Abstract:
A system for collection and delivery of sub-milliliter liquid samples is described that provides a dramatic simplification for the measurement of clinical values. The system produces high dilutions of capillary size samples, such as bodily fluids or blood, by a factor of 1000 or more. Multiple assays can be conducted on a sample of 0.1 cc or less. A small lancet can create a drop of blood on a fingertip or other location, which can be collected into a self-priming capillary blood collector. The sample is then loaded into a consumable loader. Then a fluid, such as saline, is flowed into the consumable loader, and passes through the capillary collector, washing out the fluid. Downstream, the blood in the capillary is reliably diluted by mixing with appropriate reagents to allow analysis of selected blood properties. One or more individual bubbles can be inserted into the stream during loading. The capillary loading system can be used for one or several assays on a single blood sample. It can be very compact and lightweight and is suitable for use in remote environments, such as outer space, in which it is difficult to access diagnostic assays.

Description:
[0001]    This application claims the benefit of the priority of U.S. provisional application 61/630,591, which is incorporated herein by reference in its entirety. 
     
    
     BACKGROUND 
       [0002]    Collecting blood samples and delivering aliquots of blood to one or several analytical instruments is a common procedure in medicine. Typically, a patient will have a needle placed in a vein, and multiple tubes containing specific reagents will be filled from that needle. Such a system is commonly encountered in doing a physical examination, or otherwise establishing the state of the patient. As an occasional practice, the drawing of ten to  100  milliliters of blood is normally not of concern. However, if done frequently, such volumes have a potential for lowering red cell density in the bloodstream. 
         [0003]    A number of tests for specific conditions, which may need to be repeated frequently, begin by pricking a fingertip with a lancet. Blood flows from the site, and is collected in a capillary, or by collecting a droplet into a test tube or the like. Blood from the collected droplet is then placed in an assay system. This method is unlikely to alter patient blood parameters, but it is poorly suited for multiple tests. It can also be more painful than collecting blood from a vein. 
         [0004]    In addition, in most medical situations, blood must itself be treated as a potentially infectious agent. Hence, minimization of potential exposure of personnel to blood is an additional goal. However, because staff time is expensive, the procedures must remain simple and fast even as exposure risk is reduced. 
         [0005]    In light of these sometimes competing priorities, there is an ongoing need for simplification of sample handling when drawing blood. Similar considerations apply to clinical sampling of other bodily fluids. 
       SUMMARY OF THE INVENTION 
       [0006]    An improved system is described for the introduction of clinical samples from a patient into an analytical system, and for the detection and analysis of properties of such samples. In the improved system, a capillary device and a consumable loader are used to transport a clinical sample from a source, such as a drop of blood, into an analytical device or system. In the capillary device, a capillary, which may be straight or curved, and which may contain sharp bends or branches, is loaded with a clinical sample to be analyzed. The capillary device is then connected to a device for loading consumables (a “consumable loader”), which in turn is connected to a fluid source upstream of the sample-containing capillary, and to a fluid pathway leading to an analysis system downstream of the consumable loader. 
         [0007]    Flow of the upstream fluid source and the sample is initially separate except for diffusion at the interface. Bubbles may be placed at one or both ends of the sample in the capillary, for signaling the start or cessation of sample flow to the detection and analysis system, and for controlling the rate of sample mixing during flow through the system. The location of bubbles in the capillary sample has four options: bubble upstream, bubble downstream, bubbles on both sides, and no bubbles. (The upstream side is the direction of flow of liquid from a source leading into the capillary). In addition to being boundary markers, changing the location of the bubbles can give different sample dilution profiles during the analysis procedures, which in turn may be different for different sample types (CSF, blood, saliva, urine, etc.) or cell types (red blood cells, white blood cells, platelets, etc.). 
         [0008]    After the sample is loaded, dilution of samples to suitable levels is accomplished by arranging for mixing of the sample with co-flowing diluent fluid as they flow together down a length of tubing, or other passage. In a preferred method, the sample and diluent are introduced into a tube in which they will initially flow side-by-side. The sample is then diluted further using two or more mixing zones selected from a variety of methods. In-line mixing of the sample with streams of one or more diluents or detection reagents is also possible. The diluted sample next passes through an analysis region including one or more detection modules, and the value of one or more parameters is measured. 
         [0009]    Use of differing dilution fluids is available for handling a set of assays. The fluids may be used with a separate cassette, or may be loaded with additional blood from the sample or with blood from the same capillary. Such fluid may be separated by additional bubbles, or other markers. 
         [0010]    Each assay is designed to be easily performed by a single person with minimal training. Because of its small size and simple fluidic pathway, the analytical system can be placed in a portable hand-held device, similar in size and weight to a portable telephone. Reporting from the device can be local or remote. 
     
    
     
       DESCRIPTION OF THE FIGURES 
         [0011]      FIG. 1  shows a block diagram of the blood analysis system of the invention. 
           [0012]      FIG. 2  shows the steps of an insertion of a capillary device carrying a sample into a consumable loader. 
           [0013]      FIG. 3  shows a cartoon of the insertion of a capillary device, with associated lancet, into a consumable loader. 
           [0014]      FIG. 4  shows a cross section of a capillary loader of the invention and its use. 
           [0015]      FIG. 5  shows a cycle of use of a lancet of the invention. 
           [0016]      FIG. 6  shows a capillary device with capillary and a consumable loader. 
           [0017]      FIG. 7  shows a cycle of use of the consumable loader into which the capillary collector is inserted. 
           [0018]      FIG. 8  shows the steps of testing a patient&#39;s blood with the system of the invention. 
           [0019]      FIG. 9  shows a design in which the consumable loader is cleaned by a dummy consumable. 
           [0020]      FIG. 10  shows a “T-shaped” capillary device for control of bubble placement. 
           [0021]      FIG. 11  shows a capillary device being inserted into a consumable loader. 
           [0022]      FIG. 12  shows a system for differentially loading bubbles into one end or the other of a capillary device. 
           [0023]      FIG. 13  shows a consumable design where a bubble elimination mechanism is integrated into the consumable. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0024]    Medical diagnosis and treatment have made many advances, but access to care is difficult in remote locations, and can be difficult in towns and cities, even in well-off countries. Many diagnostic assays require complex automatic equipment, which is typically located in a hospital or a specialized analytical laboratory. Alternatively, a few specific assays might be performed in the field by trained personnel. However, field assays can be difficult because of a lack of automated analysis equipment. Such problems are acute in outer space, or in a remote station, but are also visible in urban areas. One significant source of these problems is the need to maintain and operate complex equipment. While routine in a clinical laboratory, this is much more difficult in a remote site. Complex training is often needed but not feasible. 
         [0025]    The present invention is directed to creating a simple, error-resistant, inexpensive system for collecting and analyzing samples for one assay or a panel of assays, using small, light weight analytical devices. The system is particularly directed to performing diagnostic routines in remote places, or in other locations where simple clinical analysis is not readily available. 
         [0026]      FIG. 1  shows a schematic flow diagram of the mixing and detection system. On the left, a reservoir of saline  11  supplies a consumable loader  13  with a flow of saline. The saline reservoir is typically pressurized to about 5 psi (ca. 0.7 atmosphere) when fluid is being moved. A capillary device  15  is used for transferring blood to the system, and includes a capillary  17  which is filled with collected blood. The capillary device  15  is connected to the consumable loader  13 . The capillary device  15  carries a defined amount of sample in the capillary  17 . Saline, optionally buffered, is a preferred diluent, but other solutions can also be used. 
         [0027]    When the capillary device  15  is inserted into the consumable loader  13 , the saline reservoir  11  is connected, via consumable loader  13 , to the upstream end of the capillary device  15 , and the downstream end of the capillary device  15  is connected to consumable loader  13 , and then connects downstream to an analysis device and processor  20 . A bubble may be inserted into the upstream and/or downstream ends of the capillary device  15 , to help define the sample in the detection system, or to allow other forms of mixing. Optionally, depending on the design, O-rings or other fluid sealing elements may be provided in one or both of capillary device  15  and consumable loader  13 . 
         [0028]    If a sample is properly loaded, then dilutions of  1000  or more can be achieved in the tubing downstream of where the sample was loaded. The challenges of sample loading are consistent sample insertion, control of bubbles in the system, creating a good fluid seal, and the ability to load a defined volume of sample. 
         [0029]    Once the capillary device  15  is in place in the system, flow from the saline reservoir  11  through the consumable loader  13  into the capillary  17  of the capillary device  15  begins. This flow washes through the capillary  17  and into a processor  20 , displacing the sample downstream and beginning its dilution. The processor  20  may add additional reagents to the flowing sample, and has a detection system for one or more sample components of interest. After analysis, the sample is sent to a waste reservoir  22  for disposal. A computer  24 , which may be integrated with the processor  20 , reports and stores readings. The processor  20  is small, preferably hand-held, and has as major components an optical detection system, together with inputs for reagents, as described herein. 
         [0030]    After the sample is cleared from capillary  17 , the disposable capillary device  15  may be removed from the system, and may be discarded. Removal of capillary device  15  may interrupt the flow of saline through the system, either via low fluid pressure, or by a pressure sensor and a valve. This is desirable in some circumstances, to minimize use of consumables. Alternatively, the consumable loader  13  or a separate device (see below) may be placed to permit saline flushing when there is no sample in the system; or the state with no sample can be a fluid-conducting state, as shown below, and system flow control can be managed by valves or other controllable devices. 
         [0031]    A second sample can be inserted into the system at any time, preferably after any background due to the first sample has cleared the detection system. Alternatively, there may be more than one location at which capillaries containing samples for analysis can be connected between a saline supply and the detection system. Likewise, there can be more than one detection location in the device, which may be downstream of a first detection location, or which could be in parallel with it if desired. The capillary device is preferably a disposable item, but could be cleaned on line, or in a separate cleaning circuit. In addition, a flow of pressurized saline or other fluid could be directed from reservoir  11  directly to the processor  20  for any needed purpose, including sample dilution as described below, and system flushing and cleaning. Likewise, a second reservoir with cleaning components (not illustrated) could be switched into the inlet to the consumable loader  13 . 
         [0032]      FIG. 2  shows cross-sectional detail of one version of a device and method for loading samples. In  FIG. 2A , the consumable loader  13  is pictured without the capillary device  15  inserted. O-rings (not shown) can be used to create a seal between the driving side  25  and driven side  27  of the loader. Saline or other fluid can be driven though inlet/outlet tubing  35  to clean the device and/or prime the system. Priming acts to fill o-rings with a reservoir of saline. Forces from springs  29  act to restore the device to this position. 
         [0033]    In  FIG. 2B , pressing the button  26  forces the driving side  25  away from the driven side  27 , breaking the seal and providing an opening for the insertion of the capillary device  15  (not shown). At this point, the driving side  25  is just about to contact the pivot  31 . 
         [0034]    In  FIG. 2C , driving side  25  has contacted pivot  31 , which then rotates about pin  32  and forces the driven side  27  to open away from the driving side  25 , providing a large enough opening for the capillary device  15  to be inserted. Guide rails (not shown) may be used to ensure that the capillary device  15  is aligned properly relative to the consumable loader  13 . In this embodiment, the sample is loaded into the side of the capillary  17  adjacent to the driven side  27 . 
         [0035]    In  FIG. 2D , the user releases the button  26  once capillary device  15  is fully inserted. The pivot  31  couples the motion between the driving side  25  and driven side  27  so that both close equal amounts until the driven side  27  contacts the collection capillary  17 . Saline pooled in the O-ring on the driven side  27  can create or enhance a fluid-fluid seal with the fluid in the capillary  17 , and drives said fluid towards the other end of the capillary  17  so that no air remains. 
         [0036]    In  FIG. 2E , the driven side  27  can no longer move because it is in contact with the capillary device  15  which is fixed in place by guide rails (not shown). This leaves only the driving side  25  to move. The driving side  25  continues to close until it connects with the other side of the blood collection capillary  17 . This enables flow through tubing  35  into capillary  17 , containing sample to be analyzed, and flow out of the capillary  17  into the downstream side  35   a  of the tubing. 
         [0037]    To remove the capillary device  15 , pressing the button  26  will restore the loader  13  to the position in  FIG. 2C , at which point the user can manually remove the capillary device  15 . Releasing the button  26  will restore the consumable loader  13  to the position in  FIG. 2A , the closed state, where it is ready for the next use. 
         [0038]    The embodiment described above creates a no-bubble sample. To include a bubble on the leading or trailing edge, the sample should be loaded from the side adjacent to the driving side  25 . Reversing the direction of flow determines which end of the sample contains a bubble. 
         [0039]      FIG. 3  shows a cartoon of the installation of a capillary device  15 , with a capillary  17 , into a consumable loader  13 . The capillary  17  will connect to the fluid tubing  35 , connecting upstream with the saline reservoir and downstream with the data processor. The cartoon format gives a sense of the scale of the devices of the invention, by contrast with the pictured hand. The capillary device  15 , for example, which carries the capillary  17 , is generally in the range of 10-60 mm in width and height, and 3 to 10 mm in thickness. The consumable loader  13  is depicted here as a stand-alone device, which is a common format in the development process, but it may be integrated with the processor  20  in the hand-held product format. The saline source  11 , not shown here, is also efficiently integrated into a hand-held device, and integration is an option for the waste receptacle  22 . In this cartoon, a single-use lancet  40  is also present, snap-connected to the capillary device  15  which is about to be loaded into (or is being removed from) consumable loader  13 . 
         [0040]    In  FIG. 4 , a variation of the device of  FIG. 1 , separate fluid capillaries  38  can be provided, in the type of consumable loader  13  illustrated in Fig,  1 , so that saline can be flushed through when a sample is not in the cell. (This is provided directly in the device of  FIG. 2 ). The extra capillary  38  as illustrated could be in a spring-mounted version of consumable loader  13 , so that capillary  38  would bridge the gap in consumable loader  13  as a default position, and thereby allow flow even when no capillary device  15  was placed in the fluid path (A). But when a capillary device  15  with a loaded capillary  17  is inserted, the inner part of the consumable loader  13  would slide away and not interfere with passage of fluid as shown in  FIG. 1  or  3 . This arrangement allows fluid flow into the device to be steady, so that a previous sample can reach the analysis section during the interval when another sample is being prepared for insertion into the system. 
         [0041]      FIG. 5  shows a cross-section of a disposable lancet package  40  that can be used in the invention. In  FIG. 5A , a cylindrical lancet  41  is embedded in a cylinder  42  which is placed between two casing halves  43  which create a tube around the cylinder  42 . A stiff upper spring  44  is retained against the casing  43 . Spring  44  opposes a more flexible return spring  46 . The lancet cylinder  41  rests on the edge of a button  47 , when the lancet is cocked. The button has a hole  48  in it, which is retained in a position which keeps the lancet cocked by a safety tab  49 . When the cap  49   a  is removed the safety tab  49  is also withdrawn. When the button  47  is pressed, then the lancet is rapidly driven into the skin by the upper spring  44  ( FIG. 5B ). Next, the return spring  46  very quickly pushes the lancet back out of the skin ( FIG. 5C ), allowing a drop of blood to be formed on the surface of the skin. The lancet is safe because there is no way to re-cock it. The blood on the skin (not illustrated) is sampled by one or more capillary devices, such as the capillary device  15  of  FIG. 1  or by other sampling means. The quick, automatic retraction of the lancet minimizes pain. 
         [0042]      FIG. 6  shows a use cycle of the consumable loader  13 . In the first panel (left), any capillary device  15  (having capillary inlet and outlet  17 ) in the consumable loader  13  is removed, and the loader  13  is opened to allow cleaning. Then (center panel) the loader  13  is closed to allow priming of the loader and the rest of the fluid path with saline or other fluid. Fluid flow occurs, when the lid is closed, through a passage  52  in the lid  53  of the capillary loader  13 , which can be seen in the left or right panels. Finally (right panel), a loaded capillary device  15  is inserted into the consumable loader, and the next test is ready to run. 
         [0043]      FIG. 7  shows a variation of  FIG. 4  that is structured to prevent some types of user error. In the neutral position, shown in panel A, the linkages  73  rest against a moving insert  72 . The loading surface  70  of the insert  72  sits below the surface  71  of the device. When the buttons  74 / 74   a  are pressed, as shown in panels A and B, the linkages  73  drive the insert driving pin  75  upwards in the insert travel slot  78 . At first, the motion of the buttons  74  does not move the insert  72 , as the pin  75  slides from the bottom to the top of slot  78  (panel B). Once the pin  75  reaches the top of the insert travel slot  78 , as in panel B, the motion of the buttons  74  drives the insert  72  upwards until the guides on the moving insert  72  reach the top of the vertical guide track (not pictured). The device has reached this position in panel C. In this position, the loading surface  70  is fully exposed beyond the surface  71  of the device to allow for cleaning. Once cleaning is complete, release of buttons  74  drives the insert  72  back inside the device, returning to the position in panel A. When the consumable device  15  is inserted into the enclosure  76 , it connects with the loading surface  70  on the insert  72  and drives the insert  72  downwards. The buttons  74  do not move, as the insert  72  moves relative to the insert driving pin  75 . In panel D, when the capillary device  15  is fully inserted, the linkage lock feature  71  on the linkage  73  falls into a slot  80  on the capillary device  15 , as seen in panel E. This action holds the capillary device  15  in place until buttons  74  are pressed (panel F), driving the insert  72  upwards and the capillary device  15  into a waste container (not pictured). 
         [0044]      FIG. 8  shows the cycle of use of the devices of the invention. Panel A shows the cleaning of a consumable loader  13 . In Panel B, the openings for sample flow through the consumable loader  13  are inspected and cleaned. From Panel B, in one branch of the work course, a sample is needed, leading to panel C, which shows a finger-tip pricking, in which a lancet  75  creates a blood sample. Blood is drawn into capillary  17  in Panel D. This blood sampling can either be done in real time, in the sequence shown, or the loaded capillary device  15  can be prepared previously. In Panel E, the loaded capillary device  15  is placed into consumable loader  13 , and then tests are run (Panel F). Then the used capillary device  15  is discarded, and the consumable loader  13  returns to the state pictured in panel A for cleaning. Multiple capillary devices can be in use in a busy system. In a remote system or one seldom used, it may be efficient to discard capillary devices rather than recycle them. 
         [0045]      FIG. 9  shows a design in which the consumable loader  83  is cleaned by a dummy consumable  90 . The dummy, which slides up and down in the consumable loader, is used to prime the consumable loader  83  as shown in panel A. Then, as shown in panel B, a capillary device  84 , loaded with a sample by the procedures of  FIG. 8  (above), is placed in the consumable loader and aligned so that flow through the consumable loader and the capillary device in channel  85  is possible. The consumable is released and discarded, as in panel C. The top view of panels B and C are shown to demonstrate a possible opening mechanism. 
         [0046]      FIG. 10  shows a T-shaped capillary device  90 . The T-shaped consumable, functionally similar to the capillary device, is designed to precisely meter a sample of fluid into the capillary device in a way that gives control of the bubble location. The blood or bodily fluid sample is collected using the vertical portion of the T in the consumable. The T-shaped capillary fills from the bottom via capillary action, rising in capillary  91  and spreading horizontally in capillary  92 . Upon insertion into the consumable loader  13 , a pin in the loader (not shown) displaces a predetermined volume of fluid from the vertical portion of the T-loader. Fluid comes out the horizontal portions  62  of the T and fluid contact is made with receiving gaskets in the consumable loader to create a fluid seal (not illustrated).. This approach allows a precise amount of fluid in the horizontal section of the T-consumable to be dispensed into the system. It also allows regulation so that bubbles can be placed where needed. 
         [0047]      FIG. 11  shows a different variety of consumable loader and capillary. In Panel A, the consumable loader  101  is open and accepts a capillary device  15  with capillary  17 . The open state is made by finger action on grips  104  with respect to proximal end  105 . The grips ride on rails  107 . The capillary is preloaded with blood or other sample as previously described. In Panel B, the grips  104  are released and the capillary device  15  is captured between the distal structure  101  and the grips  104 . Panel C shows a port  108  which is available to supply the contents of capillary device  15  to an analysis section. 
         [0048]      FIG. 12  shows an in-line capillary loader, similar to that of  FIG. 11 . It has an asymmetric spring-loaded platform that allows the cylindrical capillary device  15  to be inserted into one O-ring before the other. This creates a possibility for asymmetric loading. By allowing one side of the consumable device to contact the O-ring first, precise control is gained over the manner in which bubbles are loaded. In particular, by contacting one side first, the fluid bulges out the back side of the capillary. This allows fluid seals to be made on both sides of the capillary device. This capillary device also has guiderails which position the cylindrical consumable precisely in-line with the rest of the system. Valving may be incorporated to ensure that fluid remains in the system during the loading process. 
         [0049]      FIG. 13  shows a consumable design that integrates bubble elimination independent of the consumable loader  13 . In the starting position ( FIG. 13A ), the bubble eliminator  109  extends as far outside the consumable  15  as possible. The bubble eliminator  109  surrounds a small area of a larger diameter than the capillary  17 , located between the end of the capillary and the end of the bubble eliminator  109 . The sample  110  is drawn into the device filling the aforementioned area first. An area not filled with the sample  110  may exist on the far end of the capillary (right side in  FIG. 13A ). In  FIG. 13B , the consumable  15  is pressed against the loading surface  79 , creating a seal with the bubble eliminator  109 . As the consumable device  15  is inserted further ( FIG. 13C ), the main body of the device moves towards the loading surface  70 , but the bubble eliminator  109  remains stationary because it is already in contact with the loading surface  70 . This action causes the bubble eliminator  109  to slide along the capillary  17 . This motion reduces the volume available for sample collection and forces the sample  110  into the previously empty area. The sample  110  emerges from the far end of the capillary  17  before it comes in contact with the loading surface  79 , thus ensuring no bubbles exist in the sample capillary  17 . In  FIG. 13D , the consumable  15  is fully inserted with no bubbles present. 
         [0050]    Additional steps, not illustrated, can be added to the operation of the system. In particular, the processor  20  can have facilities for adding diluents or reagent streams to the entering fluid, and it will have detection means for measuring one or more properties of the sample. More than one detection system can be present in the processor. 
         [0051]    Moreover, since the system of the invention is intended to be of use in remote areas and preferably on hand-held devices or equivalent, alternative modules for detection can be used. Because the volume of blood collectable from a single finger prick will typically be enough for many assays, the same blood sample can be used to fill many collection modules. Alternative detection reagents can be used, and the sample can be diluted to various extents. It is also possible to place one or more detection agents into the incoming saline stream if that is convenient. Moreover, different capillary lengths may be required for different assays. 
         [0052]    Unless defined otherwise, all technical and scientific terms used herein have the same meanings as commonly understood by one of skill in the art to which the disclosed invention belongs. Although any methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present invention, the preferred methods, devices, and materials are as described. Publications cited herein and the material for which they are cited are specifically incorporated by reference, where such incorporation is permitted. Nothing herein is to be construed as an admission that the invention is not entitled to antedate such disclosure by virtue of prior invention, where relevant. Those skilled in the art will recognize, or be able to ascertain using no more than routine experimentation, many equivalents to the specific embodiments of the invention described herein. Such equivalents are intended to be encompassed by the following claims.