URINE AND BF AUTOMATION

1. Urine and Body Fluid Analysis Automation
Prepared by: Prince Henry V. Osena, RMT

2.  The ultimate goal of urinalysis automation is to improve reproducibility and color
discrimination while increasing productivity and standardization for reporting urinalysis
results
 Subjectivity associated with visual discrimination among colors has been alleviated by the
development of automated reagent strip readers that use a spectrophotometric
measurement of light reflection termed “reflectance photometry.”

3. Reflectance photometry uses the principle that light reflection from the test pads
decreases in proportion to the intensity of color produced by the concentration of the test
substance.

4. ADVANTAGES OF AUTOMATION
Several automated instruments are available that standardize
 sample processing
 analyze test strips
 perform urine sediment analysis
 and report results with consistent quality
 and reduced hands-on time.
The instruments are user-friendly and include visual and audio prompts for operation. The
various manufacturers’ instruments include different features and principles for testing

5. Additional advantages to automation include
 online computer capability with LIS interface;
 bar coding;
 manual entry of color, clarity, and microscopic results to be included on the printed
report; flagging abnormal results;
 storing patient and control results;
 and minimal calibration, cleaning, and maintenance

6. Automated instruments in urinalysis include semi-automated and fully automated chemistry
analyzers, automated urine cell analyzers, and completely automated systems.
Semi-automated instruments still depend on an operator for specimen mixing, test strip
dipping, and microscopic results input. In a fully automated chemistry analyzer, the tubes of
urine are placed on a rack or a carousel and moved automatically through the instrument.
Automated urine cell analyzers mix, aspirate, dilute, and stain urine to classify urine
sediment particles.
Automated urine systems perform a complete urinalysis that includes the physical, chemical,
and microscopic parts of a routine urinalysis

7. Semi-Automated Urine Chemistry Analyzers

8. Semi-Automated Urine Chemistry Analyzers
- Test for the chemical components of urine.
- The instruments read and interpret the reagent
strip results consistently, thereby standardizing
the interpretation of reagent strip results and
eliminating personnel color bias and timing
discrepancies

9. Semi-automated analyzers are well suited for small- and medium-
volume laboratories.
For a semi-automated instrument,
the reagent strips are manually dipped and placed on the strip
reader, the reaction pads are read at the correct time, and the strip
is moved to the waste container. The results are displayed, printed,
or transmitted to an LIS. Patient identification Positive results are
flagged to indicate a patient sample that requires additional
confirmation testing or microscopic evaluation.

10. The semi-automated instrument requires the operator to:
1. Dip the reagent strip into a well-mixed urine sample.
2. Blot the strip to remove excess urine.
3. Place the strip onto the reagent strip platform.
4. Press the analyze/enter button.
Results are printed out, and abnormal results are flagged
automatically
Daily maintenance is minimal and includes cleaning the reagent strip
platform and emptying the reagent strip waste container.

11. Fully Automated Urine Chemistry Analyzers

12. Fully Automated Urine Chemistry Analyzers
- designed for a high-volume urinalysis
laboratory with user walk-away capability.
- The various instruments have the ability
to load many samples on a carousel or
rack at one time with the capability to
insert a STAT specimen during the run.

13. 1. The start or analyze button is pressed to
begin testing and the specimen
automatically moves through the
instrument.
2. The specimen is identified.
3. A sample probe aspirates an exact
amount of urine sample and dispenses it
directly onto the reagent strip

14. 4. The reagent strip advances automatically
to the reflectance photometer to measure
the color change of each reagent pad
5. The strip then advances automatically to
the disposal area
6. Tests are measured by the dry pad test
using reflectance photometry to detect color
change, and taking readings at the
appropriate time and wavelength for each
specific test.

15. Automated Microscopy

16.  Manual microscopy is not easily standardized because of the high
variation among operators even in the same institution.
 Routine specimen processing such as centrifugation can affect
accuracy because rare elements such as casts or cells may be lost
during handling.
 It has been demonstrated that recovery of formed elements in
the sediment after centrifugation is highly variable
 Manual microscopy is not cost effective because of the labor and
time required to process and analyze the specimen, which ultimately
reduces turnaround times for results
Results are not quantitative because they must be
reported in ranges or averages.

17. Automated urine cell analyzers provide
efficient standardized results in less than 1
minute as compared with approximately 6
minutes using the manual method, markedly
improving turnaround times.
Two automated urine cell analyzers are
currently available in the United States: the
Sysmex UF-1000i and the iQ 200 from Iris
Diagnostics.

18. Automated Urinalysis Systems

19.  Combining automated urine chemistry analyzers and automated
urine cell analyzers to create completely automated urinalysis
systems has significantly improved turnaround times for urinalysis.
 Technologists’ hands-on time has been significantly reduced as well.
Using similar sample racks and moving on a conveyor system,
samples are easily transferred from one instrument to the next,
providing a complete walkaway capability with minimal specimen
handling from sampling through results

20.  By interfacing with the LIS, bar-coded samples are automatically
identified and processed according to the requested tests. The
systems can independently perform both physical and chemical
testing, microscopy analysis, and a combination of both. A
complete urinalysis report can be sent directly to the LIS or printed
out, thereby reducing clerical error.

21. • The Clinitek Atlas ,an automated urine chemistry analyzer, and the
Sysmex UF-1000i , an automated urine cell analyzer, have been
integrated to develop the CLINITEK AUWi System (Siemens),
which performs a completely automated urinalysis