for an efficient work
flow, reduced labor costs and high-
quality results. Specific hardware and
software features support the easy
integration of the urinalysis work place
into the routine rack lab. And the most
sample and reagent handling together
with a convenient user interface ensure
the system’s ease of use for all staff.
Aution Max AX-4030
- Finest fully automated urine analyzer
- Various measurements such as S.G.,
color-tone, turbidity and abnormal
coloration are available, as well as ten
qualitative analyses. Two strip feeders -
loadable with different types of strips.
Micro volume sample (2mL) using the
spotting method.
- Also, a fully automated urine chemistry
analyzer. Easy to use and maintain, the
AUTION MAX AX-4030 generates
accurate and reliable urine chemistry
results without interruption offering
high throughput of up to 225 samples
per hour and continuous loading of up to
100 samples.
iChem Velocity
- The iChem VELOCITY sets the standard
for automated urine chemistry analysis
with the development of the ascorbic
acid test pad to identify possible ascorbic
acid interference with key chemistry
assays, ensuring laboratories receive
clinically relevant information.
- This urine chemistry instrument offers
high throughput of up to 210 samples
per hour and ease of use to maximize lab
performance and productivity.
Automated Microscopy
 In a routine urinalysis, a test strip
determines the chemical analytes, and
the formed elements are determined by
microscopy.
 Manual microscopy is not easily
standardized because of the high
variation among operators even in the
same institution.Routine specimen
processing such as centrifugation can
affect accuracy because rare elements
such as casts or cells may be lost during
handling.
 It has been demonstrated that recovery
of formed elements in the sediment after
centrifugation is highly variable.
 Results are not quantitative because they
must be reported in ranges or averages.
 Overall, manual microscopy is not cost
effective because of the labor and time
required to process and analyze the
specimen, which ultimately reduces
turnaround times for results.
 Automated urine cell analyzers provide
efficient standardized results in less than
1 minute as compared with
approximately 6 minutes using the
manual method, markedly improving
turnaround times.
 Two automated urine cell analyzers are
currently available in the United States:
 the Sysmex UF-1000i
 the iQ 200 from Iris Diagnostics.
Sysmex UF-1000i
 The Sysmex UF-1000i (Sysmex
Corporation, Kobe, Japan) uses laser-
based flow cytometry that measures
forward light scatter, side scatter,
fluorescence staining characteristics,
Page 3
 and adaptive cluster analysis to identify
stained urine sediment particles.
 To perform an automated microscopy, 4
mL of uncentrifuged urine is aspirated
into the instrument and divided into two
channels: one for urine particle analysis
and one for bacteria staining and
detection.
 Each channel has a specific stain that
targets the internal components of the
cells. The stained urine sample passes
through the flow cell, where it is hydro
dynamically focused and presented to a
red semiconductor laser (635 nm).
 Resulting values are presented in
quantitative cells per microliter and cells
per high- or low-powered field.
Thresholds to be flagged for primary
elements can be established and
abnormal results are flagged for
confirmatory review. The main particles
enumerated are red blood cells (RBCs),
white blood cells (WBCs), epithelial cells,
hyaline casts, and bacteria. The results
are displayed as scattergrams.
These parameters are directly reportable
without technologist intervention and may be
autovalidated. Flagged particles include
pathologic casts, crystals, small round cells
(renal tubular epithelial cells or transitional
epithelial cells), sperm, mucus, and yeast-like
cells, and must be confirmed by manual
microscopy. A latex particle quality control
system monitors performance, and quality
control records can be viewed on the
instrument screen in a Levy-Jennings graph.
The analyzers can store up to 10,000 patient
results, including scatter grams, histograms,
and specimen characteristics, which can be
saved and viewed by the user. A bidirectional
interface is provided to download and report
results. The UF-1000i can be used
independently or integrated with an
automated urine chemistry strip reader to
create a complete urinalysis system.
iQ 200
 The iQ 200 Automated Urine Microscopy
Analyzer (Iris Diagnostics,
Chatsworth,Calif.) uses digital imaging
and APR to automatically analyze and
preclassify urine particles in
uncentrifuged urine based on size and
shape.
 The instrument also can be used for body
fluid cell counts by adding the body fluids
software module.
 It can be used independently or
integrated with an automated urine
chemistry analyzer to create a complete
urinalysis system. The analyzer mixes
the sample and aspirates approximately
1 mL of urine to a planar flow cell, where
500 digital photomicroscopic images are
taken per sample. Strobe light passes
through the collimator in a single beam
to illuminate the specimen passing
through the flow cell.
 The specimen is surrounded by a lamina
that functions to orient the particles for
microscopic viewing. The digital video
camera then takes 500 pictures as the
specimen passes through the flow cell.
The digital images are sent to the
computer, where the actual analysis will
take place.
The system uses Auto Particle Recognition
(APR) software that preclassifies urine
particles in the photographs based on size,
shape, texture, and contrast into 12
categories: RBCs, WBCs, WBC clumps, hyaline
casts, unclassified casts,squamous epithelial
cells, nonsquamous epithelial cells, bacteria,
yeast, crystals, mucus, and sperm.
 Particle identification is confirmed, or
flagged and checked by the user before
release. Results are sent to an operator
screen or compared with user-defined
auto-release parameters. If results are
within the defined criteria they are sent
directly to the LIS. Because the
photographs are digitally archived,
results can be reviewed easily and
reclassified by the operator without the
need for manual microscopy.
 The software allows the user to
subclassify 27 additional categories to
indicate the specific types of crystals,
casts, epithelial cells, yeast with
pseudohyphae, trichomonads, and oval
fat bodies. Free text comments can be
added to the report as needed.
Page 4
The sedMAX  The instrument automatically reflexes
 (77Elektronika, distributed in Europe samples requiring sediment analysis,
andAsia by A. Menarini Diagnostics) reducing the time associated with
performs automated microscopy with manual microscopic analysis. Results
digital imaging. are automatically verified and
 The instrument uses newer technology, integrated into a complete urinalysis
and as of this writing is not yet FDA report to be sent to the LIS or printed.
approved for use in the United States.
 The sedMAX requires a minimum of 2 mL The CLINITEK AUWi System provides the
of urine that is centrifuged in a special following
cuvette to produce a monolayer of urine
sediment. Test methods:
 The sediment is analyzed by a bright-  Leukocyte Esterase
field microscope and digital camera to  Nitrite
capture and categorize 15 particle  Occult Blood
images based upon size and shape using  Protein
image-processing software. 2 An  Glucose
advantage to this instrument is the zoom  Ketones
capability to view images and  Urobilinogen
interpretation of the images is similar to  Bilirubin
manual microscopic smears.  pH
 Specific Gravity
Automated Urinalysis Systems  Color
 Clarity
 Automatic sample transport from one
workstation to another allows you to Also, offers the following measurement
work more efficiently technologies:
 Automatic verified results are reported  Dry pad test measurement
directly to the LIS, which minimizes
 Color change measured by reflectance
technician follow up
photometry
 High on-board sample and reagent
 Dual readings at reactive and reference
capacity helps to deliver the walkaway
wavelengths
capability needed in busy lab
 Specific gravity by refractive index
environments
method
 Loading up to 100 samples allows you to
 Clarity measured by transmitted and
complete up to 80 tests per hour while
scattered light
performing other tasks
 Enhanced bacteria detection on UF-
The UF-1000i lets you perform tests via
1000i due to separate measurement
formed elements
channel for better clinical results
 RBC
 Ability to cross-check with urine
 WBC
chemistry leukocyte and nitrite results
 Epithelial Cells
increases confidence in UTI assessment
 Hyaline Casts
NOTE:
 Min. of 5 mL is needed  Bacteria and flagged parameters
 bar-coded tubes are racked and placed  Pathological Casts
onto the system  Crystals
 rack advances to the ATLAS analyzer,  Small Round Cells
where the specimen is identified,  Sperm
mixed, aspirated, and tested for  Yeast
physical and chemical components.  Also, offers the following measurement
 The sample then travels across a technologies:
connecting bridge to the UF-1000i for o Urine fluorescent flow cytometry
microscopic analysis. o Two stains with fluorescent dye
Page 5
 o Separate bacteria channel for iChem®VELOCITY™ Automated Urine
improved discrimination Chemistry System When connected as a workcell
The iRICELL Automated Urinalysis Systems TestsPerformed 13 (10) Urine Chemistries,
(Iris Diagnostics) Specific Gravity, Color and
 Consist of the iChem VELOCITY urine Clarity
chemistry analyzer and the iQ 200 Measurement
microscopy analyzer. Methods
 Analyzes up to 210 urine samples per • Test Strip Three wavelengths—Iris
hour Chromaticity with variable
endpoint
 Features 300 strip load capacity
 Stores up to 10,000 patient records • Specific Gravity Refractive index
 Prevents use of expired components
 Provides fewer errors when • Color / Clarity In-flow transmission and
reconstituting by using ready-to-use scattering color sensor
consumables with white light
 Load urine samples, press START and illumination
walk away for effortless operation Measurement 472, 520, 630 nm
 Reduce downtime with continuous strip Wavelengths
loading capability while system is Measurement Reflectance Photometry
running Principle LEDs with CMOS Camera
Test Strip iChem Urine Chemistry
 Receive more clinically relevant
Strip, 100-test vial;
information since ascorbic acid detection
Storage 34°- 86°F (1°-
informs the user of potential
30°C)
interference with key chemistry assays
Test Strip Capacity 1 to 300 test strips
 Recall QC or patient results easily with Sample Throughput Up to 210 samples per
user-friendly software hour
Sample Identification Auto-ID barcode
iQ® Automated Urine Microscopy Systems Sample Rack 10-tube rack
Particles RBC, WBC, Bacteria, Hyaline Specimen Volume Min volume: 2.0 mL
Identified by Auto Casts, Pathological Casts,
Sample Capacity 60 / 210 samples with
Particle Crystals, Squamous Epithelial
continuous feed optional
Recognition Cells, Non-Squamous Epithelial
load / unload modules
(APR™ Cells, Yeast, WBC Clumps,
Data Storage 10,000 results
Sperm and Mucus
Operating Temperature: 64°- 82°F
Specimen Barcode or keyboard entry of
Environment (18°- 28°C); Humidity: 20 -
Processing ID; 60-specimen walk away
80%; non-condensing
capability; 10-tube rack system
with continuous feed
NOTE:
Specimen Volume Min. volume: 2.0 mL of un-
 minimum of 1-2 mL of urine
spun urine; aspiration volume:
 The bar-coded tubes are placed into the
approx 1.0 mL
10-position rack and are moved to the
Measurement Flow Cell Digital Imaging
iChem VELOCITY, where the sample is
Principle mixed and the urine is aspirated. Upon
Sample Rack 10-tube rack completion of the physical and chemical
Data Storage Onboard storage of up to analysis, the rack moves across the
10,000 patient results connecting bridge to the iQ 200 for
Electrical Power Microscopy Module: 90-240 microscopy testing.
Req. Vac, 50-60 Hz Monitor: 100-  Samples can be reflexed to urine
240 Vac microscopy based upon urine chemistry
results. One hundred percent microscopy
is not required with iRICELL.
 Results for a complete urinalysis are
transmitted to the LIS or printed.

Page 6
Body Fluid Analysis Automation
 Body fluid cell counts and differentials
are traditionally performed manually
using a Neubauer hemocytometer.
 Automation brings quality control and
precision to a method that previously
was uncontrolled
 Automated instruments have not,
however, completely eliminated the use
of a manual hemacytometer count.
 The laboratory must define the limits for
the instrument and establish the lower
limits for cell counting to determine
when a manual procedure must be
performed
Hematology analyzers
 That are used to perform body fluids cell
counts include the:
 ADVIA2120i (Siemens),
 Sysmex XE 5000 (Sysmex)
 Beckman Coulter LH780
 UniCel DxH800 (Beckman
Coulter, Inc.).
 The ADVIA 2120i uses flow cytometry,
light scatter, and absorbance to count
red and white blood cells, and perform a
WBC differential that includes
percentages and absolute numbers of
mononuclear cells and
polymorphonuclear cells on samples
with greater than 20 WBC/μL
o The prepared sample remains
stable for 4 minutes to 4 hours
when stored at 18°C to 30°C..
o The specimen is aspirated into
the instrument and cells are
differentiated and enumerated by
three optical measurements.
o The signals are digitized and used
to construct the CSF cytogram.
NOTE:
With this system, more cells are counted,
achieving increased accuracy and precision.
The automated RBC, WBC,
polymorphonuclear, mononuclear, and
differential results are available within 1
minute of sample aspiration.
 In addition, the ADVIA 2120i can provide
a rapid automated diagnostic test for
fetal lung maturity
 Sysmex XE-5000 is the newest
generation hematology analyzer that
includes a dedicated body fluid mode.
o Body fluids can be analyzed
without sample preparation or
pretreatment.
o In the body fluid mode, a new
software algorithm is used to
count RBCs (sheath flow
impedance) and WBCs (side
scatter and fluorescence
intensity) after dye-staining
NOTE:
RBC using sheath flow impedance and WBCs
using side scatter and fluorescence intensity
after dye-staining nuclear DNA or RNA.
o Polymorphonuclear cells and
mononuclear cells are counted in
the differential (DIFF) channel
o It is recommended that only
nonmalignant fluid be analyzed
on the XE-5000
 iQ 200 using digital flow cell imaging can
be used forbody fluids by adding the
body fluids software module
o Includes CSF, synovial, pleural,
peritoneal, peritoneal dialysate,
peritoneal lavage, pericardial, and
general serous fluids.
 Two dilutions
 One tube is diluted with an Iris
(iQ) diluent
 Iris RBC-lysing reagent
Page 7