Urinalysis has played a key role in central lab settings as a non-invasive cost-effective method for detecting conditions such as early kidney disease, urinary tract infections, and liver dysfunction. With increasing urinalysis testing volumes, central and reference laboratories are looking to automate and maximize productivity of their urine testing processes, including options to integrate urine chemistry and sediment testing for even greater workflow efficiency.

Automation at the urinalysis bench has the potential to aid the clinical laboratory in achieving quality metrics for incentive payments. Labs can lead the way to smarter, more cost-effective testing by evaluating urinalysis automation as a tool for reducing the number of urine cultures. Fully automated urinalysis provides the ability to streamline workflow and create a high level of standardization for the lab.

Trends in Automated Urinalysis

Fully automated analyzers. Advances in urinalysis technology have offered greater sensitivity, reproducibility, and accuracy in addition to reducing time-consuming manual preparation and examination of urine sediments. Several technologies have been introduced in automation of urinalysis. Fully automated integrated analyzers analyze all physical and chemical characteristics and sediments of urine in a single platform. Some fully automated urinalysis systems currently in use employ video stop-motion camera technology to capture hundreds of frames of digital images of cells, yeast, bacteria, casts, and crystals. These images can be stored and reviewed accordingly to determine the number and types of particles present. Automated reagent strip readers can standardize the interpretation of color changes using reflectance photometry and are commonly used in a large number of laboratories.

In another system, flow cytometry technology has been used. As urinary elements pass through a laminar flow cell, laser illumination provides forward angle and side scattering events that are used to identify and quantitate white and red cells, bacteria, epithelial cells, and casts, in addition to identifying the presence of yeast, crystals, dysmorphic RBCs, and abnormal casts. Because fixed urine sample sizes are used, highly accurate evaluations by both methods can provide clinical information previously not available.

Automated analyzer versus manual microscopy. Automated analyzers use a different technology to classify and quantify urine sediment particles and offer improvement in standardization over manual microscopy by eliminating potential inter-technician variability during slide interpretation. The current generation of urine sediment analyzers is capable of interfacing with automated strip analyzers to produce comprehensive routine urinalysis reports. Both physicochemical and microscopic examinations appear necessary for effective screening purposes, and use of a fully automated system allows this to be accomplished while avoiding the cumbersome and labor-intensive process of manual microscopy. The primary advantage of automated analysis over microscopic procedure is that the former reduces the inter-observer variability and increases accuracy and productivity. While microscopic analysis takes several minutes to be performed, automation can release a result in about one minute.

Standardization of results. Individual labs strive to standardize urinalysis results by establishing reference ranges for their patient populations, reporting the number of blood cells per high-powered field. Consistency in preparing urine sediments - fixed urine volume to be centrifuged, centrifuge speed, centrifuge tube size, and proper aspiration of the supernatant - all contribute to variability in sediment evaluation. Fully automated urinalysis systems offer a faster, accurate, and more consistent way to manage a high volume test with minimal technical assistance. Today's urinalysis departments need both advanced technology and truly innovative strategies. Companies are offering solutions that facilitate optimization and advancement of urinalysis and body fluid testing.

Laboratories are looking for an automated system that is accurate and efficient, and that standardizes workflow, fits in the desired lab space, and has a high level of bacteria detection. They are also keeping in mind the over-arching objectives of automation in the clinical lab to lower costs, increase efficiency, and help improve the quality of patient care.

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