9. automation in urine analysis

Automation in urine analysis
Presenter: Dr G SanthiPriya
Moderator: Dr Rashmi S
12/11/2018 Seminar- Automation in urinalysis

Contents
• Introduction
• Objectives
• Types of automation
• Principles
• Advantages and disadvantages
• Conclusion
• References

Introduction
• Urinalysis is one of the most commonly performed tests
in the clinical laboratory.
• Several instruments are available to automate either the
macroscopic/chemical analysis or the microscopic
portions of the routine urinalysis.
• However, manual microscopic sediment examination is
labor-intensive, time- consuming, and lacks
standardization in high-volume laboratories.

Objectives
• Identify the automated methods for urine sediment
identification .
• Describe methodology used for the automated urinalysis
sediment examination.
• Compare advantages and disadvantages of manual
microscopy and automated systems.

Urinalysis Automation
• Several automated instruments are currently available to
standardize:
• Sample processing
• Biochemical test strips analysis
• Microscopy analysis
• Report results

• Automation Urinalysis Features:
1. On-line computer capability
2. Bar coding
3. Manual entry of colour
4. Clarity
5. Microscopic results
6. Flagging of abnormal results
7. Sorting of patient and control results
8. Minimal calibration
9. Cleaning
10. Maintenance

• Automated urine analyzers are in use in all large
laboratories.
• Different types of instruments are on the market, each one
being based on its own technology:
• They are divided into :-
 Semi-automated – The test strip is dipped in the urine
manually and then analyzed by an instrument.
 Fully-automated – The test strip is analyzed completely
by an instrument

Biochemical test strips
Control

Control
Protein error of indicators

Control
Glucose oxidase-
peroxidase reaction

Control
Sodium nitroprusside

Control
Diazo reagent

Control
P- dimethyaminobenzaldehyde
or 4- methoxy- benzene
diazonium tetrafluoroborate

Control
Tetramethylbenzidine,
hydroperoxide

Control
Diazotization of nitrite
with an aromatic amine
to produce a diazonium
salt

Control
Pyrrole amino acid ester
3-OH-5 Phenyl pyrrole

Control
Bromothymol blue

Control
Bromthymol blue,
Methyl red

Semiautomated Chemistry Instruments
1) Clinitek 200/200, 500 Siemens Medical Diagnostics
2) Chemstrip Urine Analyzer Roche Diagnostics
3) Urisys 1800 System Roche Diagnostics

Fully automated Chemistry Instruments
1. Clinitek Atlas Siemens Diagnostics
2. Chemstrip Super Automated Urine Analyser Roche
Diagnostics
3. Urisys 2400 system Diagnostics Roche Diagnostics

Automated Microscopy
1. UF-50,100, 1000i Urine Cell Analyser Sysmex
2. iQ200 Automated Urine Microscopy Iris Diagnostics
Division
3. Cuvette-based microscopy (UriSed/sediMAX, 77
Elektronika/A. Menarini Diagnostics)

Fully Automated Urinalysis Systems
1. ADVIA Urinalysis Workcell Siemens Diagnostics
2. ARKRAYAUTION HYBRID AU-4050 Urinalysis

Semiautomated
• Clinitek

Video- semiautomated

Advantages of strip test automation
1. Enhances work flow saving labour and time
2. Standardizes some aspects of manual urinalysis
3. Reduces subjective errors
4. Large number of samples in short time
5. Performed on UNCENTRIFUGED urine

Fully automated chemistry instruments
Urisys 2400 system Chemistrip superautomated

Reflectance photometry

Automated microscopy
Different automated microscopic urine analyzers works
based on different principles:
1. Flow cytometry
2. Auto Particle Recognition
3. Automated microscopy with digital imaging

• Examples of analysers using flow cytometry
1) Sysmex UF 50, 100, 1000i
2) Sysmex UF 2000i.
• Examples of analysers using Auto partical recognisation
1) Automated intelligent microscopy (iQ200, Beckmann)
2) AVE 763 analyser.
• Examples of Automated microscopy with digital
imaging
1) Cuvette-based microscopy (UriSed/sediMAX, 77
Elektronika/A. Menarini Diagnostics).

Automated microscopy
SysMex UF 50 SysMex UF 100

Flow cytometry
sample
Stain with 2 dyes- orange
and green floresence
DNA- Phenathedine
Nu mem, mtc- carbocyanine
Laser beam and
fluorescence
Scattogram and histogram

IQ 200 Automated Urine microscopy analyzer
Flow video microscopyAuto particle Recognition12/11/2018 Seminar- Automation in urinalysis

Auto Particle Recognition (APR)

Automated microscopy with digital imaging
• It also works on principle of auto particle recognisation.
• A walk-away automatic urine sediment analyzer.
• These are similar to the microscopic fields seen with
manual microscopy.

Automated Urinalysis Systems
• Clinitek Atlas, an automated urine chemistry analyzer and
the Sysmex UF-100, an automated urine cell analyzer ,
have been integrated to develop the ADVIA Urinalysis
Workcell System

Sysmex UF 1000i

• The instrument consists for three principal units
1. Main unit which aspirates dilutes, mixes and analyzes
urine samples
2. Auto sampler unit supplies samples to the main unit
automatically
3. IPU (Information processing unit) which processes data
from the main unit and provides the operator interface
with the system.
• The UF- 1000i is equipped with a sampler that provides
continuous automated sampling for up to 50 tubes

UF 1000i Tube Rotator

UF-1000i Reagents
UFII SEARCH™-SED
UFII PACK™-SED
UFII SHEATH™
UFII SEARCH™ -BAC
UFII PACK™-BAC

UF-1000i Technology
Bacte
ria
Sedime
nts
BacteriaSediments Stain
Incubation
Detection
unit
Sediments Bacteria
Diluents
Twochambersforstainanddilution
Improved
determination of
bacteria
Redsemiconductor laser
•Down sizing
•Long life
•Reducedpower
consumption

Sedimax

• A single-use patented cuvette is filled with automatically
mixed native urine (volume aspirated: 2.0 mL, volume
examined: 2.2 μL)

• The sample is ultra centrifuged within the instrument (10
seconds at 260 g).
• The cuvette is forwarded to the microscope table.
• An automatic focusing at different levels is performed.
• A built-in camera takes a digital image of each field of
view (magnification: ~400x)

• For each sample 15 images are taken.
• Identification and quantitation of the particles (as No/µL
or No/HPF) is carried out by Auto Image Evaluation
Module (AIEM), a complex artificial neural network
structure which has specifically been developed for the
instrument.
• 100 samples/hour.

UTI- WHOLE FULL VIEW:WBC AND BACTERIA

UROLOGICAL DISEASE: ISOMORPHIC
RBCS AND DEEP TRANSITIONAL CELLS

Advantages and disadvantages

Conclusion
• Automated urinalysis offers the benefits of convenience,
efficiency, and increased sensitivity for detecting renal
and urinary tract abnormalities.
• Therefore, they are very useful/recommended for labs
with >100 samples/day

References
• Karcher DS, McPherson RA, Pincus MR. Urinalysis. In: McPherson
RA, Pincus MR, eds. Henry’s Clinical Diagnosis and Management
by Laboratory Methods. 23rd Ed. Chine: Elsevier; 2017.p.441-80.
• Richard Tompson, Andrew Gammie, Debbie Lewis, Rebecca Smith
CE. Evidence review: Automated urin screening systems.
CEP10030. Cent Evidence- based Purch. 2010;1-46.
• Shayanfar N, Tobler U, Von Eckardstein A, Bestmann L.Automated
urinalysis: First experiences and a comparison between the Iris iQ200 urine
micrscopy system, the Sysmex UF-100 flow cytometer and manual
microscopic particle counting Clin Chem Lab Med. 2007;45:1251-6.
• Strasinger SK, Lorenzo MS Di. Automated Urinalysis. In: Strasinger
SK, Lorenzo MS Di, ed. Urinalysis and body fluids. 5th Ed.
Philadelphia: F.A. Davis; 2008.p.259-63.
• Budak YU, Huysal K.Comparision of three automated systems for
urine chemistry and sediment analysis in routine laboratory practice.
Clin Lab. 2017;57:47-52.

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