Preanalytical Automation in the Clinical Lab

Alexandra Sommer, PhD joined Tecan in 2015 as senior product manager and is responsible for Tecan’s clinical lab automation portfolio. Prior to working in the diagnostic industry in 2006, she worked as scientist in oncology research and tropical medicine in different organizations in Europe. Alexandra is a biologist by training and holds a PhD from the University of Hamburg, Germany.

What issues can arise when laboratory staff process blood samples manually?

With whole blood processing, normally you should mix the sample well, open it, and then start distributing. What operators often do instead to save time is mix all of the samples sitting in the rack first, and then open all the tubes and start pipetting. Unfortunately, while you are pipetting, the cells start to settle so they are not equally distributed in the specimen. This could have an impact on results, depending on the assay you want to do downstream.

Another issue is contamination. You first have to mix the samples, so when you open the tubes, they can give a little splash on the outside, which can get on the operator or on another tube. We also have some customers who have safety concerns about manual processing of blood samples. They prefer not to open the samples manually to avoid exposure to potentially infectious material. 

The manual process is not only labor intensive, but it’s also easy to mix up samples. 

How can labs avoid those issues?

With automation, it will always be the same workflow done in the same way, leading to standardized results. Also, automation today in the clinical lab has full traceability of the samples, from loading to output.

What differentiates Tecan’s preanalytical automation solution from others on the market?

If you compare it to other automation solutions, ours can tell not only whether enough volume was pipetted, but also whether you pipetted the amount that was expected. 

Also, I’m not aware of another company offering reliable piercing of closed tubes with a good pipetting precision. The problem arising here is that if you want to pipet from a closed vacuum tube, you’ll normally create a vacuum inside the tube through liquid aspiration, impacting the pipetting performance. We have found a way to prevent that happening with our tip, so we have very precise pipetting for small and large volumes. 

For mixing samples, other instruments shake the tubes or mix the samples by pipetting up and down several times. Ours mimics the human motion more precisely by rotating the tubes upside down. That’s closer to what is usually described in the instructions for assay use with a manual workflow.

What role has lab automation played in infectious disease testing?

Lab automation enables traceability of samples and results, thus providing an additional layer of safety to reported results. 

In light of COVID-19 testing, lab automation was an absolute need because of the large volume of samples that had to be tested. I don’t think that you could process and get the results in a short amount of time and in a reliable way if you didn’t have the automation behind it.

Everybody is currently so focused on COVID-19 testing that many other infectious diseases aren’t tested for. For example, a major disruption in tuberculosis detection could result in additional 400 000 lives lost as indicated by the WHO. Thus, reduced testing would have a (negative) impact on the ‘END TB’ Strategy defined by the WHO.

I mention tuberculosis because we have several customers using the Fluent Mix and Pierce Workstation for latent tuberculosis testing in humans, as well as farm animals.

Aside from infectious disease, what’s another common application of Tecan’s preanalytical automation solution? 

Another area where our solution is commonly used is in immunosuppressant analysis. Quantification of immunosuppressive drugs in whole blood is needed for optimization of treatment and to avoid toxicity or unwanted side effects. The samples need to be very well mixed because you’re looking for therapeutic drugs that are associated with blood cells, so you need to have a fraction that represents the normal blood you take from the patient in which the cells have not settled.