1. MLAB 2401: Clinical Chemistry Keri Brophy-Martinez
Automation

2. History of Automation 1957 1970 1976-1978 1980-Present
Technicon develops the first automated analyzer
Continuous flow
Issues: carryover and costly
1970
Dr Anderson(NASA) develops a centrifugal analyzer
DuPont ACA revolutionized chemistry with a non-continuous flow, discrete analyzer with random access availability
Kodak Ektachem: dry slide technology
Small volumes of sample
Reagents on slides for dry chemistry analysis
1980-Present
Discrete analyzer take over Chemistry
“walk-away” capabilities

3. Ektachem & ACA

4. Drivers For Technology Advances
Reduction in TAT’s
Staff shortages
Economic factors
Increase throughput
Reduction in lab error
Increase safety
24/7 operations
Focus on automation of tasks rather than manual methods

5. Automated Chemistry Analyzers
Advantages
Increased number of tests/technologist
each tech can perform more tests during a period of time
Minimizes variations in results
eliminates errors in pipetting, calculations
Small sample size and reagent volumes

6. Automated Chemistry Analyzers
Disadvantages
Methods vary with the instrument type, etc.
Generally, cost of equipment, maintenance, amount of QC
Techs must be kept knowledgeable & careful in set-up and operations

7. Basic Types of Instruments
Continuous flow
Centrifugal analysis
Discrete analysis
Batch analyzer
perform only test that is requested
can perform many combinations of tests
do not consume reagents for tests not ordered
Continuous flow, centrifugal and discrete analyzers can all use batch mode

8. Automated Chemistry Instruments
Continuous flow analysis
Reagents are pumped continuously through the system.
Samples are introduced sequentially at timed intervals and follow each other through the same network of tubing coils, heating baths and photometer / other detector.
While economical for profiles of tests, not good for stats or single order tests.
All samples get all tests, ordered or not
Could not easily interrupt the process once initiated.
*Also prone to “carryover”.
Wasteful of reagents
Example: Chem 1 By Technicon

9. Automated Chemistry Instruments
Centrifugal analysis
A discrete system where the transfer of solutions is carried out by the use of centrifugal force
Runs multiple samples, one test at a time
Example:
Cobas-Bio and IL Monarch

10. Automated Chemistry Instruments
Discrete analysis
Each sample is contained in a separate reaction vessel
Make up the majority of modern chemistry analyzers
Run multiple tests one sample at a time or multiple samples one test at a time called RANDOM sampling
Examples:
Dade Behring Dimension RXL
Kodak Ektachem
Alfa Wasserman Ace Alera

11. Automated Chemistry Systems
Wet chemistry systems
Reagents come ready to use or lyophilized and must be reconstituted
Systems include batch and profile analyzers or stat analyzers
Examples: Beckman Coulter CX-7, Vitros, Dade, Advia, Roche Integra, Hitachi, Alfa Wasserman Ace Aleria, etc.

12. Automated Chemistry Systems
Dry reagent systems
Reagents can be tablets or found on cellulose fibers located on strips, cards, or layered on film.
Reagents easy to handle, store well, and have fairly long shelf life.
Examples: Vitros, Seralyzer, Kodak Ektachem, ChemPro, Dupont Analyst

13. Automated Chemistry Analyzers
Concepts and definitions

14. Automated Chemistry: Terms
Throughput
Max # samples that can be processed in 1 hour
Dwell time
minimum amount of time required to get test result after sampling
varies greatly with instrument
can be important consideration when selecting instrument

15. Automated Chemistry:Terms
Stat testing
Latin statum = immediate
a widely used (abused) word in the lab, used to prioritize work
Stat turn around time - within 1 hour after order entry

16. Costing of chemistry lab tests
Things that are included in pricing
labor – processing
equipment maintenance
reagents - including a portion of start-up
calibration and QC
consumables - containers, paper
capital - proportionate amt of life of instrument
hospital overhead - facility maintenance

17. Automated Chemistry Test repertoire
What tests the instrument is capable of doing
Consider cost analysis
Immediate test repertoire
What it can do without any changes (set- up or programmed for)
Total test repertoire
Total number of tests that can be performed on the instrument, with a few changes, ie. reagents, filters or components.

18. Analytic Phases
Preanalytic
Analytic
Postanalytic

19. Preanalytic Phase Specimen collection Specimen transport
Right tube for right tests
Proper patient label
Correct draw site
Specimen transport
Phlebotomists
Volunteers
Pneumatic-tube systems

20. Analytic Phase Sample handling
Important to check the specimen for hemolysis, lipemia, clots or fibrin
Some analyzers use closed-tube,some open-tube
Most instruments utilize a level-sensing probe to detect the amount of serum or plasma in a tube

21. Summary of Analyzer Operations
Sample identification: bar code or manual read
Determination of tests to be performed: LIS can communicate this or operator
Reagent systems and delivery: reagents dispensed into cuvet
Specimen measurement and delivery: sample aliquot in introduced into reaction cuvet
Chemical reaction phase: Sample and reagents mixed and incubated
Measurement phase: Optical readings
Signal processing and data handling: Concentration is estimated from a calibration curve stored in analyzer
Send results to LIS or read and entered off results tape

22. Postanalytical Phase Bidirectional communication
Decreases opportunity for error
Auto-verification

23. Trends Total Laboratory Automation (TLA) Integrated work cells
Specimen manager
Track system
Immunoassay
Chemistry

24. References
Bishop, M., Fody, E., & Schoeff, l. (2010). Clinical Chemistry: Techniques, principles, Correlations. Baltimore: Wolters Kluwer Lippincott Williams & Wilkins
Sunheimer, R., & Graves, L. (2010). Clinical Laboratory Chemistry. Upper Saddle River: Pearson .