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MLAB 2401: Clinical Chemistry Keri Brophy-Martinez Automation.

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Presentation on theme: "MLAB 2401: Clinical Chemistry Keri Brophy-Martinez Automation."— Presentation transcript:

1 MLAB 2401: Clinical Chemistry Keri Brophy-Martinez Automation

2 History of Automation 1957 – 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 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 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 8

9 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 10

11 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 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 13 Automated Chemistry Analyzers Concepts and definitions

14 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 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 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 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 – 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 1.Sample identification: bar code or manual read 2.Determination of tests to be performed: LIS can communicate this or operator 3.Reagent systems and delivery: reagents dispensed into cuvet 4.Specimen measurement and delivery: sample aliquot in introduced into reaction cuvet 5.Chemical reaction phase: Sample and reagents mixed and incubated 6.Measurement phase: Optical readings 7.Signal processing and data handling: Concentration is estimated from a calibration curve stored in analyzer 8.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.


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