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