NOTES ON ANALYSIS OF URINE AND OTHER BODY FLUIDS

Notes Compiled by: Renz Louie Galanto

Strasinger, Seventh Edition

UNIT 2: URINE AND BODY FLUID ANALYSIS AUTOMATION

UNIT OUTLINE

• Urinalysis Automation ▪ FUS-100 and FUS-200 Analyzers

o Reflectance Photometry o Automated Urinalysis Systems
o Analyzers ▪ Clinitek AUWi System and AUWi Pro System
▪ Semiautomated Urine Chemistry Analyzers ▪ iRICELL Urinalysis Systems
o Fully Automated Urine Chemistry Analyzers ▪ LabUMat 2 with UriSed 2 or UriSed 3 System
o Automated Microscopy Analyzers ▪ cobas 6500 Urine Analyzer
▪ Sysmex UF-1000i Fully Automated Urine Particle ▪ UX-2000 Automated Urinalysis Analyzer
Analyzer and Sysmex UN-2000 Automated o Body Fluid Analysis Automation
Urinalysis System ▪ ADVIA 2120i
▪ Beckman Coulter’s iQ200 Microscopy Analyzer ▪ Sysmex XN-Series Analyzers
▪ 77 Electronika UriSed 2 and 3Pro Automated Urine ▪ GloCyte Automated Cell Counter for CSF
Sediment Analyzer ▪ Beckman Coulter’s iQ200

URINALYSIS AUTOMATION
● Studies have shown that the major variable in urinalysis testing is ● The ultimate goal of urinalysis automation is to improve
the conscientiousness of the laboratory personnel in their timing reproducibility and color discrimination while increasing
and interpretations of the color reactions productivity and standardization for reporting urinalysis results
o Correct color readings depend on the accuracy of the timing

REFLECTANCE PHOTOMETRY______ ● Automated instruments in urinalysis include semiautomated and

fully automated chemistry analyzers, automated urine cell
● Subjectivity associated with visual discrimination among colors
microscopy analyzers, and systems that are completely automated
has been alleviated by the development of automated reagent strip
● Semiautomated instruments still depend on an operator for
readers that use a spectrophotometric measurement of light specimen mixing, test strip dipping, and microscopic results input
reflection, termed “reflectance photometry”
● In a fully automated chemistry analyzer, the tubes of urine are
● It uses the principle that light reflection from the test pads
placed on a rack or a carousel and moved automatically through
decreases in proportion to the intensity of the color produced by the instrument
the concentration of the test substance
o Automated urine cell microscopy analyzers mix, aspirate,
● A monochromatic light source is directed toward the reagent pads
dilute, and stain urine to classify urine sediment particles
by placing a filter between the light source and the reflective
o Automated urine systems perform a complete urinalysis that
surface of the pad or by using a light-emitting diode (LED) to includes the physical, chemical, and microscopic parts of a
provide the specific wavelength needed for each test pad color
routine urinalysis by integrating a fully automated chemistry
reaction analyzer with an automated urine cell microscopy analyzer
o The light is reflected to a photodetector, as well as a ● The automated urinalysis instruments currently available are
converter that is either analog or digital listed in Table 2-2; however, new instruments are being developed
o The instruments compare the amount of light reflection with
continually
that of known concentrations and then display or print Table 2-1. Measurement Technology Methods in Automated Urinalysis
concentration units or transmit data to a laboratory
Urine Measurement Technology
information system (LIS).
Manufacturer Color Clarity Specific Gravity
● Several automated instruments are available that standardize
sample processing, analyze chemistry test strips, perform urine U.S. ARKRAY, Inc. Reflectance Light scatter Refractive index
sediment analysis, and report results with consistent quality and photometry
reduced hands-on time Iris Diagnostics- Light Light Refractive index
● The instruments are user-friendly and include visual and audio Beckman Coulter, transmission/li transmission/
prompts for operation Inc ght scatter light scatter
● The various manufacturers’ instruments include different features DIRUI Reflectance Turbidity Refractometry
and principles for testing photometry
o See Table 2-1 for a breakdown of the measurement Roche Diagnostics Reflectance Turbidity Refractometry
technologies used by the major urine analyzer manufacturers photometry
● Additional advantages to automation include online computer Siemens Healthcare Reflectance Light Refractive index
capability with an LIS interface; barcoding; manual entry of color, Diagnostics, Inc. photometry transmission/
clarity, and microscopic results to be included on the printed light scatter
report; flagging abnormal results; storing patient and control Sysmex Corporation Reflectance Reflectance Refractometry
results; and minimal calibration, cleaning, and maintenance. photometry photometry
 UNIT I: SAFETY AND QUALITY MANAGEMENT Strasinger, 7th Edition, 2021
Table 2-2. Urinalysis Automation Laboratory Improvement Amendments (CLIA)–waived
Equipment Manufacturer standards.
Semiautomated Chemistry Instruments ● Semiautomated analyzers are self-calibrating, and some
Clinitek Advantus Siemens Healthineers instruments perform automatic checks (auto-checks) to identify
Clinitek Status Siemens Healthineers strip type and humidity exposure
Urisys 1800 system Roche Diagnostics ● For a semiautomated instrument, the reagent strips are manually
COBAS u411 Roche Diagnostics dipped into the urine and placed on the strip reader, the reaction
AUTION Eleven AE-4022 U. S. ARKRAY Inc. pads are read at the correct time, and the strip is moved to the
Fully Automated Chemistry Instruments waste container
Clinitek Atlas Siemens Healthineers ● The results are displayed, printed, or transmitted to an LIS
o Patient identification and specimen color and clarity may be
Clinitek Novus Siemens Healthineers
entered manually, or a barcode reader can be used to identify
Urisys 2400 system Roche Diagnostics
samples
AUTION MAX AX-4030 U.S. ARKRAY, Inc. ● Positive results are flagged to indicate a patient sample that
IChemVELOCITY Iris Diagnostics-Beckman Coulter, requires additional confirmation testing or microscopic
Inc. evaluation
Cobas u 601 urine analyzer Roche Diagnostics ● The semiautomated instrument requires the operator to:
FUS-100 and FUS-200 DIRUI o 1. Dip the reagent strip into a urine sample that has been
Automated Microscopy mixed well
UF-1000i Urine Cell Analyzer Sysmex Corporation o 2. Blot the strip to remove excess urine.
UN-2000 Sysmex Corporation o 3. Place the strip onto the reagent strip platform
iQ 200 Automated Urine Microscopy Iris Diagnostics-Beckman Coulter, o 4. Press the analyze/enter button.
(IQ200SELECT, IQ200ELITE, Inc. ● The results are printed out, and abnormal results are flagged
IQ200SPRINT) automatically
Urine Analyzer (iQ 200 Sprint) Iris Diagnostics-Beckman Coulter, ● As the strip moves through the instrument, reflectance readings
Inc. are taken at the correct time intervals.
Cobus u 701 Microscopy Analyzer Roche Diagnostics o Some manufacturers’ test strips have a color compensation
LabUMat 2 77 Elektronika pad that adjusts results for urine color
Automated Urinalysis Systems ▪ This feature allows the instrument to subtract the urine
iRICELL Urinalysis – IQ Series Iris Diagnostics-Beckman Coulter, color from the color developed on the reaction pad,
Urinalysis Workcell (iRICELL Inc. providing an accurate result for each pad despite the
3000plus, iRICELL 2000plus, iRICELL interference
3000pro, iRICELL 2000pro, iRICELL ▪ Then the strips are moved to the waste container
1500) ● Results are stored in the analyzer, printed, or sent to the LIS
CLINITEK AUWi Pro System Siemens Healthineers o Examples of semiautomated instruments are shown in
Cobas 6500 Roche Diagnostics Figures 2-1 through 2-5.
Dirui FUS – 100/200 with H-800 DIRUI ● Daily maintenance is minimal and includes cleaning the reagent
UriSed 2 or UriSed 3 with LabUMat2 77 Elektronika strip platform and emptying the reagent strip waste container
UX-2000 Sysmex Corporation
AUTION HYBRID AU-4050 U.S. ARKRAY, Inc.
Body Fluid Analyzers
ADVIA2120i with Body Fluids Siemens Healthcare Diagnostics,
Software Inc.
Sysmex XN-Series using Body Fluids Sysmex Corporation
mode
iQ 200 using Body Fluids Software Iris Diagnostics-Beckman Coulter,
Inc.
DxH 900 Hematology Analyzer Beckman Coulter, Inc.

ANALYZERS_______________________
SEMIAUTOMATED URINE CHEMISTRY ANALYZERS
● Semiautomated urine analyzers test for the chemical components
of urine
● The instruments read and interpret the reagent strip results
consistently, thereby standardizing the interpretation of reagent
strip results and eliminating personnel color bias and timing
discrepancies
● Depending on the instrument and the reagent strip used, the
following tests can be performed:
o Leukocyte, nitrite, protein, blood, glucose, ketone, bilirubin,
urobilinogen, pH, specific gravity, color, creatinine, and
protein-to-creatinine ratio
● Semiautomated analyzers are well suited for small- and medium-
volume laboratories and physicians’ offices and meet the Clinical
UNIT I: SAFETY AND QUALITY MANAGEMENT Strasinger, 7th Edition, 2021

FULLY AUTOMATED URINE AUTOMATED MICROSCOPY

CHEMISTRY ANALYZERS___________ ANALYZERS_______________________
● In a routine urinalysis, a test strip determines the chemical
● Fully automated instruments are designed for a high-volume
analytes and the formed elements are determined by
urinalysis laboratory with user walk-away capability
microscopy.
● The various instruments can load many labeled tubes of urine on
● Manual microscopy is not easily standardized because of the
a carousel or rack at one time with the capability to insert a stat
● high variation among operators even in the same facility. Routine
sample during the run
● specimen processing, such as centrifugation, can affect accuracy
o The “start” or “analyze” button is pressed to begin testing,
● because rare elements, such as casts or cells, may be lost during
and the sample moves through the instrument automatically
● handling. It has been demonstrated that recovery of formed
o The sample is identified, mixed, and aspirated
● elements in the sediment after centrifugation is highly variable.
o A sample probe aspirates an exact amount of urine and
● Results are not quantitative because they must be reported in
dispenses it directly onto the reagent strip
ranges or averages. Overall, manual microscopy is not cost
▪ The reagent strip advances automatically to the
● effective because of the labor and time required to process and
reflectance photometer to measure the color change of
● analyze the specimen, which ultimately increases turnaround
each reagent pad
● times (TATs) for results. Automated urine cell microscopy
● Then the strip advances automatically to the
● analyzers provide efficient standardized results in less than
disposal area
● 1 minute compared with approximately 6 minutes using the
● Tests are measured by the dry chemistry test
● manual method, markedly improving TATs. A number of
strip, using reflectance photometry to detect
● automated urine cell microscopy analyzers are currently
color change and then taking readings at the available in the United States. Two types of technology are used
appropriate time and wavelength for each
for
specific test
● urine sediment analysis with these instruments: flow cytometry
● Analytes measured vary by the instrument and may include
● and digital imaging techniques
leukocytes, ketones, protein, glucose, nitrite, blood, urobilinogen,
pH, bilirubin, color, clarity, creatinine, and protein-low
SYSMEX UF-1000I FULLY AUTOMATED URINE PARTICLE
o Color is measured by either reflectance photometry or
ANALYZER AND SYSMEX UN-2000 AUTOMATED
spectrophotometry at multiple wavelengths URINALYSIS SYSTEM
● Specific gravity is measured by the refractive index methodology,
and clarity is a measurement of transmitted or scattered light ● The Sysmex UF-1000i (Sysmex Corporation, Kobe, Japan) uses
● The instruments use integrated barcoded sample identification fluorescent flow cytometry to measure the forward-scattered,
and allow abnormal ranges to be selected so that samples that side-scattered, and fluorescence light characteristics of particles
require microscopic examination or confirmatory testing can be present in urine
identified and flagged o Information obtained from these measurements is used to
● Patient results and quality control results and calibrations are detect & identify stained urine sediment particles (Fig 2-10)
stored for visual display, print-out, or transmission to an LIS ● To perform an automated urine sediment analysis, 1.2 mL of
o Standardized controls are run as set by laboratory protocol uncentrifuged urine is aspirated into the instrument and divided
● Examples of fully automated urine chemistry analyzers are shown into two channels: the sediment channel for urine particle analysis
in Figures 2-6 through 2-9 and the bacteria channel for bacteria staining and detection (Fig.
2-11)
o Each channel has a specific stain that targets surface and/or
internal components of the cells
▪ The stained urine sample passes through the flow cell,
where it is hydrodynamically focused and presented to
a red semiconductor laser (635 nm) (Fig. 2-12)
▪ Particles are identified by measuring the height and
width of the fluorescent and light scatter signals, which
are presented in scattergrams and histograms
o In the bacteria channel, the diluent stabilizes the pH and lyses
the nonbacterial particles, reducing interference from
amorphous crystals
▪ The stain is specific to the ribonucleic acid (RNA) in a
bacterial cell, eliminating any nonspecific staining of
debris
UNIT I: SAFETY AND QUALITY MANAGEMENT Strasinger, 7th Edition, 2021
▪ The width of the fluorescent signal measures cellular o Then the technologist has the opportunity to review the
inclusions, and the width of forward light scatter captured images and identify the type(s) of urine particles
measures the length of cells (Fig. 2-13). present
● Resulting values are presented in quantitative cells per microliter ● The UN-2000 uses a single-screen data management system for
and cells per high- or low-powered field monitoring analyzer status, result reporting, and reflex rule
● Thresholds to be flagged for primary elements can be established, setting, as well as providing the connection point for interface
and abnormal results are flagged for confirmatory review with the LIS or middleware system
o The main particles enumerated are red blood cells (RBCs), ● In the United States and Canada, this data management system is
white blood cells (WBCs), squamous epithelial cells, hyaline called the Urinalysis Data Manager (UDM)
casts, and bacteria ● In regions outside the United States and Canada, U-WAM is the
o The results are displayed as scattergrams (Fig. 2-14). name of the data management system for UN-Series analyzers
▪ These parameters are reportable directly without
technologist intervention and may be autovalidated
● Flagged particles include pathological casts, crystals, small round
cells (renal tubular epithelial cells or transitional epithelial cells),
sperm, mucus, and yeastlike cells, and these particles must be
confirmed by manual microscopy
● A latex particle quality control system monitors performance, and
quality control records can be viewed on the instrument screen in
a Levy-Jennings graph
o The analyzers can store up to 10,000 patient results,
including scattergrams, histograms, and specimen
characteristics, which can be saved and viewed by the user
o A bidirectional interface is provided to download and report
results
● The UF-1000i can be used independently or integrated with an
automated urine chemistry strip reader to create a complete
urinalysis system.
● The newest Sysmex model, the UN-2000 (Fig. 2-15), is an
automated, modular, and scalable urinalysis system that combines
urine flow cytometry with digital image analysis by integrating
the UF-5000 Fully Automated Urine Particle Analyzer (Fig. 2-16)
and the UD-10 Fully Automated Urine Particle Digital Imaging
Device (Fig. 2-17) Figure 2–12 Staining elements for the Sysmex UF1000i. (Image
● The UF-5000 utilizes fluorescent flow cytometry coupled with a courtesy of Sysmex Corporation, Kobe, Japan.)
blue semiconductor laser to measure particle length, particle
volume, particle internal complexity, and total amount of nucleic
acid contained within the particle (Figs. 2-18 and 2-19)
o The shorter wavelength blue (488 nm) semiconductor laser Figure 2–13 UF1000i
offers the benefit of enhanced detection and differentiation signal waveform for cells.
of small particles (Image courtesy of
● The sediment and bacteria channels used in the previous- Sysmex Corporation,
generation UF-1000i have been replaced with two new analysis Kobe, Japan.
channels to further enhance the sensitivity and specificity of
particle detection in urine sediment.
o The core channel (CR ch) stains elements with nuclear
material, such as WBCs, epithelial cells, and bacteria (Fig.
2-20)
▪ In regard to the bacteria analysis in the CR ch, the
degree of staining, and thus intensity, of the side
fluorescence signal is dependent on the bacterial cell
wall structure
o The surface channel (SF ch) stains and measures anucleate
elements, such as RBCs, crystals, and casts (Fig. 2-21)
● In addition to the two new measuring channels, the UF-5000 has
a new depolarized side scatter (DSS) detector that provides
information on the particles’ ability to depolarize light (Fig. 2-22)
o Through the detection of depolarized light, the DSS detector
works to differentiate urine particles that are birefringent,
such as crystals
o An advantage of the Sysmex UF-5000 is that it requires a
minimal volume of urine for analysis.
● The Sysmex UD-10 is a complementary digital imaging system
designed to capture detailed images of urine particles in urine
samples that require further review
o All captured urine particle images are classified, based on
size, into eight different classes
UNIT I: SAFETY AND QUALITY MANAGEMENT Strasinger, 7th Edition, 2021
● The microscopy unit can be integrated with an automated urine
chemistry analyzer to provide a complete urinalysis system
● The analyzer mixes the sample and aspirates 1.3 mL of urine
● The sample is hydrodynamically focused in a planar flow cell and
presented to a digital microscope in a thin moving sheet
o Then a digital camera takes 500 images as the sample
advances through the flow cell (Fig. 2-24)
● Individual urine particles are extracted from the raw images and
automatically classified using a proprietary neural network
algorithm into 12 major classification categories: RBCs, WBCs,
WBC clumps, squamous epithelial cells, nonsquamous epithelial
cells, unclassified casts, hyaline casts, unclassified crystals,
bacteria, yeast, mucus, and sperm (Figs. 2-25 and 2-26)
● Results are either reviewed by a trained operator or autoreleased
to the LIS based on user-defined parameters
● Because the images are archived digitally, results can be reviewed
easily and reclassified by the operator without the need for manual
microscopy
● In addition to the 12 major categories, the software allows the user
to subclassify particles into 27 additional categories, such as
specific types of crystals, casts, nonsquamous epithelial cells,
yeast with pseudohyphae, trichomonas, and oval fat bodies
● Additional user observations can be added to the report in the Edit
Comment section.

77 ELECTRONIKA URISED 2 AND 3PRO AUTOMATED

URINE SEDIMENT ANALYZER
● The UriSed 2 and UriSed 3 Pro (77 Electronika, Budapest,
Hungry) perform automated microscopy with digital imaging
using auto image evaluation module (AIEM) software
● The UriSed 2 requires a minimum of 2 mL of urine that is
centrifuged in a special cuvette to produce a monolayer of urine
sediment
o The sediment is analyzed by a bright-field microscope and
digital camera to capture and categorize 15 particle images
based upon size and shape using AIEM software
● Advantage to this instrument is the zoom capability to view
images, and 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,
BECKMAN COULTER’S IQ200 MICROSCOPY ANALYZER such as hyaline casts, RBC membranes, crystals, and yeast
● The iQ200 Automated Urine Microscopy Analyzer (Iris ● Both the UriSed 2 and UriSed 3 can be linked with the chemistry
Diagnostics-Beckman Coulter, Brea, CA) uses digital flow analyzer LabUMat 2 to make a complete automated urinalysis
morphology (imaging) and auto particle recognition (APR) to laboratory system
categorize and count urine particles automatically in
uncentrifuged urine based on size, shape, texture, and contrast. FUS-100 AND FUS-200 ANALYZERS
● The instrument also can be used for counts of body fluid cells by ● FUS-100 and FUS-200 urine sediment analyzers (DIRUI
adding the optional body fluids software module (Fig. 2-23) Industrial Co., Ltd., Changchun City, Jilin Province, China)
UNIT I: SAFETY AND QUALITY MANAGEMENT Strasinger, 7th Edition, 2021
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
● A digital camera captures up to 820 photos, and the AII identifies
and classifies 12 visible components in urine based on shape,
contrast, texture, and frequency domain features
● The FUS instruments can be integrated with the H-800 chemistry
analyzer for a total automated urinalysis system

AUTOMATED URINALYSIS SYSTEMS

● Combining automated urine chemistry analyzers and automated
IRICELL URINALYSIS SYSTEMS
urine cell analyzers to create completely automated urinalysis
systems has improved TATs for urinalysis significantly. ● The iRICELL Automated Urinalysis System (Iris Diagnostics-
Technologists’ hands-on time has been reduced significantly as Beckman Coulter, Brea, CA) consists of the iChemVELOCITY
well urine chemistry analyzer and the iQ200 urine microscopy
● Using similar sample racks and moving on a conveyor system, analyzer (Fig. 2-28)
samples are easily transferred from one instrument to the next, ● A minimum of 4 mL of urine is required
providing complete walkaway capability with minimal sample ● Barcoded tubes are placed into the 10-position rack and are
handling from sampling through results moved to the iChemVELOCITY
● By interfacing with the LIS, barcoded samples are identified ● Upon completion of the physical and chemical analysis, the rack
automatically and processed according to the requested tests moves across the connecting bridge to the iQ200 for microscopy
● The systems can independently perform both physical and testing, where a reflex rule may be applied based on settings
chemical testing, microscopy analysis, and a combination of both ● Combined chemistry and microscopy urinalysis results are
● A complete urinalysis report can be sent directly to the LIS or transmitted to the LIS or printed.
printed out, thereby reducing clerical error ● The IQ series of urinalysis workcells (iQ2000 and iQ3000) pairs
● Autoverification of results and reflex testing can be validated the Iris IRICELL series of urine microscopy instrumentation and
according to laboratory protocol the ARKRAY AUTION MAX AX4030 fully automated urine
o Abnormal results are flagged for manual examination by chemistry analyzer to provide a complete walk-away urinalysis
laboratory personnel system (refer back to Table 2-2)

CLINITEK AUWI SYSTEM AND AUWI PRO SYSTEM

● The Clinitek Atlas System (Siemens Healthcare Diagnostics,
Tarrytown, NY), an automated urine chemistry analyzer, and the
Sysmex UF-1000i (Sysmex Corporation, Mundelein, IL), an
automated urine cell analyzer, have been integrated to develop the
Clinitek AUWi System (Siemens), which performs a completely
automated urinalysis (Fig. 2-27)
● A minimum of 5 mL of urine is required in the automated mode
● The barcoded tubes are racked and placed onto the system. The
rack advances to the Atlas analyzer, where the sample is
identified, mixed, aspirated, and tested for physical and chemical LABUMAT 2 WITH URISED 2 OR URISED 3 SYSTEM
components ● The chemistry analyzer LabUMat 2 (77 Electronika) can be
o Then the sample travels across a connecting bridge to the integrated with the UriSed 2 or UriSed 3 (77 Electronika)
UF-1000i for microscopic analysis microscopic urine analyzers to make a complete automated
● The instrument automatically reflexes samples requiring urinalysis laboratory system
sediment analysis, reducing the time associated with manual ● The minimum volume is 3 mL of uncentrifuged urine for the
microscopic analysis. combined instruments, and the system can analyze up to 240 tests
● Results are verified automatically and integrated into a complete per hour
urinalysis report to be sent to the LIS or printed. o The samples are loaded into the 10-position sample racks
● The Clinitek AUWi PRO Automated Urinalysis System integrates where the physical (color, clarity, and specific gravity) and
the Clinitek Novus Automated Urine Chemistry Analyzer and the chemical tests (10 parameters) are performed by the
Sysmex UF-1000i Urine Particle Analyzer. LabUMat2
o This automated system can load up to 200 sample tubes and o Then the sample racks are transferred across a connecting
complete up to 80 tests per hour bridge to the UriSed 2 (bright-field microscopy) or the
o As with the AUWi system, the sample volume requirement UriSed 3 (both bright-field and phase microscopy) for the
is 5 mL in the automated mode and 2 mL in the manual mode urine microscopic analysis
▪ Samples can be placed on the instrument with fewer
manual steps, and no centrifugation is required COBAS 6500 URINE ANALYZER
● Autoverification of results to be reported to the LIS is based on
laboratory protocol ● The cobas 6500 Urine Analyzer (Roche Diagnostics,
● In addition, the system is capable of automatically reflexing Indianapolis, IN) is another fully automated urine system. Its
samples requiring sediment analysis based on rules defined by modular design integrates the cobas u 701 microscopy analyzer
each laboratory and the cobas u 601 fully automated urine chemistry analyzer into
one platform
UNIT I: SAFETY AND QUALITY MANAGEMENT Strasinger, 7th Edition, 2021
● Cassettes with urine testing strips and sediment cuvettes are Series analyzers (Sysmex America, Inc.), and the DxH 900
loaded onto the instrument, and 2.8 mL of urine is required (Beckman Coulter, Inc.).
● Urine is pipetted on the chemical strip, where 12 physical and
chemical urine tests are performed using the cobas u 601 urine ADVIA 2120I
analyzer ● The ADVIA 2120i uses flow cytometry, light scattering, and
● After chemical testing, the sample is resuspended before pipetting absorbance to count RBCs and WBCs, as well as to perform a
and automatically centrifuged at 2000 rpm for 10 seconds to a WBC differential that includes percentages and absolute numbers
monolayer of sediment of mononuclear cells and polymorphonuclear cells on specimens
● The cobas u 701 uses digital imaging to take 15 microscopic with more than 20 WBC/µL
images of the sediment, and the images are displayed on the result o The WBC differential includes the numbers of neutrophils,
screen lymphocytes, monocytes, and eosinophils
o Particle recognition software determines the identification of ● A specimen of cerebrospinal fluid (CSF) is pretreated with CSF
RBCs, WBCs, bacteria, epithelial cells, casts, crystals, yeast, reagent to fix and spherize the cells
sperm, and mucus o The prepared specimen remains stable for 4 minutes to 4
● Automated result validation and automated reflex testing are hours when stored at 18°C to 30°C
available. o The specimen is aspirated into the instrument, and cells are
differentiated and enumerated by three optical measurements
UX-2000 AUTOMATED URINALYSIS ANALYZER o The signals are digitized and used to construct the CSF
● The UX-2000 (Sysmex Corporation, Kobe, Japan) is a fully cytogram
automated integrated urine analyzer ● With this system, more cells are counted, achieving increased
● It consists of a chemical component for analyzing the physical accuracy and precision
and chemical part of urine as well as a flow cytometry component ● The automated results for RBC, WBC, polymorphonuclear,
for microscopic examination of sediments contained in a single mononuclear, and differential are available within 1 minute of
instrument. sample aspiration
● The system requires 5 mL of urine ● In addition, the ADVIA 2120i can provide a rapid automated
● For the physical examination, refractometry, reflectivity diagnostic test for fetal lung maturity by counting lamellar bodies
measurement, and light scattering are used to measure specific in amniotic fluid
gravity, turbidity, and color o Lamellar bodies are counted in the platelet channel using
● The chemical examination uses a test strip that is measured by the high and low laser light scattering.
dual-wavelength reflectance methods ● The analyzer is approved for counting cells in pleural fluids,
● The microscopic examination uses fluorescent-flow cytometry to peritoneal fluids, and peritoneal dialysates
measure RBCs, WBCs, hyaline casts, bacteria, and epithelial cells
● Crystals, yeast, small round cells, spermatozoa, and casts are SYSMEX XN-SERIES ANALYZERS
detected and flagged for laboratory personnel to review because ● The Sysmex XN-Series analyzer is the newest-generation
this analyzer cannot differentiate between those types of particles hematology analyzer that includes a dedicated body fluid mode is
in urine sediment cleared for analysis of synovial fluid, pleural fluid, and peritoneal
fluid, and the XN-10 analyzer is also cleared for CSF specimens
BODY FLUID ANALYSIS AUTOMATION in the body fluid mode.
● Traditionally body fluid counts for RBCs and WBCs, as well as ● Bronchoalveolar lavage and amniotic fluid are not cleared for
WBC differentials, are performed manually using a analysis on the XN-Series analyzers
hemocytometer and optical microscopy ● Table 2-3 lists the fluid types cleared for analysis on the XN-
● Three types of hemocytometers are available—Fuchs-Rosenthal, Series analyzers
Nageotte, and Neubauer—and each differs in the design of the ● The body fluid mode has extended cell counting to increase
calibrated counting area etched on the slide precision in specimens with small numbers of cells
● An exact amount of fluid fills the chamber that provides a defined ● Body fluids can be analyzed without specimen preparation or
volume for cell enumeration pretreatment.
o These procedures are labor-intensive and time-consuming, ● The body fluid mode on the XN-Series reports both a body fluid
and often they are subject to technologist variability white blood cell count (WBC-BF) and a total nucleated body fluid
● Automation brings quality control, precision, faster TATs, and cell count (TC-BF) as well as a reportable two-part automated
standardization of results to a method that previously was differential that differentiates mononuclear and
uncontrolled polymorphonuclear cells using flow cytometry technology
o However, automated instruments have not eliminated ● The XN analyzer also identifies high-fluorescing body fluid cells
completely the use of a manual hemacytometer count. (HF-BF), such as mesothelial cells, synovial cells, and
● Body fluids with low cell counts or malignant cells still require a malignant/tumor cells, or, rarely, large cell clusters
manual differential using a stained cytospin smear ● Digital imaging technology also may be used for body fluid
● The laboratory must define the limits for the automated differentials
instrument and establish the lower limits for cell counting to ● The CellaVision DI-60 software classifies five different nucleated
determine when a manual procedure must be performed cell types found in body fluid
o For example, iQ 200 is linear down to zero (0 to 10,000 o This software allows users to add reference cells to a digital
cells/L) library, enables tagging and sharing of cell images
▪ Linearity can be extended during method comparison electronically, and offers a program to improve staff
● In addition, the laboratory must follow manufacturers’ competency
recommended procedures for special treatment required for the ● The XN analyzer uses impedance counting principles for RBC-
specific body fluid analyzed, intended use, and reportable ranges BF enumerations and flow cytometry for performing the WBC-
● Hematology analyzers that are used to perform body fluids cell BF counts and the two-part differential
counts include the ADVIA 2120i (Siemens), the Sysmex XN- ● The XN series uses Lysercell WDF as an RBC lysing reagent and
Fluorocell WDF to stain RNA and DNA in the nucleated cells
UNIT I: SAFETY AND QUALITY MANAGEMENT Strasinger, 7th Edition, 2021
● In addition, the differential scatterplots should be inspected
visually to detect non-cellular particulate matter, such as bacteria,
Cryptococcus, and interference from large cells (macrophages
and mesothelial cells)
Table 2-3. Body Fluids Analyzed on the Sysmex XN-Series
XN-10 XN-11 XN-20
CSF Yes No Yes
Peritoneal Fluid Yes Yes Yes
Pleural Fluid Yes Yes Yes
Pericardial Fluid No No No
Synovial Fluid Yes Yes Yes
CSF, Cerebrospinal fluid

GLOCYTE AUTOMATED CELL COUNTER FOR CSF

● The GloCyte analyzer (Sysmex Corporation, Kobe, Japan)
combines the principles of both technologies to accurately
enumerate cells present in CSF, even at low numbers
● A 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 cells as they are illuminated
with a semiconductor laser
● The instrument automatically enumerates each cell type and
displays the stained cells on a screen

BECKMAN COULTER’S IQ200

● The iQ200 (Iris Diagnostics – Beckman Coulter, Brea, CA) can
be used for body fluid analysis using the iQ200 Body Fluid
Module
● The Body Fluid menu includes such fluids as CSF, synovial,
pleural, peritoneal, peritoneal dialysate, peritoneal lavage,
pericardial, and general serous
● Two dilutions of the body fluid specimen are analyzed; one tube
is diluted with Iris Diluent, and the other with the iQ Body Fluids
Lysing Reagent.
● The instrument provides counts for total cells, nucleated cells, and
RBCs
● As with urine microscopy, results are either reviewed by a trained
operator or auto-released to the LIS based on user-defined-
parameters.

Reference:

Notes from the book by Urinalysis and Body Fluids, Seventh Edition
Strasinger (2021)

Disclaimer: All notes in this material are from the following reference
above. No additional notes were included for the creation of this
material.