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

Centrifugal

Analyzers

Tubing

flow of reagents and patients samples

Centrifuge

Discrete

Separate

force to mix sample and reagents

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

or large batch testing?

Single instrument or multiples?

Storage
Need

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