ANALYSIS OF URINE & BODY FLUIDS
LECTURE | CHAPTER 2 : Urine and Body Fluid Analysis Automation
CHAPTER OUTLINE
I. Urinalysis Automation
II. Reflectance Photometry
III. Analyzers
IV. Fully Automated Urine Chemistry Analyzers
V. Automated Microscopy Analyzers
VI. Automated Urinalysis Systems
VII. Body Fluid Analysis Automation
LEGEND
✪ Important ✱Verbatim ✎Book-based
Urinalysis automation
Ultimate Goal of Urinalysis Automation
➔ To improve reproducibility and color
discrimination while increasing productivity
and standardization for reporting urinalysis
results.
Reflectance Photometry
➔ Spectrometric measurement of light reflection
that is used in automated reagent strip
readers.
➔ Alleviates visual discrimination in urine color
➔ Principle: light reflection from the test pads
decreases in proportion to the intensity of
color produced by the concentration of the
test substance.
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✎ Reflectance Photometry
➔ A monochromatic light source is directed
toward the reagent pads by placing a filter
between the light source and the reflective
surface of the pad by using a light-emitting
diode (LED) to provide the specific
wavelength needed for each test pad color
reaction.
➔ The light is reflected to a photodetector, as
well as a converter that is either analog or
digital.
➔ The instruments compare the amount of
light reflection with that of known
concentrations.
✎ Several Automated Instruments
➔ Standardize sample processing
➔ Analyze chemistry test strips
➔ Perform urine sediment analysis
➔ Report results with consistent quality and
reduced hands-on-time
Additional Advantages to Automation
➔ Online computer capability with Laboratory
Information System (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
◆ Minimal calibration
◆ Cleaning and maintenance
Automated Instruments in Urinalysis
➔ Semi-Automated Instruments
◆ Depends on an operator for specimen
mixing, test strip dripping, and
microscopic results input.
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 ANALYSIS OF URINE & BODY FLUIDS
LECTURE | CHAPTER 2 : Urine and Body Fluid Analysis Automation

➔ 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 analysis
➔ Completely Automated Urine Systems
Fully Automated Urine Chemistry Analyzers
◆ Perform a complete urinalysis that
includes the physical, chemical, and ➔ Designed for a high-volume urinalysis
microscopic parts of urinalysis laboratory with user walk-away capability
➔ Instruments can load many samples on a
carousel or rack at one time with the capability
Semi-automated Urine Chemistry Analyzers
to insert STAT specimen during the run.
➔ Test for the chemical components of urine. ➔ Analytes measured vary by the instrument and
➔ Read and interpret the reagent strip results may include leukocytes, ketones, protein,
➔ Eliminates personnel color bias and timing glucose, nitrite, blood, urobilinogen, pH,
discrepancies. bilirubin, color, clarity, creatinine, and
➔ Leukocyte, nitrite, protein, blood, glucose, protein-low
ketone, bilirubin, urobilinogen, pH, specific ➔ Color is measured by either reflectance
gravity, color, creatinine, and photometry or spectrophotometry
protein-to-creatinine ratio can be tested ➔ Specific gravity is measured by refractive index.
depending on the reagent strip used. ➔ Clarity is a measurement of transmitted or
➔ Well suited for small and medium volume scattered light
laboratories
➔ Self-calibrating and some instruments
perform automatic checks (Auto-Checks) to
identify strip type and humidity exposure. The
semi-automated instrument requires the
operator to:
◆ Dip the reagent strip into a well-mixed
urine sample.
◆ Blot the strip to remove excess urine. Source: Urinalysis and Body Fluids 6th Ed. by
◆ Place the strip onto the reagent strip Strasinger
platform.
◆ Press the analyze/enter button.
● *Results are printed out, and
abnormal results are flagged
automatically

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 ANALYSIS OF URINE & BODY FLUIDS
LECTURE | CHAPTER 2 : Urine and Body Fluid Analysis Automation

✎ Sysmex UF-1000i Fully Automated Urine

Particle Analyzer and Sysmex UN-2000
Automated Urinalysis System
➔ uses fluorescent flow cytometry to measure
the forward-scattered, side-scattered, and
fluorescence light characteristics of particles
present in urine.
➔ The information obtained from these
measurements is used to detect and identify
stained urine sediment particles

✱ To perform an automated urine sediment

analysis:
Automated Microscopy / Automated Urine Cell ➔ 1.2 mL of uncentrifuged urine is aspirated
Analyzers into the instrument, which is divided into 2
➔ Provides efficient standardized results in less channels (each has a specific stain):
than 1 minute ◆ Urine particle analysis
◆ Bacteria staining and detection

Two Automated Urine Cell Analyzers (US)

1. Urine Stained urine sample passes
1. Sysmex UF 1000i particle through the flow cell.
2. iQ 200 from Iris Diagnostics analysis
Particles are identified by
Sysmex UF-1000i measuring the height and width
of the fluorescent and light scatter
signals (presented in
➔ Uses laser-based flow cytometry that
scattergrams and histograms).
measures forward light scatter, side scatter,
fluorescence staining characteristics, and
adaptive cluster analysis to identify stained
urine sediment particles.

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 ANALYSIS OF URINE & BODY FLUIDS
LECTURE | CHAPTER 2 : Urine and Body Fluid Analysis Automation

2. Bacteria Diluent stabilizes the pH and lyses

Resulting values are presented in
channel the non-bacterial particles.
quantitative cells per microliter
and cells per high- or
The stain is specific to the
low-powered field
ribonucleic acid (RNA) in a
bacterial cell.
Main particles enumerated are
RBCs, WBCs, squamous epithelial
The width of the fluorescent signal
cells, hyaline casts, and bacteria
measures cellular inclusions.
Results are displayed as
The width of forward light scatter
scattergrams
measures the length of cells.
Flagged particles include
pathologic casts, crystals, small
round cells, sperm, mucus, and
yeast-like cells (confirmed
manually)

Can store up to 10,000 patient

results.

iQ200

➔ Uses digital imaging and Auto Particle

Recognition (APR)
➔ automatically analyze and pre-classify urine
particles in uncentrifuged urine based on size,
shape, texture, and contrast into 12 categories
(RBCs, WBCs, WBC clumps, hyaline casts,
unclassified casts, squamous epithelial cells,
Nonsquamous epithelial cells, bacteria, yeast,
crystals, mucus, and sperm).
➔ Can also be used for body fluid cell counts

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 ANALYSIS OF URINE & BODY FLUIDS
LECTURE | CHAPTER 2 : Urine and Body Fluid Analysis Automation
microscope and digital camera
◆ to capture and categorize 15 particle
images based upon size and shape
using AIEM software.
➔ Both the UriSed 2 and UriSed 3 can be linked
with the chemistry analyzer LabUMat 2 to
make a complete automated urinalysis
laboratory system.

✎ 77 Electronika UriSed 2 and 3Pro Automated

Urine Sediment Analyzer

Advantages
✎ Beckman Coulter’s iQ200 Microscopy
Analyzer
➔ Analyzer mixes the sample
➔ Aspirates 1.3 mL of urine to a planar flow cell
➔ Then a digital camera takes 500 images as
the sample advances through the flow cell.
➔ Results are either reviewed by a trained
operator or auto-released to the LIS.
➔ Zoom capability to view images
➔ Interpretation of the images is similar to that
of manual microscopic smears.
➔ UriSed 3 Pro incorporates phase contrast
microscopy (in addition to bright-field
microscopy)
◆ to improve differentiation of
elements, such as hyaline casts, RBC
membranes, crystals, and yeast.

FUS-100 and FUS-200 Analyzers

➔ Identify cells using flat-flow cell digital

imaging technology and a trained neural
network.
➔ Artificial imaging identification (AII)
software is used to classify and quantify the
cells and formed particles in the uncentrifuged
urine.
◆ identifies and classifies 12 visible
components in urine based on shape,
UriSed 2 and 3Pro Automated Urine Sediment
contrast, texture, and frequency
Analyzer
domain features.
➔ A digital camera captures up to 820 photos.
➔ Perform automated microscopy with digital
imaging using auto image evaluation module
(AIEM) software. Automated Urinalysis
➔ UriSed 2 requires a minimum of 2 mL of urine Systems/Completely Automated Urine
Systems
that is centrifuged in a special cuvette to
produce a monolayer of urine sediment. ➔ Combination of automated urine chemistry
➔ The sediment is analyzed by a bright-field analyzers and automated urine cell analyzers

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 ANALYSIS OF URINE & BODY FLUIDS
LECTURE | CHAPTER 2 : Urine and Body Fluid Analysis Automation
➔ The systems can
independently perform both physical and
chemical testing, microscopy analysis, and a
combination of both.
➔ Complete analysis reports can be sent directly
to the LIS or printed out, reducing clerical
error.

✎ Automated Urinalysis Systems

➔ Improved TATs for urinalysis significantly
➔ Hands-on time of technologists has been
reduced significantly
➔ Using similar sample racks and moving a
conveyor system, samples are easily
transferred from one instrument to the next,
providing complete walkaway capability
with minimal sample handling from
sampling through results.
➔ Autoverification of results and reflex testing
can be validated according to laboratory
protocol.
➔ Abnormal results are flagged for manual
examination by laboratory personnel. ✎ Clinitek AUWi PRO Automated Urinalysis
System
➔ Integrates the Clinitek Novus Automated
Clinitek AUWi System
Urine Chemistry Analyzer and the Sysmex
UF-1000i Urine Particle Analyzer
➔ This is an integration of Clinitek Atlas ➔ Can load up to 200 sample tubes
(SIemens) and Sysmex UF-1000i (Sysmex) ➔ Complete up to 80 tests per hour
➔ Performs a complete automated urinalysis ➔ Sample requirement is 5 mL in the
➔ Requires a minimum of 5mL of urine automated mode
➔ Results are automatically verified (sent to LIS ➔ 2 mL in the manual mode
➔ The sample can be placed on the
or printed)
instrument with fewer manual steps, and no
centrifugation is required
ATLAS Where the specimen is identified, ➔ Autoverification of results to be reported to
Analyzer mixed, aspirated, and tested for the LIS is based on laboratory protocol.
physical and chemical components ➔ The system is capable of automatically
reflexing samples requiring sediment
UF-1000i The specimen travels across a analysis based on rules defined by each
connecting bridge to the UF-100i for laboratory.
microscopic analysis.

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 ANALYSIS OF URINE & BODY FLUIDS
LECTURE | CHAPTER 2 : Urine and Body Fluid Analysis Automation
iRICELL Automated Urinalysis Systems (Iris
Diagnostics)
➔ Consists of the iChemVELOCITY urine
chemistry analyzer and iQ200
➔ Requires a minimum of 4 mL of urine
➔ Results are transmitted to the LIS or printed
iChem ➔ Where the sample is mixed
VELOCITY and aspirated
➔ Physical and chemical analysis
iQ 200 Microscopy testing
✎ iRICELL Urinalysis Systems
➔ Barcoded tubes are placed into the
10-position rack and are moved to the
iChemVELOCITY.
➔ Upon completion, the rack moves across the
connecting bridge to the iQ200 for
microscopy testing, where a reflex rule may
be applied based on settings.
✎ IQ Series of Urinalysis Workcells (iQ2000 and
iQ3000)
➔ Pairs the Iris IRICELL series of urine
microscopy instrumentation and the
ARKRAY AUTION MAX AX4030 fully
automated urine chemistry analyzer to
provide a complete walk-away urinalysis
system.
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LabUMat 2 with UriSed 2 or UriSed 3 System
✎ LabUMat 2 (77 Electronika)
➔ Integrated with the UriSed 2 or UriSed 3 (77
Electronika) microscopic urine analyzers to
make a complete automated urinalysis
laboratory system.
➔ Minimum volume is 3 mL of uncentrifuged
urine for the combined instruments
➔ The system can analyze up to 240 tests per
hour
➔ Samples are loaded into the 10-position
sample racks where tests are performed by
the LabUMat2.
✎ LabUMat 2 (77 Electronika)
LabUMat Where the physical (color, clarity, and
2 specific gravity) and chemical tests (10
parameters) are performed
UriSed UriSed 2
➔ Bright-field microscopy
UriSed 3
➔ Both bright-field and phase
microscopy
cobas 6500 Urine Analyzer
✎ cobas 6500
➔ Integrates the cobas u 701 microscopy
analyzer and the cobas u 601 fully
automated urine chemistry analyzer into
one platform
➔ Cassettes with urine testing strips and
sediment are loaded onto the instrument
➔ 2.8 mL of urine is required
➔ Particle recognition software determines the
identification of
◆ RBCs
◆ WBCs
◆ Bacteria
◆ Epithelial cells
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 ANALYSIS OF URINE & BODY FLUIDS
LECTURE | CHAPTER 2 : Urine and Body Fluid Analysis Automation
◆ Casts
◆ Crystals
◆ Yeast
◆ Sperm
◆ Mucus
➔ Automated result validation and automated
reflex testing are available.
✎ cobas 6500 (Roche Diagnostics, Indianapolis,
IN)
cobas u Urine is pipetted on the chemical
601 strip, where 12 physical and chemical
urine tests are performed
After chemical testing, the sample is resuspended
before pipetting and automatically centrifuged at
2000 rpm for 10 secs to a monolayer of sediment.
cobas u Used digital imaging to take 15
701 microscopic images of the sediment
UX-2000 Automated Urinalysis Analyzer
✎ UX-2000 (Sysmex Corporation, Kobe, Japan)
➔ Consists of a chemical component for
analyzing the physical and chemical part of
urine as well as flow cytometry component
for microscopic examination of sediments
contained in a single instrument.
➔ Requires 5 mL of urine
➔ Physical examination: specific gravity,
turbidity, and color
◆ Refractometry
◆ Reflectivity measurement
◆ Light scattering
➔ Chemical examination
◆ Uses a test strip that is measured by
the dual-wavelength reflectance
methods
➔ Microscopic examination
◆ Uses fluorescent-flow cytometry to
measure RBCs, WBCs, hyaline casts,
bacteria, and epithelial cells
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➔ Crystals, yeast, small round cells,
spermatozoa, and casts are detected and
flagged for laboratory personnel to review
◆ The analyzer cannot differentiate
these types of particles in urine
sediment.
Body Fluid Analysis Automation
Hematology analyzers used to perform body
fluids cell counts:
➔ ADVIA 2120i (Siemens)
➔ The Sysmex XN-Series analyzers (Sysmex
America, Inc.)
➔ GloCyte Automated Cell counter for CSF
➔ Beckman Coulter’s IQ200
✎ ADVIA 2120i (Simens)
➔ Uses flow cytometry, light scatter and
absorbance to count red and white blood
cells, and perform WBC differential.
➔ For the Cerebrospinal fluid, CSF specimen is
pretreated with CSF reagent to fix and
spherize the cells.(stable for 4min. To 4
hours at 18 degree celcius to 30 degree
Celsius)
➔ Automated RBC, WBC, polymorphonuclear
and mononuclear and differential results are
available within 1 minute of sample
aspiration.
➔ Provides rapid automated diagnostic test
for fetal lung maturity by counting lamellar
bodies in amniotic fluid.
➔ The analyzer is approved for counting cells
in pleural fluids, peritoneal fluids, and
peritoneal dialysates.
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LECTURE | CHAPTER 2 : Urine and Body Fluid Analysis Automation

✎ Sysmex XN-Series analyzers

➔ Newest generation hematology analyzer
➔ Cleared for analysis of synovial fluid, pleural
fluid, and peritoneal fluid
➔ Also cleared for CSF specimens in the body
fluid mode.
➔ Includes dedicated body fluid mode
◆ The body fluid mode has extended
cell counting to increase precision in
specimens with small numbers of
cells.
➔ Body fluids can be analyzed without sample
preparation or pretreatment.
➔ Sheath flow impedance used to count RBCs
➔ Side scatter and fluorescence intensity to
count WBC
➔ The body fluid mode on the XN-Series
reports both a body fluid:
◆ White blood cell count (WBC-BF)
◆ Total nucleated body fluid cell count ✎ Book based
(TC-BF) ➔ Digital imaging technology also may be
◆ High-fluorescing body fluid cells used for body fluid differentials
(HF-BF) ➔ CellaVision DI-60 software
● Such as mesothelial cells, ◆ Classifies five different nucleated cell
synovial cells, and types found in body fluid
malignant/tumor cells, or, ◆ This software allows users to add
rarely, large cell clusters reference cells to a digital library,
◆ as well as a reportable two-part ◆ Enables tagging and sharing of cell
automated differential that images electronically
differentiates mononuclear and ◆ Offers a program to improve staff
polymorphonuclear cells using flow competency
cytometry technology.
➔ XN analyzer uses
◆ impedance counting principles for
RBC-BF enumerations ✎ GloCyte Automated Cell Counter for CSF
◆ flow cytometry for performing the ➔ Originated from Sysmex Corporation, Kobe,
WBC-BF counts and the two-part Japan
differential ➔ Combines s the principles of both
➔ Uses Lysercell WDF as an RBC lysing technologies to accurately enumerate cells
reagent and Fluorocell WDF to stain RNA present in CSF, even at low numbers.
and DNA in the nucleated cells ➔ Fluorochrome-labeled antibody stains the
RBCs, and a dye specific to nucleic acids in
WBCs is used to treat aliquots of the CSF
specimen.
➔ Digital imaging is used to count the cell as
they are illuminated
➔ Automatically enumerates each cell type
and displays the stained cells on a screen

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 ANALYSIS OF URINE & BODY FLUIDS
LECTURE | CHAPTER 2 : Urine and Body Fluid Analysis Automation

✎ Beckman Coulter’s iQ200

➔ can be used for body fluid analysis using the
iQ200 Body Fluids Module
➔ Body fluids menu includes:
◆ CSF,
◆ Synovial
◆ Pleural
◆ Peritoneal
◆ peritoneal dialysate
◆ peritoneal lavage
◆ Pericardial
◆ General serous
➔ Two dilutions of the body fluid specimen are
analyzed;
◆ One tube is diluted with Iris Diluent
◆ The other with the iQ Body Fluids
Lysing Reagent
➔ The instrument provides counts for total
cells, nucleated cells, and RBCs.

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