Critical Value Reporting Policy
(Medical Center Policy No. 0125)
The University of Virginia Medical Center Clinical Laboratories have established criteria for reporting critical laboratory values (results) to the practitioner responsible for the care of the patient. Critical laboratory test results are defined as those that have a potential life threatening significance in the diagnosis, treatment and management of the patient.
A listing of critical values can be found below:
CRITICAL LABORATORY VALUES
The following critical laboratory values will be immediately reported to the requesting physician or to the responsible practitioner.
Microbiology
|
Positive blood and sterile body fluid gram stains and cultures |
|
Positive peritoneal dialysis cultures |
|
Positive Group A Strep (Streptococcus pyogenes) cultures |
|
Positive Group B Strep (Streptococcus agalactiae) cultures from labor and delivery patients and newborns |
|
Positive acid-fast smears and cultures |
|
Positive cultures for systemic fungi |
|
Positive direct tests or cultures for specific viruses |
Hematology/Coag/Urinalysis
|
Analyte |
Restrictions |
Critical Values |
|
Hematocrit |
< 1 day |
<18.0% and >74.9% |
|
1 day to 1 month |
<18.0% and >66.9% |
|
|
> 1 month |
<18.0% and >59.9% |
|
|
Hemoglobin |
< 1 day |
<6.0 g/dL and >24.0 g/dL |
|
1 day to 1 month |
<6.0 g/dL and >22.0 g/dL |
|
|
> 1 month |
<6.0 g/dL and >20.0 g/dL |
|
|
WBC |
|
<1.0 x 109/L and >50.0 x 109/L |
|
Platelets |
|
<25 x 109/L and > 1,000 x 109/L |
|
INR |
|
>4.5 |
|
Partial Prothrombin Time |
|
>60.0 secs |
|
Fibrinogen |
|
<120 mg/dL |
|
Urinalysis |
< 2 Years old |
Glucose and other sugars |
|
|
abnormal pathologic crystals (cystine, tyrosine, leucine, cholesterol) |
|
|
Smears |
|
Positive Malaria Smears |
Endocrinology
|
Analyte |
Critical Values |
|
17-OH Progesterone |
>2000 ng/mL |
|
Cortisol |
<3.0 g/dL |
|
Prolactin |
>100 ng/mL |
|
T3 |
>350 ng/dL |
|
Total T4 |
>20 g/dL |
|
Free T4 |
>3.0 ng/dL |
|
25-OH Vitamin D |
>150 ng/mL |
|
Urine Epinephrine |
>50 µg/24 hours |
|
Urine Norepinephrine |
>150 µg/24 hours |
|
Urine VMA |
> 12 mg/24 hours |
|
Total Urine Metanephrines |
>1.5 mg/24 hours |
Chemistry
|
Analyte |
Restrictions |
Critical Values |
|
Bilirubin |
< 28 days |
>18 mg/dL |
|
Arterial Blood Gas pH |
|
<7.2 and >7.6 |
|
Arterial Blood Gas pCO2 |
|
<20 mm Hg and >70 mm Hg |
|
Arterial Blood Gas pO2 |
|
<40 mm Hg |
|
Calcium |
|
<6.0 mg/dL and >13.0 mg/dL |
|
Ionized Calcium |
|
<3.0 mg/dL and >6.5 mg/dL |
|
CO2 |
|
<10 mmol/L and >40 mmol/L |
|
Glucose |
<28 days |
<40 mg/dL and >300 mg/dL |
|
>28 days |
<40 mg/dL and >700 mg/dL |
|
|
Post-glucola (GTT) |
<40 mg/dL and >300 mg/dL |
|
|
Magnesium |
|
<1.0 mg/dL and >4.7 mg/dL |
|
Phosphorous |
|
<0.9 mg/dL |
|
Potassium |
Pre-dialysis* |
<2.5 mmol/L and >6.4mmol/L |
|
All others |
<2.5 mmol/L and >5.9 mmol/L |
|
|
Sodium |
|
<120 mmol/L and >160 mmol/L |
* Approved clinics, NEPHD, NEPHO, NEPH2
Drugs
|
Analtye |
Restrictions |
Toxic Values (all GREATER than) |
|
Alcohol |
|
350 mg/dL |
|
Amikacin |
Trough |
10 µg/mL |
|
Peak |
40 µg/mL |
|
|
Random |
40 µg/mL |
|
|
Acetaminophen |
|
150 g/mL |
|
Caffeine |
|
20 µg/mL |
|
Carbamazapine (total) |
|
20 µg/mL |
|
Digoxin |
Total |
2.0 ng/mL |
|
Free |
1.5 ng/mL |
|
|
FK-506 |
|
25 ng/mL |
|
Gentamicin |
Trough |
2 µg/mL |
|
Peak |
10 µg/mL |
|
|
Random |
10 µg/mL |
|
|
Iron |
|
300 µg/mL |
|
Lidocaine |
|
6 µg/mL |
|
Lithium |
|
2 mmol/L |
|
Phenobarbital (total) |
|
60 µg/mL |
|
Phenytoin (total) |
|
30 µg/mL |
|
Procainamide + NAPA |
|
30 µg/mL |
|
Salicylate |
|
30 mg/dL |
|
Sirolimus |
|
15 ng/mL |
|
Theophylline |
|
25 µg/mL |
|
Tobramycin |
Trough |
2 µg/mL |
|
Peak |
10 µg/mL |
|
|
Random |
10 µg/mL |
|
|
Valproic Acid (total) |
|
150 µg/mL |
|
Vancomycin |
Trough |
20 µg/mL |
|
Peak |
60 µg/mL |
|
|
Random |
60 µg/mL |
|
|
Tricyclic Antidepressants: |
Individual drugs (Nortriptyline, Amitriptyline, Desimpramine, Imipramine) |
500 ng/mL |
|
Totals (Desi + Imi or Nort + Ami) |
500 ng/mL |
