*4.2.2.1 Offer*

equipment can operate for about 7 years, if the manufacturer's operating recom-

However, we will not discuss this technique in this study because, since its performance is comparable to that of the HPLC method, capillary electrophoresis quickly became the method of choice, just like HPLC, for the study of hemoglobinopathy. In addition, it is of economic interest: although the material cost is comparable to that of the HPLC, the expenditures on reagents are much lower. Indeed, the price of a capillary is much lower than that of a chromatography column, and the

Manual systems for native electrophoresis (on cellulose acetate and agarose gel) or isoelectrofocusing offer the best acquisition possibility both in terms of cost and operational constraints. Their limits both in the separation and in the identification of hemoglobin variants will be used for the routine forms to be specified by the customer (identification of the electrophoretic profile, identification of specific

The coupling of these methods to the reading system (densitometers) makes it possible to quantify the separate variants. And from this point of view, agarose gel electrophoresis offers better performance than cellulose acetate. On the other hand, the reagents are in the form of combs which often require a minimum of seven samples. Such a constraint requires, for economic reasons, to launch the samples in series of seven, which requires a consequent sizing and proper holding wire.

For native electrophoresis the system is usually composed of a current generator

The devices typically contain conventional electronic parts and boards, used in the manufacture of power generators. These components are often not complex, and do not require advanced technical repair. In addition, it has been found that when equipment actually meets ISO, FDA, or CE marking standards, it works well

These systems can be used in very small laboratories, without large volume flow of samples, for the screening of hemoglobinopathies, by planning a periodic operation. Indeed, the pre-analytical phase requires a lot of sample preparation time and immobilizes the staff for quite a long time. They can also be used in medium

The isoelectrofocusing system will be more targeted for newborn screening because it allows for a good separation of the Hb F, Hb A, and Hb S fractions, which

assumes that the system is usually installed near a maternity ward.

and a migration tank. For isoelectrofocusing, the system consists of a stabilized

supply, an isoelectrofocusing, unit, and a circulating cryostat.

method for screening for hemoglobin abnormalities [33].

*Human Blood Group Systems and Haemoglobinopathies*

volumes of buffer used are much lower, about 1000 times less [34].

On the other hand, high-performance liquid chromatography has been developed to allow both the detection and confirmation of hemoglobinopathy in newborns with high sensitivity and specificity. In fact, its good sensitivity to the major variants involved in pathology and its speed of completion (about 3 min per sample), allowing the analysis of a large number of samples, have made HPLC a particularly suitable

mendations are followed.

*4.2.1 Manual systems*

*4.2.1.1 Offer*

variants).

*4.2.1.2 Facilities*

and lasts for a long time.

laboratories as a backup system.

*4.2.1.3 Use*

**188**

Semiautomatic systems for native electrophoresis on cellulose acetate or agarose gel offer the possibility of processing large series of samples. Although the cost of the system is still high for a large number of health facilities, the manual routine is clearly improved. Semiautomatic systems (on cellulose acetate or agarose gel) are embedded on compact systems generally comprising a migration and coloring modules, which considerably reduce user handling.

The reading system, often equipped with advanced post-processing software, can be incorporated or remote. Nevertheless, the results obtained show the same limits as in the case of manual methods because the operating principles of the migration and coloring units taken separately are the same as those of the manual system.

#### *4.2.2.2 Facilities*

The semiautomatic system is generally composed of a compact unit comprising a thermoregulated migration module connected to a current generator and a fluidic module for coloring migrated gels. Technologically, an intelligent electronic unit manages the high voltage of the migration module, the fluidics of the coloring module, and the application programs for the two modules.

Generally, devices typically contain conventional electronic parts and boards. The process control is often ensured by position and temperature sensors. As their complexity is not great, maintenance can be easily carried out by a duly trained biomedical technician.

#### *4.2.2.3 Use*

These systems can equip medium-sized laboratories by planning either periodic operation or continuous operation, depending on the flow of samples. They are fairly widespread in the private laboratories which can obtain them and some public hospital laboratories often on behalf of specific programs. User maintenance monitoring must be ensured to guarantee proper functioning, and periodic annual maintenance must be carried out, insured in accordance with the manufacturer's recommendations.

#### *4.2.3 Automatic techniques*

#### *4.2.3.1 Offer*

Automatic techniques (only capillary zone electrophoresis) are the best offer, both in terms of flexibility of use and technical performance. Prices are still very high for many customers in Africa. Nevertheless, a good expression of needs and an adequate exploitation planning can allow a return on investment in an acceptable time.

#### *4.2.3.2 Facilities*

These techniques are carried out on compact systems, generally comprising capillaries at the ends plunging into reservoirs of buffer solution, themselves connected to the current generator. The apparatus also includes a detection system, most often a UV–visible spectrophotometer, linked to the wavelength of specific absorption of hemoglobin at 415 nm.


**Migration**

**191**

**Advantages**

**Disadvantages**

**Systems**

Semiautomatic


 module

 - Medium

 - Steady

150,000

voltage



room

*DOI: http://dx.doi.org/10.5772/intechopen.92546*



 cryostat


 - Steady

voltage



room

*Contribution of Biomedical Equipment Management to Better Management of Sickle Cell Disease…*


> Liquid vein


(capillaries)



> **Table 1.**

*Summary table of different devices.*

 fractions

quantification

 of



environment

Automatic

 - Compact migration and


 - Steady

30,000

voltage



room



quality

detection module

 **Materials**

**Maintenance**

**Constraints**

 **Average**

**cost (€)**

**level**

**support**


*Contribution of Biomedical Equipment Management to Better Management of Sickle Cell Disease… DOI: http://dx.doi.org/10.5772/intechopen.92546*

> **Table 1.** *Summary table of different*

 *devices.*

**Migration**

**190**

**Advantages**

**Disadvantages**

**Systems**

 **Materials**

**Maintenance**

**Constraints**

 **Average**

**cost (€)**

**level**


 Good grounding

**support**

Paper

 - Native


peptides

Cellulose


electrophoresis







> Agarose gel -Native






and Hb O


and Hb G

homogeneous

electrophoresis


Manual

 - Current generator



Semiautomatic

 - Compact staining and

migration module and

densitometer

 (integrated

 or no)

Densitometer





15,000

stable



room



 Free

 Free

 7000

HB E and Hb O

electrophoresis

electroendosmosis

 flow



hemoglobin

A2) and for the detection of variants with

fast migration (Hb H and Hb Bart's)


Implementation

 with low

quantification

concentration

 (Hb

 of

implementation

hemoglobins

 S, D, and G migrate at

hemoglobins

 A2, C, E, and O migrate

reproducibility

electroendosmosis

 currents

Manual

 - Current generator



Semiautomatic

 - Compact staining and

migration module and

densitometer

 (integrated

 or no)

Densitometer





15,000

voltage



room



 Good grounding


 Free

 Free

 7000

acetate



proteins, hemoglobin,

 and isoenzymes

lipoproteins,

homogeneous

 than paper

electrophoresis






homogeneity

electroendosmosis

 current

Manual

 - Current generator



Densitometer




 Good grounding

*Human Blood Group Systems and Haemoglobinopathies*

 Free

 Free

 7000

More sophisticated technology includes a capillary thermoregulation system, a control system comprising various sensors that manage optics, robotics, pneumatics, and detection, and a set of intelligent electronic cards capable of communicating with each other. Unlike previous methods, this method allows both to launch samples in an emergency without restriction and to process large series of samples.

In view of the complexity of its technology, management requires competent personnel who are regularly trained by the manufacturer. Water quality and user maintenance of equipment are of paramount importance to ensure the quality of results. This assumes that the supplier provides user training for the best care.

#### *4.2.3.3 Use*

Thanks to their flexibility in the work organization, these automated systems can equip laboratories with small volumes of samples, as well as those which process large volumes. Indeed, there are small and large models of automata to cover all these needs. Because of their high prices, these automata are acquired in public hospitals on the basis of research projects and specific programs. Private clinics acquire them for routine because of their performance. However they do have a few requirements that must be observed: the operating environment must be less dusty, the quality of electricity flawless, the quality of pure water, and regular maintenance.

We present in **Table 1** a summary of different devices that we have reviewed.
