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