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CRITICAL LIMITS FOR LABORATORY TEST VALUES
*Critical values will be reported only for tests that are ordered. No results for unordered tests will be given.
*Critical values are posted in the on-line laboratory handbook.
*Laboratory personnel will initiate notification of an appropriate caregiver (physician, house staff, or nurse) of any defined critical value(s) detected within 20 minutes of detection of the result in the lab. After 20 minutes, the Organizational Policy #201, “Chain of Command of the Unstable Patient”, will be followed.
*Multiple, repetitive critical results will be notified each new calendar day.
*Reference separate Microbiology/Virology/Molecular/Histology and Pathology critical policy procedures.
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DEPARTMENT/TEST
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VALUE
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HEM/ONC CLINICS
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CRITICAL TESTS (The following two tests will be called every time regardless of result)
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Frozen Section of Surgical Specimens: 90% within CAP Guidelines of 20 minutes.
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Gram Stains
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All CSF gram stains (positive or negative)
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All CSF gram stains (positive or negative)
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CRITICAL RESULTS (The following test results will be called based on defined result ranges and policies listed above)
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CHEMISTRY
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Ammonia
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>150 umol/L
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None
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Bilirubin, Total
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>12 mg/dL at <one day old
>15 mg/dL all others
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None
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Calcium
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<3 - >7 mEq/L
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None
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Carbon Dioxide
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<10 - >40 mEq/L
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<10 - >40 mEq/L
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CPK
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>4000 U/L
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None
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HCO3
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<10 - >40 mEq/L
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None
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Glucose
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<50 - >300 mg/dL
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None
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Ionized Calcium
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<1.5 mEq/L
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None
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Lactate
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>45 mg/dL
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None
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Lead
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>30 ug/dL
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>30 ug/dL
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Magnesium
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<1 - >5.5 mEq/L
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None
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pCO2
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<15 - >70 mm Hg
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None
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pH
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<7.2 - >7.6
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None
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Phosphorus
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<2 - >10 mg/dL
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None
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pO2 (Arterial)
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<40 mm Hg
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None
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Potassium
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<2.5 - >6.5 mEq/L
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<2.5 - >6.5 mEq/L
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Sodium
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<124 - >156 mEq/L
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<124 - >156 mEq/L
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Uric Acid
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>10 mg/dL
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None
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COAGULATION
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Fibrinogen
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<80 mg/dL
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None
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Protime
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>17 seconds
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None
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WPT (INR) Patients on warfarin therapy
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<1.4
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>3.5
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PTT
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>48 seconds
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None
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Thrombin Time
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>25 seconds
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None
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HEMATOLOGY
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Hemoglobin
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<7.0 gm/dL
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<5.0 gm/dL
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Hematocrit
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<21 - >65%
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None
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Platelets
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<50,000 - >1,000,000
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<5,000
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WBCs
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Newborn <5,000 - >35,000
Others <2,000 - >25,000
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None
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Morphology
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Presence of blasts
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Presence of blasts
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CEREBROSPINAL FLUID
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Protein
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>150 mg/dL
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None
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Glucose
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<31 mg/dL
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None
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MICROBIOLOGY/VIROLOGY
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AFB-TB
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Positive
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Positive
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Blood Culture
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Positive
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Positive
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Body Fluid (sterile) Culture
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Positive
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Positive
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CSF Culture
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Positive
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Positive
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Fungal Culture – Syst Infect
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Positive
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Positive
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MRSA Screen/Culture
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Positive
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Positive
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MRSA PCR
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Positive
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Positive
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Viral Culture – Syst Infect
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Positive
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Positive
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TOXICOLOGY
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Acetaminophen
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>25 ug/mL
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>25 ug/mL
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Carbamazepine
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>20 ug/mL
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>20 ug/mL
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Gentamicin
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>10 ug/mL
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>10 ug/mL
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Methotrexate
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>1 umol/mL
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>1 umol/mL
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Phenobarbital
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>60 ug/mL
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>60 ug/mL
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Phenytoin
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>30 ug/mL
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>30 ug/mL
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Salicylate
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>30 mg/dL
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>30 mg/dL
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Theophylline
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>25 ug/mL
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>25 ug/mL
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Tobramycin
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>10 ug/mL
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>10 ug/mL
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Valproic Acid
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>200 ug/mL
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>200 ug/mL
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Vancomycin
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>50 ug/mL
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>50 ug/mL
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Urine Toxicology Screen
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Any positive
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Any positive
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BLOOD BANK
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Any undue delay in transfusing a patient due to the inability to find a compatible product or due to the unavailability of a product.
Acute hemolytic or anaphylactic reaction.
Identification of a blood product as potentially contaminated by bacteria after the unit has been transfused.
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REFERENCE LAB
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Any critical limit phoned as defined by the reference laboratory.
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Updated: 6/21/2009
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