UPDATE IN URINALYSIS
Diane Gaspari, SH(ASCP)
Division Manager, Core Lab
York Hospital, York, PA
Program Objectives
• Enhance knowledge of CKD and the NKF’s guidelines for laboratory diagnosis & monitoring of CKD.
• Identify pre-analytic variables of urinalysis testing & analytic variables of manual urine sediment testing.
• Understand the technology, software features, and flagging parameters of the Sysmex UF-1000i automated urine sediment analyzer.
• Identify the benefits of automated urine sediment analysis.
Did You Know . . .“Urinalysis is the most valuable single test of the anatomic integrity of the kidneys that is readily available to the clinician”
SchreinerFrom J. Szwed, The Importance of Microscopic Examination of the Urinary Sediment, American Journal of Medical Technology, 48:2, Feb. 1982
Functions of Kidney
• Remove waste products & drugs from body.
• Balance body’s fluid, release hormones to regulate blood pressure, and produce active vitamin D.
• Regulation of body’s salt, potassium, & acid content
National Kidney Foundation
• http://www.kidney.org/kls/index/cfm
• http://www.kidney.org/professionals/kdoqi/guidelines
• New Guidelines February 2002
• Addition to Guidelines in 2003, 2005, 2006, 2007, 2008, and 2012.
Incidence and Prevalence of End-Stage Renal Disease in the
U.S.
CHRONIC KIDNEY DISEASE
• CKD is a world-wide public health problem that is under-diagnosed and under-treated.
• Early diagnosis is critical as kidney disease is often silent in the early stages.
• Most common causes of CKD in North America is diabetes, hypertension, and glomerular disease.
CHRONIC KIDNEY DISEASE
• Presence of excessive amounts of urine protein is most common clinical sign of early kidney dysfunction.
• Other markers of kidney damage– abnormal urine sediment– abnormal findings on imaging studies– abnormal blood & urine chemistry results
that identify renal tubular syndromes
CHRONIC KIDNEY DISEASE
• Symptoms– fatigue– difficulty concentrating– poor appetite– sleeplessness– muscle cramping at night– swollen feet and ankles
CHRONIC KIDNEY DISEASE
• Symptoms (cont.)– Puffiness around the eyes, especially in the
morning– Dry, itchy skin– Frequent urination, especially at night
Complications of CKD
• Result of reduction of GFR, disorder of tubular function, or reduction in endocrine function of the kidney– Hypertension– Malnutrition– Anemia– Low serum albumin and serum calcium
Complications of CKD
– High serum phosphate concentration and high serum parathyroid hormone concentration
– Reduced activities of daily living– Lower quality of life– Increased risk of cardiovascular disease and
stroke
Laboratory Diagnosis and Monitoring of CKD
• Definitive diagnosis of the type of kidney disease is based on biopsy or imaging studies– Biopsy and invasive imaging procedures are
associated with a risk or serious complications and are usually avoided unless a definitive diagnosis would change treatment or prognosis
Laboratory Diagnosis and Monitoring of CKD
• GFR is the best overall index of kidney function– Decreased GFR precedes the onset of kidney
failure and persistently reduced GFR is a specific indicator of CKD.
– Drug dosing in CKD is based on GFR levels
Laboratory Diagnosis and Monitoring of CKD
• GFR cannot be measured directly– Serum creatinine is used to measure GFR in
most cases• Use of an international standard or traceable
standard for creatinine calibration is recommended.
• Creatinine clearance is considered too inaccurate due to difficulties in obtaining a correctly timed specimen.
Laboratory Diagnosis and Monitoring of CKD
• The NKF guidelines recommend that clinical labs report an estimate of GFR using the MDRD prediction equation in addition to the serum creatinine.
• Variables that will affect the estimation of GFR include: age, sex, race, diet, body build, medication, and pregnancy.
• If the variables are significant, use the creatinine clearance.
Laboratory Diagnosis and Monitoring of CKD
• Serum creatinine is recommended at least yearly in patients with CKD.
• The rate of decline in GFR can be used to estimate the interval until onset of kidney failure and facilitate planning for therapy, diet, or kidney replacement.
• An acute decline in GFR may be superimposed on CKD and result in acute deterioration of kidney function.
Laboratory Diagnosis and Monitoring of CKD
• Most common causes of deterioration of kidney function are:– Reduced blood flow to the kidney, usually
related to volume depletion.– Toxic insult– Obstruction from tumors, stones, or blood.– Inflammation and infection
Cystatin C
• 13 kDa cysteine protease inhibitor constantly produced by all nucleated cells
• Advantages over creatinine– Constant rate of production, freely filtered by the
glomerulus
– Unaffected by muscle mass, diet or gender
– No renal tubular secretion
– Good assay precision (~3% CV throughout assay range)
– Assay unaffected by spectral interferences
NKF Guidelines for Adults and Children
• Under most circumstances, untimed (“spot”) urine samples should be used to detect and monitor proteinuria.
• First morning urines preferred but random specimens are acceptable. Timed urine collection (overnight or 24 hr) is not necessary.
NKF Guidelines (cont.)
• In most cases, screening with urine dipsticks is acceptable for detecting proteinuria– Standard urine dipsticks are acceptable for
detecting increased total urine protein.– Albumin-specific dipsticks are acceptable for
detecting albuminuria
NKF Guidelines (cont.)
• Patients with a positive dipstick (1+ or greater): confirm proteinuria by a quantitative measurement (protein-to-creatinine ratio >200 mg/g or albumin-to-creatinine ratio >30 mg/g) within 3 mos.
• Patients with 2 or more positive quantitative tests temporally spaced by 1-2 weeks: diagnosed as persistent proteinuria; further evaluation needed
NKF Guidelines (cont.)
• Monitoring proteinuria in patients with CKD should be performed using quantitative measurements.
• Children Without Diabetes:– orthostatic proteinuria must be excluded by
repeat measurement on a first morning specimen if the initial proteinuria was obtained on a random specimen.
NKF Guidelines (cont.)
• Children Without Diabetes:– Screen spot urine sample for total urine
protein using either: standard urine dipstick or total protein-to-creatinine ratio
– When monitoring proteinuria for CKD, total protein-to-creatinine ratio should be measured in spot urine specimens.
NKF Guidelines (cont.)
• Children With Diabetes:– Screening and monitoring of post-pubertal
children with diabetes of 5+ years duration should follow the adult guidelines.
– Screening and monitoring other children with diabetes should follow the guidelines for children without diabetes.
2005 Additions to NKF Guidelines
• Bone Metabolism & Disease in Children with Chronic Kidney Disease: 10/05– Warns that bone disease begins early in the
course of CKD in children & calcium balance must be in order for growth & cardiovascular development
– Physicians need to place greater emphasis on vitamin D nutrition, levels of parathyroid hormone, & excesses of calcium intake which can lead to development of vascular calcifications.
2005 Additions to NKF Guidelines
• Cardiovascular Disease in Dialysis Patients: 4/05– Warns that CVD is leading cause of death
among dialysis patients but treatment is not as effective as in general population
– Dialysis patients are more prone to side-effects of treatment
– More research is needed to better manage CVD in dialysis patients
2006 Additions to NKF Guidelines
• Treatment of Anemia in Chronic Kidney Disease: 5/06– Patients with all stages of CKD should be
evaluated for anemia– Definition of anemia is <13.5 g/dL for males &
<12.0 g/dL for females– Treat patients with ESA(erythropoiesis
stimulating agent) &/or iron when Hgb is <11g/dL
2007 Additions to NKF Guidelines
• Chronic Kidney Disease and Diabetes: 2/07
– Emphasizes diabetes prevention, screening & management of kidney disease
– New term: diabetic kidney disease (DKD)
2012 Additions to NKF Guidelines
• Diabetes and Chronic Kidney Disease– Target HbA1c of ~7.0% to prevent or delay
progression of microvascular complications of diabetes, including DKD.
– Lipid-lowering treatment with statins suggested for patients with diabetes and CKD, including kidney transplant recipients
2012 Additions to NKF Guidelines (cont.)
• Diabetes and Chronic Kidney Disease– Withholding statin treatment initiation in
dialysis patients is suggested.– Treatment of normotensive patients with
diabetes & elevated levels of albuminuria by ACE inhibitors or angiotensin receptor blockers (ARB).
– Statin combination therapy reduces risk of CVD events.
International Classification of Diseases, 9th Revision Clinical
Modification (ICD-9-CM)
• Diagnosis codes for CKD to be based on NKF’s KDOQI Guidelines– Codes allow medical professionals to clearly
note the stage of kidney disease– Ability to identify CKD patients who are
kidney transplant recipients– Ability to link specific treatments to
appropriate CKD stage
Legislative Mandate for Labs to Report eGFR
• States with laws requiring reporting of eGFR– New Jersey, Tennessee, Michigan, Louisiana,
Connecticut, and Pennsylvania• PA General Assembly House Bill 2639
– Passed into PA state law in November, 2006– eGFR must be calculated for serum
creatinine for patients > 18 years– All labs had to comply within 2 years of
passage
Facts of Kidney Disease
• More than 26 million Americans have CKD. More than 20 million more are at increased risk for developing kidney disease and most do not know it.
• At the end of 2010, there were 651,000 Americans receiving treatment for kidney failure (end stage renal disease or ESRD).
Facts of Kidney Disease
• Each year, more than 70,000 Americans die from causes related to kidney failure.
• Every month, the number of Americans waiting for kidney transplants increases. Approximately 96,292 patients are awaiting kidney transplants and >2,500 are waiting for kidney-pancreas transplants.
Facts of Kidney Disease
• Shortage of organ donations is major contributing factor to the growing number of people on the waiting list. A new name is added every 12 minutes and eighteen people die daily while waiting.
• CKD has a disproportionate impact on minority populations, especially African Americans, Hispanics, Asians, and American Indians.
Facts of Kidney Disease
• Diabetes is the leading cause of kidney failure: 51% of new cases and 45% of all cases of kidney failure in U.S.
• Uncontrolled or poorly controlled high blood pressure is the second leading cause of kidney failure in U.S: 28% of new cases and 25% of kidney failure in U.S.
Facts of Kidney Disease
• Third & fourth leading causes of kidney failure in U.S. are glomerulonephritis and polycystic kidney disease: 8.2% and 2.2% of new cases in U.S.
• Kidney and urologic diseases continue to be major causes of work loss, physician visits, and hospitalizations among men and women.
Laboratory’s Involvement With NKF Guidelines
• Good creatinine calibration
• Add GFR prediction equation to report
• Understand limits of urine test strip protein
• Add urine test with good low end sensitivity to urine albumin (microalbumin)
• Improve urine sediment testing
Preventing Kidney Disease
• Blood glucose & blood pressure checks • Regular physician check-ups• Taking medications as prescribed by physician• Regular exercise; lose weight if overweight;
low-fat diet• Avoid tobacco use; moderate alcohol
consumption• Cholesterol levels in target range
Siemens Clinitek Microalbumin 2 Reagent Strips• Provide albumin, creatinine, and albumin to
creatinine ratio results in 1 minute• Can be used by POC or physicians’ offices• Use with Clinitek 50 or Clinitek Status
analyzers– Sensitivity as low as 2mg/dL for urine
protein– More reliable; less affected by interferences
(e.g. specific gravity and pH)
Siemens Clinitek Microalbumin 9 Reagent Strips• Provide albumin, blood, creatinine, glucose,
ketone, leukocyte, nitrite, pH, & protein and albumin to creatinine ratio & protein to creatinine ratio
• Use with Clinitek Status or Advantis analyzers– Random sample; no timed or 24 hr urine
sample required– Accurate identification of microalbuminuria
Urinalysis Testing
• Pre-analytic variables– Specimen collection: need written or clear-
cut oral instructions on specimen collection– Type of specimen collection (random, clean
catch, cath)– Delay in specimen delivery– Specimen storage conditions
Manual Urine Sediment Analysis
• Analytic variables– Mixing of samples by inversion, not swirling– Standardized volume for centrifugation;
note volume if less than 12mL– Time and G force for centrifugation; do not
use brake– Inconsistent decantation and re-suspension
steps after centrifugation
Manual Urine Sediment Analysis
• Analytical variables (cont.)– Reduced recovery rate of urine elements
after centrifugation– Variability in concentration ratio
• Supernatant removal
• Mixing of suspension
• Filling of chamber; technique-dependent
• Distributional errors
Manual Urine Sediment Analysis
• Commercial slide systems– Provide some standardization– Technique-dependent– Vary in concentration ratios: 1:5 to 1:48– Addition of drop of stain also varies
concentration ratio– Low & high power fields of view are
microscope dependent; reporting unit inequity
Manual Urine Sediment Microscopy
• Subjective element identification
• Poor reproducibility
• Lack of standardization
• Time consuming/labor intensive
Sysmex UF-1000i
Sysmex UF-1000i
• Laser-based flow cytometer utilizing 2 stains with fluorescent dyes to stain cellular elements
• Separate bacteria channel for improved discrimination
• Forward scatter, hydrodynamic focusing, forward fluorescent light, conductivity measurements, and adaptive cluster analysis
Sysmex UF-1000i System Components
• Main unit with integrated pneumatic unit• IPU (information processing unit)
Windows XP operating system• Sampler unit with tube rotator unit• Bar code reader• Laser Jet graphic printer/line printer
(1 device, 2 settings)• Handheld bar code reader
UF-1000i Tube Rotator
UF-1000i Reagents
UFII SEARCH™-SED
UFII PACK™-SEDUFII SHEATH™
UFII SEARCH™ -BAC
UFII PACK™-BAC
UF II PACK-SED / UF II SEARCH-SED
• UF II PACK-SED– Removal of amorphous salts together with heating (up to 35°C)
• UF II SEARCH-SED– Polymethine dye– Chromogen chain with electron donor and acceptor group
– Stains parts of nucleus, parts of cytoplasm and membranes– Excitation wavelength is 635 nm
– Emission wavelength is over 660 nm
UF II PACK-BAC / UF II SEARCH-BAC
• UF II PACK-BAC
– UF II PACK-BAC (e.g. its pH value) together with heating to >40°C suppresses non-specific staining of particles other than bacteria
• UF II SEARCH-BAC
– Polymethine dye
– Distinctively stains nucleic acid elements in bacteria
UF-1000i Sample Volumes
• Minimum sample volume:
– Manual mode: 1 mL
– Sampler mode: 4 mL
• Aspiration volume:
– Manual mode: 800 µL
– Sampler mode: 1,200 µL
• Processed sample volume (SRV) in sampler and manual mode:
– 150 µL for the sediment analysis
– 62.5 µL for the bacteria analysis
UF-1000iManual Sample Page
Sample Volumes and Dilution
• Addition of reagent leads to a dilution of the urine – for the SED analysis exactly by the factor 4:
• 150 µL sample plus 435 µL diluent plus 15 µL dye equals 600 µL
– for the BAC analysis exactly by the factor 8:• 62.5 µL sample plus 425 µL diluent plus
12.5 µL stain equals 500 µL
Sample Incubation
• Incubation time at certain temperature ranges needed for staining – for the SED analysis:
• 10 seconds at 35°C
– for the BAC analysis: • 20 seconds at 42°C
Flow cell
Laser light
Laminar Flow
particlesSheath reagent
Sheath nozzle
Scattered light
UF-1000i Scattergram Information
• Forward Scatter (FSC)
• Fluorescence High (FLH)
• Fluorescence Low (FLL)
• Fluorescence Low Width 2 (FLLW2)
• Fluorescence Low Width (FLLW)
• Side Scatter (SSC)
• Forward Scatter Width (FSCW)
UF-1000i Detection Parameters
MucusBacteria
Sperm
YeastHyaline Casts
Small Round CellsEpithelial Cells
CrystalsWBC
Pathological CastsRBC
Flagged ParametersEnumerated Parameters
RBC
Small - medium size
Low fluorescenceFl
Fsc
Fl
FscMedium - large size
Medium - high fluorescence
Fl
FscVery small size
Siz
e (s
ecti
on
al a
rea)
Large
Small
Fluorescence HighLow
Bacteria
WBC
Low fluorescence
S_FLH
S_FscS1: FLH / Fsc - Scattergram
YLC
X’TAL
Sperm
Low to medium fluorescenceFl
FscSmall size
Medium fluorescenceFl
Fsc
Small size
Fl
FscSmall - large size
no fluorescence
YLC
RBC
Small - medium size
Low fluorescenceFl
Fsc
Fl
Fsc
Fl
Fsc
Siz
e (s
ecti
on
al a
rea)
Large
Small
Fluorescence HighLow
Bacteria
WBC
Low fluorescence
S_FLL
S_Fsc
S2: FLL / Fsc - Scattergram
Low to medium fluorescenceFl
Fsc Small size
Medium fluorescenceFl
FscSmall size
Fl
FscMedium – very large size
Medium - high fluorescence EC
SpermVery small size
Medium - high fluorescence
Medium - large size
S3: FLLW2 / FLLW - Scattergram
FLLW2
S_FLLW2
Large
Small
Length of stained particleShort S_FLLW
FLLW
FLLW2
Little to more stainable inclusions
FLLW
FLLW
Long
Length of stained inclusions
Casts (no inclusions)Len
gth
of
s ta i
ne d
in
clu
s io
ns
Short – medium lengthof inclusions No to little inclusions
More stainable inclusions
Path. casts
Epithelia
l cells
Mucus
FLLW2
FLLW
No inclusions
SRC
WBC
FLLW2
Long
B1: Fsc / FLH - ScattergramB_FSC
Large
Small
Stainability of particlesLow B_FLH
Siz
e o
f p
arti
c le s
BACTDebris
Weak fluorescenceFlH
FscSmall size
FSC
FLH
Small to big size
No fluorescence
High
UF-1000i Sediment
1
UF-1000iSediment 2
UF-1000iSediment
3
UF-1000iSediment
4
UF-1000iSediment
5
UF-1000iBacteria 1
UF-1000iBacteria
2
UF-1000iBacteria
3
UF-1000i Technology
BacteriaSediments
BacteriaSediments Stain
IncubationIncubation
DetectionDetection unitunit
Sediments BacteriaDiluents
Two chambers for stain and dilution
Improved determination of bacteria
Red semiconductor laser•Down sizing•Long life•Reduced power consumption
UF-1000i Technology
Fluorescence
Stain DNA/RNA
Non-specific staining with debris
Forw
ard
Sca
tter
Specific stain for Nucleic Acid Specific stain for Nucleic Acid
DyeDye
Dye
Dye
DyeDye
Dye
DyeDyeDyeDye
Dye
Dye
Dye
DyeDye
Dye
Dye
Dye
DyeDyeDye
DyeDye
DyeDyeDyeDye
1) Enhanced detection of bacteria
2) Staining bacteria nuclei
Polymethine dye
UF-1000i Technology Method ComparisonUF-1000i Parameters
0.0 – 9383.4y = 0.1465 x – 51.8650.23340.4831BACTERIA
0.00 – 28.04y = 0.6125 x + 0.06290.91360.9558CAST
0.0 – 176.5y = 0.864 x – 0.11340.95580.9777EC
0.0 – 2557.5y = 0.8622 x – 1.68180.93480.9669WBC
0.0 – 4628.1y = 0.9544 x – 3.00090.98420.9921RBC
RangeRegression EquationRegression
r2
Correlation
r
Parameter
The sediment parameters, RBC, WBC, EC and CAST, demonstrate excellent correlation with the UF-100 system.
Source: Clinical Data for FDA submission
UF-1000i Technology Method Comparison
The bacteria reference intervals for the UF-1000i were significantly lower than the UF-100.
UF-100 vs UF-1000iBACT (Range 1-10,000/μL)
r = 0.4831
y = 0.1465x - 51.865
R2 = 0.2334
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000
UF-100
UF-1
000I
84.30%Negative Predictive Value
91.66%Positive Predictive Value
83.22%Percent Agreement
A comparison of the data was performed to determine the percent agreement (bacteria count) of the samples based upon the different reference intervals listed below.
UF-1000: ~1200/µL
UF-100: ~ 2800/µL
Source: Clinical Data for FDA submission
UF-1000i Technology
0.0%0CARRYOVER
0.9%1Conductivity error
0.0%0
RBC/YLC discrimination error
1.7%2
RBC/BACT 、 DEBRIS discrimination error
0.0%0
RBC/X’TAL discrimination error
REVIEW rate :2.6%
UF-1000iN=120
0.9%1P.CAST*
4.3%5SRC*
0.9%1Conductivity error
0.0%0Discrimination error
1.7%2Total count error
* Review setting is default
REVIEW rate : 6.0%UF-100
Source:SCJ R&D Study
UF-1000i Technology
UF-100 :RBC 119.8/µLX’TAL 0.0 /µL
UF-1000i: RBC 3.3/µL X’TAL 102.7/µL
Microscopy :RBC 5.6/µLX’TAL (2+)
false-positive by X’TAL interference
Reduction of false-positive by X’TAL interference to RBCScattergram
UF-100UF-1000i
The more complex the surface or inner construction, the more intensive SSC signal is.
S-FSC
UF-1000i Technology
UF-100 :EC 83.4/µL
UF-1000i: EC 18.2/µL
Microscopy:EC 24.5/µL
WBC cluster can be detected as EC. It is false positive of EC.
Reduced false positive EC with high positive WBC
Scattergram
UF-100UF-1000i
SSC parameters can help UF to distinguish WBC and EC.
WBC is accurately classified by SSC signals.
UF-1000i Data Storage
• HDD with minimum 20 GB for data storage including graphics
• Sample Explorer/Data Browser: 10,000 samples measurement data including histograms & scattergrams
• Work List: 3,000 orders• Patient information: 5,000 patients data• 100 reagent logs & error logs• Doctor & ward master
UF-1000i Sample with No Flagging
UF-1000i Sample with Flagging
UF-1000i “Cumulative” screen
UF-1000i “Service 1” screen
UF-1000i “Service 2” screen
UF-1000i Anti-Carryover Action
• Trigger: bacteria count only• Sequential mode:
– If the bacteria count exceeds the cut-offs preset in the anti-carry-over settings, additional autorinse cycles are performed before the next sample is aspirated.
• Overlapping mode:– If the bacteria count exceeds the cut-offs preset in the
anti-carry-over settings, additional autorinse cycles are performed. The next sample will be aspirated twice.
UF-1000i Anti-Carryover
UF-1000i Quality Control
• UF II Control: two level commercial controls containing particles representing RBC, WBC, EC, casts, and bacteria
• Controls also monitor conductivity plus the high level monitors sensitivity parameters-FSC, FSCW, FLH, FLL, FLLW, SSC.
• Levy Jennings & Radar Charts
UF-1000i 24 Control Files
UF-1000i QC Charts
L-J Charts
Radar Charts
300 data points
UF-1000i Flagging (Review Settings)
• X’TAL: 25.0/uL
• YLC: 25.0/uL
• SRC: 10.0/uL
• Path.CAST: 1.5/uL
• MUCUS: 10.0/uL
• SPERM: 10.0/uL
UF-1000i Q-Flags
UF-1000i Factory Defined Review Flags
• RBC/X’TAL Abn. Cls.: RBC*
• RBC/BACT Abn. Cls.: RBC*, BACT*
• RBC/YLC Abn. Cls.: RBC*
• Debris High?: BACT*
• Abn. DC Sensitivity: ≤3.0 or ≥39.0 mS/cm
• Carryover?: BACT*
UF-1000i Linearity
• RBC: 1.0-5000.0/uL
• WBC: 1.0-5000.0/uL
• EC: 1.0-200.0/uL
• Casts: 1.0-30.0/uL
• Bacteria: -5.0-10,000.0/uL
UF-1000i Reference Intervals
• RBC: ≤23.0/uL
• WBC: ≤28.0/uL
• EC: ≤31.0/uL
• Casts: ≤1.00/uL
• Bacteria: ≤358.0/uL
UF-1000i Maintenance
• Daily– Perform shutdown– Check for fluid in trap chamber of Pneumatic Unit & empty if
needed
• Monthly or every 9000 cycles– Clean the sample rotor valve (SRV)
• As Needed– Clean or replace sample filter if clogged or aspiration is
affected– Empty waste container if not connected to floor drain
UF-1000i
• Walk-away system
• Uses uncentrifuged urine sample
• No interference with amorphous urates
• Results in 1 minute; cells reported/uL or /HPF or /LPF
• Review only by exception; no image review
Benefits of Automated Urine Microscopy
• Objective, analytical measurements
• Reduction of subjective identification of elements
• Reduction of tech to tech variability
• Improved accuracy and reproducibility
• Improved workflow, productivity, efficiency, turnaround time
• Decreased labor expense
YH Urinalysis AutomationObjectives
• Annual UA volume: 58,000; 78% microscopics
• Automated dipstick analysis with Clinitek Atlas system (sample tray) in 8/95.
• Updated to Clinitek Atlas Rack system in 4/03.
• Decision to automate urine sediment analysis with the Sysmex UF-100. “Live date” June 4, 2001. UF-1000i installed 12/07.
YH Benefits Using Automated Sediment Analysis
• Reduced manual microscopic review rate to ~11%• Reduced turnaround time to <30 minutes from
>60 minutes• Reduction of 1 FTE through attrition• Improved workflow: can operate Urinalysis
Department with ~1.5 FTE instead of 3.0 FTE• Reduction in number of urine cultures• Culture criteria: WBC >28/uL, bacteria >358/uL,
& positive urine nitrite
YH Benefits Using Automated Sediment Analysis
(cont.)
• ~15% volume increase since 2001 with no additional staffing required; current fiscal year-no volume increase
• Minimal maintenance
• >99% uptime
• Smooth transition; very few physician concerns or questions
Thank You!
Questions?
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