Clinics and Departments

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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.

*Reference separate Microbiology/Virology/Histology and Pathology critical policy procedures.


DEPARTMENT/TEST	VALUE		HEM/ONC CLINICS
CRITICAL TESTS (The following two tests will be called every time regardless of result)
Frozen Section of Surgical Specimens: 90% within CAP Guidelines of 20 minutes.
Gram Stains	All CSF gram stains (positive or negative)		All CSF gram stains (positive or negative)
CRITICAL RESULTS (The following test results will be called based on defined result ranges and policies listed above)
CHEMISTRY
Ammonia	>150 umol/L		None
Bilirubin, Total	>12 mg/dL at <one day old >15 mg/dL all others		None
Calcium	<3 or >7 mEq/L		None
Carbon Dioxide	<10 or >40 mEq/L		<10 or >40 mEq/L
CPK	>4000 U/L		None
HCO3	<10 or >40 mEq/L		None
Glucose	<50 or >300 mg/dL		None
Ionized Calcium	<1.5 mEq/L		None
Lactate	>45 mg/dL		None
Lead	>30 ug/dL		>30 ug/dL
Magnesium	<1 or >5.5 mEq/L		None
pCO2	<15 or >70 mm Hg		None
pH	<7.2 or >7.6		None
Phosphorus	<2 - >10 mg/dL		None
pO2 (Arterial)	<40 mm Hg		None
Potassium	<2.5 or >6.5 mEq/L		<2.5 or >6.5 mEq/L
Sodium	<124 or >156 mEq/L		<124 or >156 mEq/L
Uric Acid	>10 mg/dL		None
COAGULATION
Fibrinogen	<80 mg/dL	None
Protime (PT)	>17 seconds	None
PT (INR)	<1.7	None
WPT (INR) Patients on warfarin therapy	<1.4	>3.5
PTT	>48 seconds	None
Thrombin Time	>25 seconds	None
HEMATOLOGY
Hemoglobin	<7.0 gm/dL	<5.0 gm/dL
Hematocrit	<21 or >65%	None
Platelets	<50,000 or >1,000,000	<5,000
WBCs	Newborn <5,000 or >35,000 Others <2,000 or >25,000	None
Morphology	Presence of Blasts; however, if the presence of Blasts has been reported within the last 30 days no notification is necessary.	Presence of Blasts; however, If the presence of Blasts has been reported within the last 30 days no notification is necessary.
CEREBROSPINAL FLUID
Protein	>150 mg/dL	None
Glucose	<31 mg/dL	None
MICROBIOLOGY/VIROLOGY
AFB-TB	Positive	Positive
Blood Culture	Positive	Positive
Body Fluid (sterile) Culture	Positive	Positive
CSF Culture	Positive	Positive
Fungal Culture – Syst Infect	Positive	Positive
MRSA Screen/Culture	Positive	Positive
MRSA PCR	Positive	Positive
Viral Culture – Syst Infect	Positive	Positive
TOXICOLOGY
Acetaminophen	>25 ug/mL	>25 ug/mL
Carbamazepine	>20 ug/mL	>20 ug/mL
Gentamicin	>10 ug/mL	>10 ug/mL
Methotrexate	>1 umol/mL	>1 umol/mL
Phenobarbital	>60 ug/mL	>60 ug/mL
Phenytoin	>30 ug/mL	>30 ug/mL
Salicylate	>30 mg/dL	>30 mg/dL
Theophylline	>25 ug/mL	>25 ug/mL
Tobramycin	>10 ug/mL	>10 ug/mL
Valproic Acid	>200 ug/mL	>200 ug/mL
Vancomycin	>50 ug/mL	>50 ug/mL
Urine Toxicology Screen	Any positive	Any positive
BLOOD BANK
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.
REFERENCE LAB
Any critical limit phoned as defined by the reference laboratory.