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
postanalyticcorresponding 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 Analyzers
Centrifuge force to mix sample and reagents
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.
CENTRIFUGAL ANALYZERS
Discrete aliquots of specimens and reagents are
piptted into discrete chambers in a rotor
The specimens are subsequently analyzed in
parallel by spinning the rotor and using the
resultant centrifugal force to simultaneously
transfer and mix aliquots of specimens and
reagents into radially located cuvets.
The rotary motion is then used to move the
cuvets through the optical path of an optical
system
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 labs 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
 http://www.youtube.com/watch?v=iqSpmwiNTHo
http://www.youtube.com/watch?v=FyLOTBicYbk
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
Physicians 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