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Easy-to-read immunochemical graphics.

Easy-to-read immunochemical graphics

There are compelling advantages to computer programs that display lab results graphically: Data conveyed in such form are often better organized and more readily interpreted than a list of numbers on a printout. Some common applications are reviewed in the two articles cited below.1, 2 Now I'd like to add another.

Our laboratory recently introduced a profile for the nephelometric quantitation of immunoglobulins A, G, and M, and kappa and lambda light chains. Ordered for the diagnosis of gammopathies, this immunochemical evaluation and a serum protein electrophoresis have allowed us to eliminate 90 per cent of our immuno-electrophoresis testing. (With some diagnoses, such as for light-chain disease, we still do an IEP occasionally.) The latter is a two-day procedure, involving much more technologist time than our new one-day approach.

So we have reduced costs considerably, halved our turnaround time, and replaced a qualitative method with a quantitative method. Data presentation is similarly streamlined, as the compact computer-generated report in Figure I illustrates. Our pathologists receive all the information they need to make an interpretive comment about a patient's results.

We wrote the 240-line display program in Microsoft BASIC for an Apple IIe with Digital Research's CP/M disk-operating system and 80-character text. The microcomputer is linked to an Epson FX-80 printer via a PKASO graphics interface card.

The program prompts the operator to enter a patient's demographic information and test results (IgA, IgG, IgM, kappa, lambda, total protein, and albumin). It then calculates the globulin level, kappa/lambda ratio, and percentage diff minus total--(A G M) - (kappa lambda), divided by A G M, times 100. The percentage diff minus total is a check on the possible presence of free light chains or IgD or IgE gammopathies.

A series of HPLOT commands in the program sets up the entire bar chart in the lower half of the report form. The computer draws a line from one designated horizontal /vertical coordinate to another. Figure II shows the commands that plot the normal range rectangles or zones on the graph, the commands for the legend at the bottom of the graph, and part of the plotting of patient values.

Finally, the report form is generated by a screen dump routine-- ordering a printout of what's on the screen--and the serum protein electrophoresis strip is mounted on the SPE space of the form.

Our pathologists can quickly scan the bar chart section of the form for patient value arrows outside the normal range rectangles and easily perceive the relationship of the concentrations to each other. For example, if all the results are slightly increased (arrows printed just above the normal range rectangles) but no significant SPE bands appear, dehydration would be suspected. An increased concentration of one or more of the immunoglobulins and one or more abnormal SPE bands indicates monoclonal or polyclonal gammopathy. If an abnormality exists, a pathologist can check the numerical results on the bar chart and make an interpretation or suggest further testing.

Because the data are so easy to grasp, our pathologists are highly pleased with graphic printouts of immunochemical evaluations.

1. Young, D.S. Interpretation of clinical chemical data with the aid of automated data processing Clin. Chem. 22: 1555-1561, 1976.

2. Connelly, D.P. Graphical displays in the clinical laboratory. J. Clin. Lab. Automation 3: 92-100, March/April 1983.

Table: Figure I Computer-printed report form and chart

Table: Figure II Plto commands for bar chart
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Title Annotation:new computer program
Author:VanderHeiden, Gary L.
Publication:Medical Laboratory Observer
Date:Dec 1, 1985
Words:573
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