automation

total laboratory automation post analytic phase (data management)

-bidirectional communication between analyzers and host computer -integration of work station managers into communication system -automated management of QC data -user-defined perimeters for many values -need for a "gap-filler" between instrument and laboratory info system

dry

-bottled as lyophilized powder(dehydrated reagent) , requiring reconstitution (add water to make it liquid again) -multilayered dry chemistry slide; reagent layer embedded into the slide that creates a chemical rxn that the analyzer can detect. suitable for small labs with few plumbing --> reduction of liquid waste; army

steps in automated analysis specimen measurement and delivery

-circular carousel or rectangular racks hold specimen containers -primary collection tubes or microsample tubes are placed in carousels or racks -aliquot is measured thru aspiration of sample into a probe and dispensed into the reaction vessel -probe and tubing are cleaned after each dispensing to minimize carryover, unless disposable probes or tips are used

steps in automated analysis signal processing and data handling

-ensure accurate calibration of analyzers; essential in obtaining accurate information -multiple instruments that measure the same constituent in the lab should be calibrated so that the results are compatible -automated instruments, once calibrated, provide long-term stability of standard curve; require only monitoring -some instruments are self calibrating -advanced automated instruments have method of reporting printed results -computerized monitoring is available for many parameters

driving forces toward more automation

-higher volume of testing, faster TAT -fewer, more centralized core labs -decline in use of lab panels or profiles -regulatory standards requiring greater accuracy and -precision -intense competition among instrument manufacturers -decreased operating budgets for labs

continuous flow analyzers

-liquids are pumped through system of continuous tubing -samples are introduced in a sequential manner

steps in automated analysis chemical reaction phase

-mixing -separation -incubation -reaction time

discrete analysis

-separation of each sample and reagent in a separate -container -most popular type; can run multiple tests on one sample at a time or multiple samples one test at a time

total laboratory automation analytic phase (chemical analyses)

-smaller microsampling -expanded onboard and total test menus -accelerated reaction times -higher-resolution optics -improved flow-thru electrodes: not clogged, don't need to be changed as often -enhanced user-friendly interactive software for QC, maintenance, and diagnostics -ergonomic, and physical design improvements suitable for hospitals with NICU

centrifugal analysis

-uses centrifugal force to transfer liquids from one compartment to the other, also contains liquids -capable of batch analysis

discrete analyzers

Ion-selective electrodes, fiberoptics, polychromatic analysis (at diff wavelengths) sophisticated computer hardware and software for data handling larger test menus

first automated analyzer

auto analyzer. by technicon. a continuous flow, single channel, sequential batch analyzer. provides a single test result on ~40 samples/hr

liquid

available in bulk volume containers or unit doses; most common

recent advances immunochemistry analyzers

can perform an assortment of tests including ISE, chemistry, hormones, tumor markers, specific proteins, assaying drugs instruments using fluorescence polarization immunoassay, nephelometry, & immunoassay w/ chemiluminescent detection. these are called modular analyzers on sample on the machine and can run all the analyzers

modular analyzers

combination of chemistry and immunoassay

basic approaches to automation

continuous flow centrifugal analysis discrete analysis

reaction time

depends on the rate of transport thru system and timed reagent additions.

kodak ektachem analyzer

first instrument to use microsample volumes and reagents on slides for dry chemistry analysis first instrument to incorporate computer technology extensively into its design and use

automatic clinical analyzer

first non-continuous flow, discrete analyzer first instrument to have random access capabilities

incubation

heating bath (water or air) to maintain required temperature of reaction mixture.

steps in automated analysis reagent systems and delivery

liquid dry preservation

steps in automated analysis 1) specimen preparation and identification

preparation: typically a manual process can be automated by robotics can be skipped, if whole blood is used for analysis plasma separator tube can be used and primary tube sampling performed with heparin plasma identification: manual label on sample cup at the analyzer barcode label affixed to primary collection tube (best in preventing errors in identification)

second generation: simultaneous multiple analyzer (SMA)

produce 6-12 of the exact same test results simultaneously at rate of 360-720 tests/hr. every patients had to have the same tests. multiple channels working synchronously

mixing

reagents and patient sample mixed together via -coiled tubing (continuous flow analyzers) -rapid start-stop of reaction tray (RA1000) -rapid start-stop of rotation or bubbling of air (centrifugal)

preservation

refrigeration, reconstitution of dry tablet, or combination of two stable components

separation

separating undesirable substances from sample

recent advances point-of-care bench top analyzers

small, portable, easy to operate used if physician office labs, surgical and critical care units

total laboratory automation preanalytic automation system

specimen is aliquoted by a machine based on the department that it needs to go to for testing. once the aliquots are done, the machine notified the lab tech that the sample is ready for testing.

first centrifugal analyzer

spin-off technology from NASA space research alternative to continuous flow technology look like disks. sample is placed in the disk center and centrifuge. the sample would separate out to different areas of reagent and spectrophotometer would go around and read each of the different spots in the disk

steps in automated analysis measurement phase

systems of measurement: -UV, fluorescent, and flame photometry -ion-specific electrodes (measures sodium, potassium, chloride) -gamma counters (rare) -luminometers -visit and UV light spectrophotometry -fluorescence polarization, chemiluminescence, bioluminescence in immunoassays

reagents are then dispensed

via tubing from bulk containers, syringes that pipet reagents into reaction containers, piston-driven pumps connected by tubing, or pressurized reagent bottles.