Automation in clinical laboratories aims to minimize manual processes and variations. It divides work into pre-analytic, analytic and post-analytic phases, with the analytic phase being the most automated. Different types of automated analyzers include continuous flow, centrifugal, discrete and random access analyzers. Total laboratory automation integrates many analyzers and physically connects processes to improve efficiency, quality and reduce costs over time despite higher initial costs. While automation decreases errors and biological risk, it can increase infrastructure needs and downtime risks.

1. Automation
in
Clinical Laboratory

2. Definition
• The process whereby an analytical instrument
performs many tests with only minimum
involvement of an analyst.

3. Advantages of Automation
Increased number of tests can be done
Minimizes the variations
Errors of manual analysis is eliminated
Very small amount of reagent and samples are
used

4. Automation In Clinical Chemistry
⮚The analytic process can be divided into three
major phases— preanalytic, analytic, and
postanalytic
⮚The analytic phase is the most automated, and
more research and development efforts are focusing
on increasing automation of the preanalytic and
postanalytic processes.

5. Autoanalyzers
Discreet analysers Flow analyzers
Random
access
analyzers
Centrifugal
analyzers Continuous
flow

6. Types of Analyzers
• Continuous Flow
• Tubing flow of reagents and patients samples
• Centrifugal Analyzers
• Centrifuge force to mix sample and reagents
• Discrete
• Separate testing cuvettes for each test and sample
• Random access

7. Continuous Flow
• The major drawbacks 🡪 carry-over problems and wasteful
use of continuously flowing reagents.

8. Centrifugal Analyzers
• It uses the force generated by centrifugation to transfer
and then contain liquids in separate cuvettes for
measurement at the perimeter of a spinning rotor

9. 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.

10. 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.

11. Beckman coulter AU680

12. Beckman coulter AU5800

13. Sample acquisition
• Manual
• Robotic system

16. Analytical process
✔ Specimen Identification
✔ Specimen Delivery
✔ Specimen processing
✔ Sample loading and aspiration
✔ Reagent handling and storage
✔ Reagent delivery
✔ Chemical reaction phase
✔ Measurement approaches
✔ Signal processing and data handling

17. Specimen Identification
❖ Bar coding
❖ Optical character recognition
❖ Magnetic stripe
❖ Radiofrequency identification (RFID)
❖ Smart cards

18. Bar coding

19. Specimen delivery
• Human carriers or runners
• Pneumatic tube delivery systems
• Electric-track-driven vehicles
• Mobile robots
• Conveyors and/or track systems

20. Sample preparation
❖Clotting time
❖Centrifugation
❖Transfer of sample to an analyzer cup

21. Sample preparation

22. Sample preparation
Usually manual but can be automated when:
⚫Using whole blood for analysis
⚫Use of plasma separator tube and primary tube sampling
with heparinized plasma
⚫Use of pre-analytical module

23. Sample delivery
❑ Sample rack
❑ Sample cups
❑ Sample probes

24. Sample rack

25. Sample cups

26. Sample probes
• Peristaltic pumps
• Robotic arm
• Positive liquid displacement pipettes

27. Positive liquid displacement pipettes
Dispense only sample
Flush sample with
diluent

28. Reagent systems &
delivery
Reagent system
Reagent handling/storage
Reagent dispensing

29. Reagent systems
• Liquid/dry reagents
• Open vs closed system

30. Reagent handling
⚫Reagents refrigerated until the moment of need and then
quickly preincubate them to the reaction temperature
⚫Dry regent ,to be reconstituted when required
⚫Manufacture the reagent in two stable compounds that will
be combined at the moment of reaction

31. Biochemical reaction
phase
Mixing
Incubation

32. Biochemical reaction phase
Chemical reaction phase occurs in cuvettes which may or
may not be disposable.

33. Mixing
• Forceful dispensing
• Vigorous lateral displacement
• Stirring paddles/probes
• Magnetic stir bars
• Ultrasonic waves
• Coiled loops

34. Incubation
⮚ Circulating water bath
⮚ Dry incubator bath : cuvette allowed to incubate with in a
chamber containing circulating air from heated metal blocks
⮚ Fluorocarbon oil incubation bath
⮚ Peltier thermal electric module-Peltier ring consist of
quartz/glass cuvettes surrounded on three sides by copper

35. Measurement Approaches
⚫Photometry/Spectrophotometry
⚫Reflectance Photometry
⚫Fluorometry
⚫Turbidimetry and Nephelometry
⚫Chemiluminescence and Bioluminescence
⚫Electrochemical

36. Post analytical processes
• Data acquisition & calculation
• Monitoring
• Display
• Control, data storage, communication

37. Steps in the automated systems
Specimen identification
Specimen delivery
Specimen preparation
Specimen loading and
aspiration
Labelling, bar coding
Courier service, pneumatic tube
system, electric track vehicle, mobile
robots

38. Steps in the automated systems
Sample introduction and
internal transport
Reagent handing and
storage
Reagent delivery
Continuous flow analyser, discrete
processing system
Reagent identification, open vs closed
system

39. Steps in the automated systems
Chemical reaction phase
Measurement approach
Signal processing, data
handing and process
control
Type of reaction vessel and cuvette,
timing of reaction, mixing of
reactants, thermal regulation
Photo/spectophotometer, reflectance
photometry, flurometry,
turbitimetry, nephelometry,
chemiluminescene, electrochemical

40. Total Laboratory Automation
Many analyzers performing different types of tests on different
sample matrices are physically integrated as modular systems
or physically connected by assembly lines.

41. TOTAL LABORATORY AUTOMATION

43. Advantages
✔Lower costs on the long term
✔Decreased congestion in the laboratory
✔Improved efficiency
✔Improved sample management and traceability
Lippi G, Da Rin G. Advantages and limitations of total laboratory automation: a personal overview.
Clin Chem Lab Med. 2019 May 27;57(6):802-811.

44. Advantages
✔Improved quality of testing
✔Lower sample volume
✔More efficient integration of tests results
✔Lower biological risk for operators
Lippi G, Da Rin G. Advantages and limitations of total laboratory automation: a personal overview.
Clin Chem Lab Med. 2019 May 27;57(6):802-811.

45. Limitations
✔Higher costs on the short term
✔Increased costs for supplies(maintenance, energy,supplies)
✔Space requirement and infrastructure Constraints
✔Increased generation of noise, heat and vibrations
✔Increased risk of downtime
Lippi G, Da Rin G. Advantages and limitations of total laboratory automation: a personal overview.
Clin Chem Lab Med. 2019 May 27;57(6):802-811.

46. Limitations
✔Differential requirements for sample management
✔Generation of potential bottlenecks
✔Disruption of staff trained in specific technologies
✔Risk of transition toward a manufacturer’s driven
laboratory
Lippi G, Da Rin G. Advantages and limitations of total laboratory automation: a personal overview.
Clin Chem Lab Med. 2019 May 27;57(6):802-811.

47. Beckman Coulter: DxA 5000

48. COBAS 8100

49. Manual Processes replaced by
Automation and IT

50. Thank You