PRINCIPLES OF CLINICAL

CHEMISTRY AUTOMATION
AUTOMATION IN CLINICAL
CHEMISTRY

 The modern clinical chemistry laboratory uses a

high degree of automation.
 Many steps in the analytic process that were
previously performed manually can now be
performed automatically.
 This Permits the operator to focus on tasks that
cannot be readily automated and increasing both
efficiency and capacity.
AUTOMATION IN CLINICAL
CHEMISTRY

 The analytic process can be divided into three major

phases— preanalytic, analytic, and postanalytic—
corresponding to sample processing, chemical
analysis, and data management, respectively.
 Substantial improvements have occurred in all three
areas during the past decade.
 The analytic phase is the most automated, and more
research and development efforts are focusing on
increasing automation of the preanalytic and
postanalytic processes.
WHY AUTOMATION?
 Increase the number of tests by one person in a
given period of time
 Minimize the variations in results from one
person to another
 Minimize errors found in manual analyses –
equipment variations – pipettes
 Use less sample and reagent for each test
TYPES OF ANALYZERS
 Continuous Flow
 Tubing flow of reagents and patients samples
 Centrifugal analyzer
 Discrete
 Separate
testing cuvets for each test and sample
 Random and/or irregular access
CONTINUOUS FLOW
 This first “AutoAnalyzer” (AA) was a
continuous-flow, single-channel, sequential
batch analyzer capable of providing a single test
result on approximately 40 samples per hour.
 Analyzers with multiple channels (for different
tests), working synchronously to produce 6 or 12
test results simultaneously at the rate of 360 or
720 tests per hour.
CONTINUOUS FLOW
 In continuous flow analyzers,
samples were aspirated into tubing to
introduce samples into a sample holder,
bring in reagent,
create a chemical reaction,
and then pump the chromagen solution into a
flow-through cuvette for spectrophotometric
analysis.
CONTINUOUS FLOW

• The major drawbacks that contributed to the eventual demise

of traditional continuous-flow analyzers in the marketplace
were significant carry-over problems and wasteful use of
continuously flowing reagents.
CONTINUOUS FLOW
 Continuous flow is also used in some
spectrophotometric instruments in which the
chemical reaction occurs in one reaction channel
and then is rinsed out and reused for the next
sample, which may be an entirely different
chemical reaction.
DISCRETE ANALYZERS
 Discrete analysis is the separation of each
sample and accompanying reagents in a separate
container.
 Discrete analyzers have the capability of running
multiple tests on one sample at a time or
multiple samples one test at a time.
 They are the most popular and versatile
analyzers and have almost completely replaced
continuous-flow and centrifugal analyzers.
DISCRETE ANALYZERS

 Sample reactions are kept discrete through the

use of separate reaction cuvettes, cells, slides, or
wells that are disposed of following chemical
analysis.
 This keeps sample and reaction carryover to a
minimum but increases the cost per test due to
disposable products.
HITACHI 902 ANALYZER
WITH AUTOMATION THERE IS
STILL SOME VERY BASIC STEPS

 Specimen preparation and Identification

 Labeling still critical
 Programming of instrument

 Laboratory personnel must perform and observe:

 Quality Assurance
 Quality Control
TOTAL LABORATORY AUTOMATION
SELECTION PROCESS
 What is your lab’s workload like?
Discrete or large batch testing?
Single instrument or multiples?
 Storage of reagents
Need refrigeration or freezing? expense
Kept at room temperature until reconstituted
POINT OF CARE
TESTING
DEFINITION
 Point-of-care testing (POCT) has been defined
by the College of American Pathologists (CAP)
as “those analytical patient-testing activities
provided within the institution, but performed
outside the physical facilities of the clinical
laboratories.”
PLACE OF ANALYSIS
 Physician’s offices
 Operating rooms

 Emergency rooms

 Intensive Care Units

 Home health care

 Patient performed
PERSONNEL ISSUES
 Most often performed by non-laboratorians
 Physicians

 Nurses or nurses aides

 Respiratory technicians

 Not specifically trained in the requirements for accurate

testing and interpretation
LABORATORY SUPPORT
 Laboratory still responsible for results
 Therefore responsible for training and
management of POCT programs
 Laboratory must build a structure to
support and facilitate POCT
SUPPORT STAFF
 Director - PhD, MD or laboratory scientist or
pathologist
 POC Coordinator – laboratory scientist with
high level technical & interpersonal skills
 POC Trainers – designated person(s) for
problem solving etc.
COMMON APPLICATIONS
 Glucose Testing
 Chemistries

 Electrolytes

 Blood gases

 Hematology

 Coagulation – ACT

 Hematocrit