Automation In Clinical Biochemistry

1. Automation In Clinical
Biochemistry
Amit Kumar Singh
Asst. Professor (Clinical Biochemistry)
Department of Medical Lab Technology
Chandigarh University, Punjab

2. Clinical Biochemistry
▪ Branch of laboratory medicine which studies chemical and biochemical
methods (on blood, urine and other body fluids)
▪ Clinical biochemistry tests comprise over one third of all hospital
investigations.
▪ Recent past has seen major advances in diagnostic methodologies and
instrumentation (automation).
▪ Uses of biochemical tests:
– diagnosis,
– screening the disease,
– monitoring patients or assessing the prognosis once a diagnosis has been made.
– research studies and in clinical trials of new drugs.

3. Steps of the Analysing Process
• There are several individual steps in the analysis process as a whole
in a laboratory such as:
– Identifying the patient
– Getting the correct sample
– Identifying and proper labeling of the sample
– Delivery of sample in proper storage condition and within time
– Preparation of sample for test
– Sample loading/aspirating
– Analysis
– Reporting
– Entering in register

5. What is Automation
• Use of laboratory instruments and specimen processing equipment to
perform assays with only minimal involvement of technologist .
• Automation in clinical laboratory is a process by which analytical
instruments perform many tests with the least involvement of an
analyst.
• IUPAC define automation as "The replacement of human manipulative
effort and facilities in the performance of a given process by
mechanical and instrumental devices that are regulated by feedback
of information so that an apparatus is self-monitoring or self
adjusting”.

6. Benefits of Automation
▪ Automation has a lot of benefits for the laboratory personnel.
– Reduces the workload
– Increases turnaround time (Saves time used per analysis)
– Increases total number of tests done in less time
– Eliminates repetition and monotony from human life so decreases
human error, improves accuracy
– Improves reproducibility (repeatability)
– Uses minimum amount of sample and reagent

7. Automation in:
• Sample collection
• Sample identification by Labeling and bar coding
• Sample delivery
• Sample preparation
• SAMPLE ANALYSIS

8. Sample collection
▪ Glucometer
▪ Vacutainers
ADDITIVE CAP COLOUR BLOOD VOLUME
Lithium Heparin GREEN 4mL
Sodium Citrate BLUE 2.7mL
Sodium Fluoride / Potassium Oxalate GREY 6mL
SST II, Clot activator & serum gel separator, Plain YELLOW 5mL
Potassium EDTA LAVENDER/PINK

9. Sample identification
• It first generates a unique identity or hospital number for each new patient.
• A record is maintained thereafter for him/her.
• All sample collected have to bear the name and details of the patient along
with this unique identity.
• The same is used while entering the details into auto analyzer software and
result is also published with this number and other details.
• Some advanced labs are using computer generated bar coding technology for
labeling samples.
• It has the advantage that it can be scanned and read by bar code reader
accurately so transcriptional error (mistake in writing manually) is avoided.

11. Sample Preparation
• Most of the labs depend on technicians for sample processing (such as serum
separation) as soon as sample arrives.
• Introduction of automation can reduce the workload on technicians and save
their time and expertise for analysis purpose.
• Therefore, now days many semi automated devices are developed which can
analyze whole blood itself.
• The automated sample processors come in 2 types: Stand alone automated
sample processors and Independent automated sample processors.
• The automated sample processors can do : sorting of samples, removing caps,
separating samples, bar coding etc.

12. Samples used for biochemical investigations
• Whole blood
• Blood
– Serum - clear liquid that can be separated from clotted blood. ( It does not
have fibrinogen or the other clotting factors)
– Plasma - liquid portion of the blood, obtained by
treated with anticoagulant
• Urine
• Body fluids
• Cerebrospinal fluid
centrifugation of blood

14. SAMPLE ANALYSIS -ANALYSER
• Auto analyzers based on above principle can be divided into two types: Open
and closed system
• Open system: Operator can purchase reagents from any company so he can save
money by buying reagents which are cheaper thereby reducing the cost per test.
• In a modular design: An auto analyzer is designed by assembling pulling
together of all parts.
• This increases the flexibility of machine according to customer’s demand.
• For example: Ion selective electrode. Due to modular approach, the facility for
analysis of sodium, potassium and chloride can be built into the system or can
be added later on.

15. Introduction
• Closed system: Operator has to buy chemicals only from a particular
company. So operator can not reduce the cost per test.
• Next, reagents have to be provided in unique containers or format as
prescribed by its manufacturer. This too adds to cost per test.
• However, it allows high degree of automation.
• Laboratory can be managed by just one or two well trained technical
assistants.

17. Processing
• Now let us understand different types of processing by auto analyzer
. It is
broadly of 2 types:
• (a) Continuous flow processing: Based on this principle a continuous flow
analyzer (CFA) is made of different modules, such as:
– Sampler
– Pump
– Mixing coil
– Heater/incubator
– Sample treatment chamber (dialysis, distillation etc)
– Signal detector
– Read out device (data generator)

18. Continuous Flow Processing
• This provides one analysis per analyte for one sample at a time.
• The flowing carrier solution passes through small tubes continuously. This is
the main principle of Continuous flow processing.
• Here sample is injected into a flowing carrier solution.
• The sample mixes with diluents and reagent and it is sent through the tubing
and mixing coils.
• The machine prevents carry over effect between different samples by injecting
bubbles of air.
• The air bubbles literally create separate space for different reactions to take
place inside the tubing and mixing coils.

23. Continuous Flow Processing
• The flow conditions are regulated.
• When reaction is taking place, the optical density of the colour formed is read
and results are obtained.
• So we do not have to wait till the reaction ends.
• It has separate heater for promoting enzymatic reaction and colour
development.
• In a nephrotic syndrome patient one want to analyze total protein, albumin and
creatinine. In case of continuous flow processing analyzer the patient sample
will be sucked by the instrument and injected into the tubing with reagents for
protein, and diluents.

24. Continuous Flow Processing
• Next air bubbles will be injected and patient sample will be sucked
again. This time instrument will inject reagent for albumin.
• Mixing will be done inside the tubing and mixing coils.
• Again the process will be repeated for creatinine estimation.
• The 3 reactions will occur inside the same long tubing but they will
remain separate due to air bubbles in between.
• CFA was designed to process only colorimetric reactions, later on CFA
were designed to read reactions based on ion selective electrode,
flame photometry, flurometry etc. depending on the need of the
laboratories.

25. There is certain disadvantage in this system
• Even when there is no test to be done, reagents are drawn to
maintain the flow.
• This adds to the cost per test.
• Maintainance of instrument is required more frequently.
• The probe and internal tubings must be free of colgs.
• When there is no sample the probe must be dipped in distilled water
to avoid blockage or precipitation.
• The machine itself occupies large space.

26. Advantage/Disadvantage of continuous flow analyser
▪ Test large number of specimen for a single test (mainly glucose/urea),
accurately and precisely
▪ At a time only one type of determination was performed in single
channel
▪ Occupies large space

27. Multi Channel Continuous flow analyser
• Sequential Multiple Analyzer 6/60: Perform 60 sample per hour and
report 6 sample simultaneously
• These test are Chloride, CO2, potassium, sodium, urea, glucose
• Sequential Multiple Analyzer 12/60: Perform 60 sample per hour and
report 12 sample simultaneously
• Used for Urea, Glucose, Creatinine, Total protein, Total bilirubin, SGPT,
SGOT, LDH, ALP, uric acid and Pi

28. Disavantages of SMA
• Only 6 to 12 fixed determination is possible, doctor
interested in these test
• Occupy large space
• SMA II or C- 20 parameters at a rate of 150 sample per hour
might not

29. Discrete Processing Analyzer
• Each sample is provided a discrete space.
• It means each analysis even for same analyte or sample takes place at different
cups (main principle of discrete processing).
• Now, in case of discrete processing analyzer the same patient sample will be
sucked by the instrument and poured into 3 different cups.
• Then reagents for protein, albumin and creatinine and diluents (if needed) will
be added. Mixing will be done.
• Cups will be read at different times to give results.
• Exact amount of sample and reagent is aspirated and mixed. So there is no loss
of excess reagents used for flow as in continuous flow processing.

30. Discrete Processing Analyzer
• Reagent and sample are pipetted in a cuvette, mixed and the end product is
measured. Foe every sample and reagent as separate cuvette is used
• End point reaction, two point assay, monochromatic or dichromatic
• More than 100 open test program can be selected
• Economical as reagent requirement is very less
• Report patient wise not sample test wise
• Levey Jenning QC program can be performed
• Minimum 200 test result can be stored
• Specific test like hormone, electrolytes, drugs can be performed

31. Semi automated Discrete Processing Analyzer
• Semi automated as initial processing can be done by technician itself
– Pipetting of reagent, sample, mixing, incubation
– Reading end point, rate of reaction, monochromatic or dichromatic
– Result display, print and memory of result
• Economical
• Display and print system parameters
• User friendly software
• Perform statistics analysis also, plot Levey Jenning chart
• Can work without power on battery back up

34. Fully Automated Autoanalyzer
 Automatic dispensing of Reagent with reagent probe
 Automatic dispensing of sample with sample probe
 Automatic mixing of reaction mixture
 Incubating of mixture

35. Fully Automated Autoanalyzer
 Sampler for accommodate various sample, std, calibrator, QC serum
 Programmable sample probe
 Reagent Probe for reagents
 Reagent Carousel
 Convenient peristaltic pump, syringe, water and waste bottle
 Cuvette rinsing station
 Two types- Batch and Random access analyzer

36. Based on this principle the auto analyzers developed into two different
varieties such as centrifugal or batch analyzer and random access
analyzer
• Centrifugal analyzer or Batch analyzer: OUTDATED NOW
• Only one test at a time as there is provision for one reagent at a time
• Sample and reagents is pipette into different chambers on a rotor.
• The centrifugal force is used for transfer and mixing of sample and
reagents.
• Rotor moves the final product upto the optical system for reading.
• This is time saving for batch analysis because all cuvetts can be read
at a time.

37. Batch analyzer
• Role of Technician:
– Sample collection, separation or serum or plasma
– Batch preparation according to test
– Reagent should be placed into analyser
– Programming should be done
• Role of analyzer
– Pipetting of Reagent and sample in specific cups
– Mixing (forceful dispensing, magnetic, vibration, rotation, UV)
– Incubation (Air bath or water bath)
– Aspiration into reading station
– Reading calculation, display, print of result

38. Batch analyzer- Mesurement
• Photometery or Spectrophotometry:
– Three important components: A radiant energy source, means of spectral
isolation and reader
– Radiant energy source: Tungsten, quartz, halogen, deuterium, mercury, xenon
or laser
– Spectral isolation is done by interference filter (multiple filer is equipped)
• Turbidimetry: Nephelometry: mainly for protein and antibodies
• Ion selective electrode: for electrolytes

40. Advantages
• Ion-Selective Electrodes are relatively inexpensive and simple to use and have an
extremely wide range of applications
• They are particularly useful in applications where only an order of magnitude
concentration is required, or it is only necessary to know that a particular ion is
below a certain concentration level (Threshold values)
• They are invaluable for the continuous monitoring of changes in concentration:
e.g. in potentiometric titrations or monitoring the uptake of nutrients, or the
consumption of reagents.
• They are particularly useful in biological/medical applications because they
measure the activity of the ion directly, rather than the concentration.
• In applications with interfering ions, pH, or high concentrations are a problem,

41. Advantages
• With careful use, frequent calibration, and an awareness of the limitations, they
can achieve high accuracy and precision levels.
• ISEs are one of the few techniques which can measure both positive and
negative ions.
• They are unaffected by sample colour or turbidity.
• ISEs can be used in aqueous solutions over a wide temperature range.

42. Batch analyzer –merit and demerit
• Large number of sample can be tested
• These are not patient oriented
• Not equipped with stat i.e., immediate reporting or emergency test
• Not performed random test
• Eg., Erba Chem 10
• Clinicon corona
• Autopacer

43. Random access analyzer
• Each sample can be analyzed for multiple tests, and multiple samples for one
test also can be done by giving appropriate commands to computer software.
• Works in random access mode: all test of a sample before moving to next
sample
• It is the most versatile of all type analyzers.
• Let us say we have 3 different samples. First one needs renal profile, second one
needs only glucose and urea and third one need triglyceride, albumin and
calcium.
• So the technician has to simple take 3 different sample cups and loads 3
samples. Then he has to enter sample number, cup number and the tests
required.
• And when he presses the start button tests will be done automatically.

44. Random access analyzer: Additional facilities
• Cuvette disc for temperature control
• Multistage cleaning system
• Reagent container single or double
• Level sensor for reagent and sample
• Individual rack for control, std, sample, caliberator, QC
• Bar code identifier
• Continuous loading facility for sample and reagent
• Plotting of daily and monthly QC chart
• ERBA superstat 919, ERBA smart lab, Abbot spectrum