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Critical Values
Critical Value:
A critical value is defined, as a laboratory result, which represents a pathophysiologic state at such a variance with normal as to be potentially life threatening or which, requires immediate medical attention. Critical value criteria established by the Department of Pathology in conjunction with Medical Staff.
Policy:
Employees of the clinical laboratory will report test results with critical values by telephone, immediately upon verification of accuracy, to the appropriate clinical individual; physician, nurse, or clerk.
| BLOOD BANK CRITICAL VALUES | |
| TEST | CRITICAL VALUE NOTIFICATION |
| Cord Blood Direct Antiglobulin (DAT) | 2+ or greater |
| CHEMISTRY CRITICAL VALUES | ||
| TEST | LOWER LIMIT | UPPER LIMIT |
| Acetone | None | Any positive result |
| Amylase | None | >250 IU/L |
| Bilirubin, Total | None | >18 mg/dL |
| Calcium | <6 mg/dL | >14 mg/dL |
| Calcium, Ionized | <0.75mmol/L | >1.55 mmol/L |
| CK Index | None | >4.0 only called when computer down |
| CO2 | <11 mEq/L | >40 mEq/L |
| Glucose | <50 mg/dL | >450 mg/dL |
| Lipase | None | >80 IU/L |
| Magnesium | <1 mg/dL | >6.9 mg/dL |
| Potassium | <3.0 mEq/L | >6.2 mEq/L |
| Sodium | <125 mEq/L | >160 Meq/L |
| Fetal Fibronectin | None | Positive |
| Lactic Acid | None | > 4.0 mmol/L |
| PREMATURE CHEMISTRY CRITICAL VALUES | ||
| TEST | LOWER LIMIT | UPPER LIMIT |
| Bilirubin, Cord Blood | None | >1.9mg/dL |
| Bilirubin, Direct Premature | None | >1.8mg/dL |
| Bilirubin, Total Premature | None | >15mg/dL |
| Bilirubin, Total Neonatal | None | >15mg/dL |
| BUN, Premature | None | >50 mg/dL |
| Calcium, Premature | <7 mg/dL | >11 mg/dL |
| Chloride, Premature | <85 mEq/L | >115 mEq/L |
| CO2, Premature | <11 mEq/L | >40 mEq/L |
| Creatinine, Premature | None | >1.6 mg/dL |
| Glucose, Premature | <40 mg/dL | >250 mg/dL |
| Potassium, Premature | <3.0 mEq/L | >6.5 mEq/L |
| Sodium, Premature | <125 mEq/L | >150 mEq/L |
| DRUG CRITICAL VALUES | ||
| TEST | LOWER LIMIT | UPPER LIMIT |
| Acetaminophen | None | >40 mcg/mL |
| Alcohol | None | >300 mg/dL |
| Carbamazepine | None | >12 mcg/mL |
| Digoxin | None | >3.0 ng/mL |
| Gentamycin, Peak | None | >12 mcg/mL |
| Gentamycin, Trough | None | >2.5 mcg/mL |
| Lidocaine | None | >5.0 mcg/mL |
| Lithium | None | >1.5 mEq/L |
| Phenobarbitol | None | >40 mcg/mL |
| Phenytoin | None | >25 mcg/mL |
| Primadone | None | >12 mcg/mL |
| Procainamide | None | >12 mcg/mL |
| Procainamide and NAPA | None | >30 mcg/mL |
| Quinidine | None | >5 mcg/mL |
| Salicylate | None | >30 mcg/mL |
| Theophylline | None | >20 mcg/mL |
| Tobramycin, Peak | None | >12 mcg/mL |
| Tobramycin, Trough | None | >2.5 mcg/mL |
| VaLproic Acid | None | >140 mcg/mL |
| Vancomycin, Peak | None | >45 mcg/mL |
| Vacomycin, Trough | None | >20 mcg/mL |
| HEMATOLOGY CRITICAL VALUES | ||
| TEST | LOWER LIMIT | UPPER LIMIT |
| Blasts | Any present in non-oncology patients | Any present in oncology patients with no blasts previously |
| D-Dimer | None | >500 ng/mL |
| Fibrin Degradation Products-FDP | None | > 20 ug/mL |
| Fibrinogen | <100 mg/dL | >800 mg/dL |
| Hematocrit (Hct) | <21 % | >60 % |
| Hemoglobin (Hgb) | < 7 g/dL | > 20 g/dL |
| Platelet Count * | < 30 k/cmm | > 950 k/cmm |
| Prothrombin Time (PT) | < 9.9 seconds | >25 seconds |
| Therapeutic Prothrombin Time (TPT) | < 9.9 seconds | > 87.2 seconds |
| Activated Partial Thromboplastin Time (APTT) | < 18 seconds | >45 seconds |
| Therapeutic APTT | < 20 seconds | >110 seconds |
| White Blood Cell Count * | < 2.0 k/cmm | > 25 k/cmm |
| INR (International Normalized Ratio) | None | >5.5 |
| PREMATURE HEMATOLOGY CRITICAL VALUES | ||
| TEST | LOWER LIMIT | UPPER LIMIT |
| APTT, Pediatric 0-6 months | < 18 seconds | > 61 seconds |
| Hemoglobin, 0-1 day | < 10.8 g/dL | > 22.5 g/dL |
| Hemoglobin, 1-3 days | < 10.5 g/dL | > 25.0 g/dL |
| Hemoglobin, 3-14 days | < 10.4 g/dL | > 22.5 g/dL |
| Hemoglobin, 14-30 days | < 7.0 g/dL | > 22.0 g/dL |
| Hemoglobin, 1mo – 12yrs | < 7.0 g/dL | > 18.0 g/dL |
| Prothrombin Time, 0-6 months | < 9.9 seconds | > 25 seconds |
| White Blood Cell Count, 0-3 days | < 2.0 k/cmm | >34 k/cmm |
| White Blood Cell Count, 3-14 days | < 2.0 k/cmm | > 25 k/cmm |
| MICROBIOLOGY CRITICAL VALUES | |
| TEST | CRITICAL VALUE NOTIFICATION |
| Blood Culture | Positive smear or culture |
| Cerebrospinal Fluid Exam | Positive smear or culture |
| Acid Fast Bacilli – AFB | Positive smear or culture |
| Herpes Culture | Positive culture from female genital specimen |
| Genital Cultures | Positive culture for Neisseria gonorrhoeae and Group B Strep from inpatient/OB genital, placenta |
| Cryptococcal Antigens | Positive |
| Hepatitis Surface Antigen | Positive postpartum within 24 hrs |