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
Tubing

Flow

flow of reagents and patients samples

Centrifugal
Centrifuge

Analyzers
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

observe:
Quality

personnel must perform and

Assurance Quality Control

TOTAL LABORATORY AUTOMATION

SELECTION PROCESS
What

is your labs workload like?

Discrete Storage Need

or large batch testing? Single instrument or multiples?

of reagents

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