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Critical Laboratory Values

It is important that critical test results are communicated in a timely manner to the licensed caregiver who may act on the results.  The communication of critical test results will be monitored for timeliness. Critical test results are defined as those test results that may be an indication of a life-threatening situation or that may have urgent importance to patient management. Critical value limits have been defined and approved by the Medical Executive Committee and are listed with each appropriate test in the alphabetical test list.  On a computer generated report these values will be designated by an upper case C.  When a test result exceeds the critical value limit established for that test, the results will be called by the laboratory staff to the licensed caregiver or designee.  When calls are made to the caregiver, the laboratory staff will ask for the full name and role of the individual receiving the results. The recipient will be asked to “read-back” the results as they are given by the laboratory staff.  This is done to confirm that the person receiving the results heard and documented the results correctly.  Documentation of the call is recorded in the Laboratory Information System along with the date and time that the call was made.  This is done in accordance with standards defined by The Joint Commission and the College of American Pathologists (CAP).  For inpatients, the results will be called to the caregiver for that patient or the unit secretary if the nurse is not able to come to the telephone.  For patients at a nursing home, the results will be called to the nursing supervisor.  For outpatients, the results will be called to the ordering physician’s office and given to a RN, LPN, or Medical Assistant.  If the physician cannot be contacted at his/her office, an attempt will be made to contact the physician through an answering service or home phone.  If no contact can be made, the pathologist on-call, may contact the patient.  If the pathologist advises the patient, a letter documenting the contact will be sent to the ordering physician the next day.

 

Therapeutic Drugs
Acetaminophen >150.0 mcg/mL NAPA* >30 mg/L Salicylate >30.0 mg/dL
Carbamazepine >15.0 mcg/mL Phenobarbital >60.0 mcg/mL Theophylline >20.0 mcg/mL
Digoxin 
(12-24 hr post)
>3.0 ng/mL Phenytoin (Dilantin) >30.0 mcg/mL Tobramycin Peak >12.0 mcg/mL
Gentamicin Peak >12.0 mcg/mL Primidone >15.0 mcg/mL Tobramycin Trough >2.0 mcg/mL
Gentamicin Trough >2.5 mcg/mL Procainamide* >or = 14 mg/L Valproic Acid >200.0 mcg/mL
Lidocaine* > or = 6 mg/L Quinidine* > or = 10 mg/L Vancomycin Trough >20.0 mcg/mL
Lithium >1.5 mmol/L *Test performed by reference lab

 

HematologyChemistryBlood Gases
*WBC <2.0 K/mcL CO2 <10 >45 mmol/L pH (arterial) <7.25 >7.55 units
ABS Neutrophil Count <1.0 K/mcL Calcium <7.0 >13.0 mg/dL pO2 <55 mm Hg
Hematocrit <21% >70% Calcium, Ionized <0.78 >1.58 mmol/L pCO2 >80 mm Hg
Blasts Present Glucose <40 >500 mg/dL %COHB >14%
*Platelet Count <50 >1000 K/mcL Lactic Acid >4.0 mmol/L pH (venous) <7.22 >7.52 units
*PTT >150 sec Magnesium >5.0 mg/dL    
PT (INR) > or = 5.0 Phosphorus <1.0 mg/dL    
Blood Parasite (Malaria) Present *Potassium <2.8 >6.2 mmol/L    
Fibrinogen (Massive Transfusion Protocol) <120 mg/dL Sodium <120 or >160 mmol/L    
* Exceptions   (Defined with input from appropriate clinical department)
Hemodialysis patients – Medicine/Nephrology:  Call Potassium if >6.5 mmol/L
Radiation Oncology patients - Radiation Oncology:  Call Platelets <20.0 K/mcL
Hematology/Oncology patients – Medicine/Hem/Oncology:  Call Platelets <20 K/cmm; WBC <2.0 K/mcL or <1.0 K/mcL neutrophils; subsequent Blasts (first blast is called)
Open Heart Surgery patients during surgery – Do not call
Infant <2 days old – Call Potassium if >7.7 mmol/L

 

MicrobiologyTransfusion Services
Positive blood cultures Positive Direct Coomb’s test on Cord blood specimen
Positive CSF – Gram stain, culture or Cryptococcus antigen Positive Antibody screen with an incompatible crossmatch, if the problem: 
1) is not quickly rectified; 
2) will cause delay in dispensing blood; 
3) will result in not having blood available for surgery.
Positive normally sterile body fluid – Gram stain or culture Evidence of  hemolytic transfusion reaction – indicated by any or all of the following: 
1) Positive Direct Coomb’s test (DAT negative pre-transfusion); 2) Visible hemolysis (not present pre-transfusion); 
3) Presence of free hemoglobin, brown/black urine; 
4) Significant ABO mismatch; 
5) Clerical error resulting in an  incorrect transfusion; 
6) Positive blood culture or bacteria seen on Gram stain.

 

Neonate Bilirubin
Age Hours Critical Value Age Hours Critical Value Age Hours Critical Value
0-18 6.9 mg/dL 39-40 12.2 mg/dL 64-65 15.5 mg/dL
18-19 7.2 mg/dL 40-42 12.3 mg/dL 65-67 15.6 mg/dL
19-20 7.4 mg/dL 42-43 12.4 mg/dL 67-69 15.7 mg/dL
20-21 7.5 mg/dL 43-44 12.5 mg/dL 69-70 15.8 mg/dL
21-22 7.6 mg/dL 44-45 12.7 mg/dL 70-72 (3 days) 15.9 mg/dL
22-23 7.7 mg/dL 45-46 12.8 mg/dL 72-78 16.3 mg/dL
23-24 (1 day) 7.8 mg/dL 46-47 13.0 mg/dL 78-84 16.7 mg/dL
24-25 8.1 mg/dL 47-48 (2 days) 13.2 mg/dL 84-90 17.1 mg/dL
25-26 8.4 mg/dL 48-49 13.3 mg/dL 90-96 (4 days) 17.4 mg/dL
26-27 8.6 mg/dL 49-50 13.5 mg/dL 96-102 17.5 mg/dL
27-28 8.9 mg/dL 50-51 13.7 mg/dL 102-108 17.5 mg/dL
28-29 9.2 mg/dL 51-52 13.8 mg/dL 108-114 17.6 mg/dL
29-30 9.4 mg/dL 52-53 14.0 mg/dL 114-120 (5 days) 17.6 mg/dL
30-31 9.7 mg/dL 53-54 14.2 mg/dL 120-126 17.5 mg/dL
31-32 10.0 mg/dL 54-55 14.3 mg/dL 126-138 17.4 mg/dL
32-33 10.3 mg/dL 55-56 14.5 mg/dL 138-144 (6 days) 17.3 mg/dL
33-34 10.5 mg/dL 56-57 14.7 mg/dL 144-150 17.5 mg/dL
34-35 10.8 mg/dL 57-58 14.8 mg/dL 150-156 17.7 mg/dL
35-36 11.1 mg/dL 58-59 15.0 mg/dL 156-162 17.9 mg/dL
36-37 11.4 mg/dL 59-61 15.2 mg/dL 162-168 (1 week) 18.2 mg/dL
37-38 11.6 mg/dL 61-62 15.3 mg/dL 1 week – 1 month 18.0 mg/dL
38-39 11.9 mg/dL 62-64 15.4 mg/dL 1 month – 18 yrs 18.0 mg/dL

 

Neonates (Birth to 1 Month)
Hematocrit <21%
>70%
Arterial pO2 <40 mm Hg
>110 mm Hg
Urine Glucose Positive
Glucose <40 mg/dL 
>200 mg/dL
Capillary pH <7.20 units
>7.50 units
   
Potassium Birth-2dys:
<2.8 mmol/L 
>7.7 mmol/L 
2 dys-3mos: >6.5 mmol/L
Capillary pCO2 >70 mm Hg    

Refer to Laboratory Services Administrative Policy A-SP-12 for additional information.

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