Kridsada Sirisabhabhorn1 Anurak Choeymang2 Supaporn Pumpa1 Krim Kamyod1 and Palakorn Puttaruk1 1Department of Medical Technology Laboratory, Thammasat University hospital, Pathumthani, Thailand 2Pharmacology and Toxicology Unit, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand

1. Improvement of bacterial estimation in urinalysis by iQ®200 ELITE®:
capture image principle urine microscopic system
Kridsada Sirisabhabhorn1 Anurak Choeymang2 Supaporn Pumpa1 Krim Kamyod1 and Palakorn Puttaruk1
1Department of Medical Technology Laboratory, Thammasat University hospital, Pathumthani, Thailand
2Pharmacology and Toxicology Unit, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
The iQ®200 urine microscopic automate analyzer system, principle in capture urine particles images has been introduced for reduction job work load unit. However,
low specificity of bacteria images is problem for estimated bacteria by semi-quantitative estimation. Also, the ASP (All Small Particles) parameter and bacterial images
background were used for estimated bacterial grading but interferences of some urine sediment and less experience effect to inaccurately and difficultly bacterial
estimation. The objective of this study was to estimate bacteria classification by semi quantitative grading in urinalysis which using ASP parameter of iQ®200 compared
with urine sediment centrifugation and microscopic examination. All 372 cases were estimated bacterial grading from principle of capture image and sediment centrifuge
examination immediately. Descriptive statistic was analyzed bacterial classified groups to semi quantitative as few moderate and numerous using median of ASP values.
The results demonstrated that frequency bacterial estimation of iQ®200 presented as few, moderate and numerous were 96.5, 2.7 and 0.8 % respectively and
microscopic examination were 40.59, 37.6 and 21.8% respectively, obviously uncorrelated classification. The classification of semi quantitative bacterial study consider
combine with ASP values of iQ®200 were illustrated ASP’s median values to few, moderate and numerous as 1,911, 3,851 and 12,845 particles/µL respectively.
Conclusion, preliminary classification of bacterial estimation with ASP particles of iQ®200 to rare, few, moderate and numerous as interval as <1,000, 1,000-3,000,
3,000-8,000 and >8,000 particles/µL respectively. Benefit from the study is helpful for rapid diagnosis of bacterial estimation by iQ®200 system urine microscopic
automate analyzer system in routine urinalysis.
Abstract
Key words: automate analyzer, bacteria, microscopic, urinalysis
Introduction
Materials and Methods
Results
Conclusion and discussion
Bacteria
Frequency
cases
Percent
(%)
few 151 40.60
moderate 140 37.63
numerous
81 21.77
Total 372 100.0
Urine 10 ml
Removed supernatant
Bacteria
Frequency
cases
Percent
(%)
few 359 96.51
moderate 10 2.69
numerous 3 0.81
Total 372 100.0
At the present urine sediment system analyzer can help to short work flow in
urinalysis. The iQ®200 urine microscopic automate analyzer system, principle
capture images of urine elements which introduce instead of conventional
urinalysis, centrifugation and observation sediments under light microscope
process. However, iQ®200 was presented low specific bacteria feature which
sometime made difficultly estimated bacteria volume. Many interference
sediments like shape bacteria such as mucous, amorphous, sperm, budding yeast
and pseudohyphae provided false positive/negative volume of bacteria. Thus
bacterial estimation was applied combine with background of elements image
and ASP (All Small Particles) values follow as recommend by product specialist.
However lack of experience skill for bacteria identification induce to confuse in
decision. Aim of this study was to design groups of semi-quantitative bacteria
which related with ASP values from iQ®200ELITE® system and compare with
bacteria estimation available from conventional method. The study benefit to
created easily guideline model for bacterial grading that result from
iQ®200ELITE® in particular laboratory.
iQ®200 urine microscopic automate analyzer systemConventional method
Table 1 illustrated frequency of
quantitative bacteria derived from iQ®200
Table 2 illustrated frequency of quantitative
bacteria available from light microscope
ASP (All Small Particles) values were classified by
descriptive statistic
Semi-quantitative
bacteria
Median
(particles/µl)
Std. Error of
Mean(particles/µl)
few 1,191.00 230.48
moderate 3,851.50 702.61
numerous 12,845.00 4,461.66
Table 3. Illustrated Median (particles/µl) and Std.
Error of Mean (particles/µl) of ASP values derived
from iQ®200 system in bacteria grading.
ASP values guideline for bacterial grading
Semi-quantitative bacteria Median (particles/µl)
rare <1,000
few 1,000-3,000
moderate 3,000-8,000
numerous >8,000
In table 1 and 2 were demonstrated non-relation of frequency cases in bacterial decision from
iQ®200 system and bacteria particles under microscope. Further study in ASP values each groups of
semi-quantitative bacteria estimations as few, moderate and numerous were illustrated ASP’s median and
standard error of mean according table 3. Conclusion, in brief result of semi-quantitative bacteria
estimation were designed ASP’s values of rare, few, moderate and numerous within range of <1,000,
1,000-3,000, 3,000-8,000 and >8,000 particles/µl respectively. The benefit in this study can apply
combination with ASP’s values in semi quantitative bacterial estimation which responsible easy decision
and reduced turn around time per case. Furthermore this study can be used as guide line for bacteria
semi-quantitative grading which perform by iQ®200 analyzer system in urinalysis. Nevertheless, if be
uncertain in difficult bacterial estimation must be confirm with microscope investigation. Finally, updating
of guideline and false positive result need to investigated in further study. Unforgettable, quality control
assurance are necessary with recommend by medical technologist always. This study declared no conflict
of interest.
References
Table 4. Design interval range guideline of semi-
quantitative bacteria grading by Median (particles/µl)
derived from iQ®200 microscopic system
Linko S, Kouri TT, Toivonen E, Ranta PH, Chapoulaud E, Lalla M. Analytical
performance of the Iris iQ 200 automated urine microscopy analyzer. Clinica
Chimica Acta, 2006, 372 : 54-64.
Sarvary E, Lee D, Varadi J, Varga M, Gaal I, Chmel R et al, The iQ200
Microscopic Analyzer is valuable tool for evaluation of urinary sediment at
transplanted patients. Intervention Medicine & Applied Science, 2010, 2: 22-6.
Discrepancy of bacteria detection result with iQ®200
0
10
20
30
40
50
60
70
80
90
100
few moderate numerous
96.51
2.69 0.81
40.6 37.63
21.77
Microscope iQ200®analyzer
Centrifuge at 1,500 rpm 5 min
Loading to iQ200 Choosing image
Observation image
All 372 urine specimens were used in study. Firstly, prepare 10 ml of urine
loaded to iQ200® then perform manual method with together. Two methods’
result were analyzed by discriptive statistic.
Graph 1. Comparison of cases were investigated
bacteria with 2 methods, conventional method and iQ200®.
(%)frequencycases
Observed urine sediment under light microscope
Materials and Methods