Abstract
Automation is conventionally defined as the use of machines, control systems, and
information technologies to optimize productivity. Although automation is now commonplace
in several areas of diagnostic testing, especially in clinical chemistry and immunochemistry,
the concept of extending this process to hemostasis testing has only recently been
advanced. The leading drawbacks are still represented by the almost unique biological
matrix because citrated plasma can only be used for clotting assays and few other
notable exceptions, and by the highly specific pretreatment of samples, which is particularly
distinct to other test systems. Despite these important limitations, a certain degree
of automation is also now embracing hemostasis testing. The more relevant developments
include the growing integration of routine hemostasis analyzers with track line systems
and workcells, the development of specific instrumentation tools to enhance reliability
of testing (i.e., signal detection with different technologies to increase test panels,
plasma indices for preanalytical check of interfering substances, failure patterns
sensors for identifying insufficient volume, clots or bubbles, cap-piercing for enhancing
operator safety, automatic reflex testing, automatic redilution of samples, and laser
barcode readers), preanalytical features (e.g., positive identification, automatic
systems for tube(s) labeling, transillumination devices), and postphlebotomy tools
(pneumatic tube systems for reducing turnaround time, sample transport boxes for ensuring
stability of specimens, monitoring systems for identifying unsuitable conditions of
transport). Regardless of these important innovations, coagulation/hemostasis testing
still requires specific technical and clinical expertise, not only in terms of measurement
procedures but also for interpreting and then appropriately utilizing the derived
information. Thus, additional and special caution has to be used when designing projects
of automation that include coagulation/hemostasis testing because peculiar and particular
requirements must be taken into account.
Keywords coagulation - hemostasis testing - errors - automation - quality
