<%@LANGUAGE="VBSCRIPT" CODEPAGE="1252"%> MGH Lab Handbook - Critical Values List
  MGH CLINICAL LABORATORY CALLBACK LIST      
 
 

The list below includes Critical Callbacks and Courtesy Callbacks/E-mails.

Critical results are defined as results that, if left untreated, could be life threatening or place the patient at serious risk. Critical results are those results from a clinical specimen that upon analysis are determined to be "critical" whether the specimen was submitted as a routine or stat specimen.

Critical test results will be communicated to a licensed caregiver within 30 minutes from the time the result is available in the laboratory.   Critical values that are reported to a non-licensed caregiver will be communicated to a licensed caregiver as rapidly as possible.

The laboratory in collaboration with the department or service involved in the monitor will monitor the time between the identification of a critical value to the time it is reported to a licensed caregiver. Ongoing organizational efforts will target improvement in the timeliness of critical value reporting.

Courtesy callbacks/E-mails are made in accordance with individual laboratory policy in an effort to improve clinical communication.

 

Laboratory

Test

Value

Critical or Courtesy

Blood gas

All blood gas tests from a non-cardiac OR

All values

Courtesy

 

Calcium, ionized

<0.8 or >1.54 mmol/L

Critical

 

Hemoglobin

<6.5 g/dl

Critical

 

PCO2 (arterial, venous, unknown)

<20 or >75 mmHg, first only (within past 24 hours)

Critical

 

pH (arterial, venous, unknown)

<7.10 or >7.59 units, first only (within past 24 hours)

Critical

 

PO2 (arterial, unknown)

<40 mmHg

Critical

Chemistry

Acetaminophen

>50 mg/L

Critical

 

Bilirubin, total

>15 mg/dL (0-3 mo)
>20 mg/dL (4-6 mo)

Critical

 

Calcium

<6.5 or >14.0 mg/dl

Critical

 

Carbamazepine

>20 mcg/ml

Critical

 

Carbon dioxide (total)

<11 or >40 mmol/L

Critical

 

Digoxin

>2.5 ng/ml

Critical

 

Gentamicin

Peak/Unknown: >9.9 ug/ml; Trough: > 2.9 ug/ml

Critical

 

Glucose, CSF

<40 mg/dl

Critical

 

Glucose, plasma

<40 or >500 mg/dl. [NOTE: For results <40 mg/dl for OUTPATIENTS, when practice is closed communication may be deferred until a time when practice is open, in recognition of the non-emergent nature of this result for an outpatient.]

Critical

 

Glucose, plasma

All results from Blake 13

Courtesy

 

Isopropanol

>100 mg/L

Critical

 

Lithium

>1.8 mmol/L

Critical

 

Magnesium

<1.2 or >5.9 mg/dl

Critical

 

Methanol

>100 mg/L

Critical

 

Osmolality, plasma or serum

<250 or >335 mOsm/kg water

Critical

 

Phenobarbital

>70 mcg/ml

Critical

 

Phenytoin

>30 mcg/ml

Critical

 

Phosphorus

<1.1 mg/dl

Critical

 

Potassium

<2.8 or >6.0 mmol/L

Critical

 

Sodium

<120 or >160 mmol/L

Critical

 

Tobramycin

Peak/Unknown: >9.9 ug/ml; Trough: > 2.9 ug/ml

Critical

 

Toxicology (serum)

Various toxic drug levels

Courtesy

 

Vancomycin

Peak/Unknown: >39.9 ug/ml; Trough: > 39.9 ug/ml

Critical

Hematology

Initial hematocrit

>56% within 30 days (ages 1 month and above)

Critical

 

Delta values

WITHIN THE LAST 30 DAYS:
Current HCT between 20- 56% with a decrease of >20% of current value

Courtesy

 

Differential

Presence of blasts on initial smear within 30 days

Critical

 

Initial hematocrit

< or = to 20% within 30 days

Critical

 

Initial platelet count

<40,000 or >999,000 within 30 days

Critical

 

Initial WBC

<1,500 or >50,000 within 30 days

Critical

 

INR

INR > or = to 5.0

Critical

 

Partial thromboplastin time

>120 seconds

Critical

 

Platelets

All pediatric patients <20 years old with a platelet count of <20,000

Critical

  Differential All pediatric patients <20 years old with the presence of blasts on peripheral blood smear Critical

 

Differential

Presence of “others” (other cells) on initial smear within 30 days

(Applies to Emergency Department testing only)
Critical

Immunology

Cryocrit

5% or higher

Courtesy

 

IgA

<7 mg/dL

Courtesy

 

IgG

<200 mg/dL

Courtesy

 

Viscosity

>3 relative viscosity units

Critical

Microbiology

Acid-fast smears

Initial Positive or if pervious positive >3 months

Courtesy

 

Aerobic Actinomycetes (Nocardia, etc) from culture

Positive

Courtesy

 

Antimicrobial Susceptibility Testing (AST)

Meropenem or imipenem-resistant Enterobacteriaceae Linezolid-resistant Staph. aureus Vancomycin-resistant Staph. aureus Drug-resistant mycobacteria

Courtesy

 

Beta Strep Throat Culture

Positive for beta-hemolytic group A streptococcus

Courtesy

 

Blood and CSF cultures

Cultures positive for bacteria, fungi, yeast or acid-fast organisms

Critical

 

C. difficile toxin and/or PCR test

Positive

Courtesy

 

Cryptococcal antigen tests (CSF)

Positive

Critical

 

Cryptococcal (non-CSF)

1st Positive Result is a CRITICAL Subsequent Positive Results

Courtesy

 

CSF non-STAT Gram Stains

Positive

Critical

 

Fungal wet prep (non-CSF samples)

Positive for mycelial elements (hyphae), or structures suggestive of dimorphic fungi such as spherules (s/o Coccidioides) or large yeast with broad-based budding (s/o Blastomyces)

Courtesy

 

Fungal wet prep on CSF

Positive

Critical

 

Fungal Culture (non CSF)

Zygomycetes molds, all Crytococcus neoformans and dimorphic fungi.

Courtesy

 

GC/Chlamydia tests

Positive

Courtesy

 

Gram Stains

Result of all STAT requests

Critical

 

HSV PCR (CSF)

Positive

Critical

 

Influenza A/B PCR

All positives

Courtesy

 

Mycobacterial culture

Positive for mycobacteria

Courtesy

 

Mycobacterium tuberculosis PCR

Positive

Courtesy

 

Parasitology exams

Positive Babesia, PCP and Malaria Smear

Courtesy

 

Rapid Malaria

Positive

Critical

 

RSV PCR

All positives

Courtesy

 

Shiga Toxin

Positives

Courtesy

 

VDRL on CSF

Positive

Courtesy

 

Virology DFA tests (Adeno, Para, hMPV, HSV & VZV)

All positives and inadequate specimens from inpatient units or Emergency Room

Courtesy

 

Enterovirus (CSF) PCR

Positive

Courtesy

 

Norovirus PCR

Positive

Courtesy

Chelsea Health Center

Bilirubin, total

>15 mg/dL (0-3 mo)
>20 mg/dL (4-6 mo)

Critical

 

Calcium

<6.5 or >14.0 mg/dl

Critical

 

Carbon dioxide (total)

<11 or >40 mmol/L

Critical

 

CBC

Within the last 30 days:
-Platelets <40,000
-Hematocrit <20%
-Hematocrit >56% (ages 1 month and above)
-WBC <1,500 or >50,000

Critical

 

Differential

Presence of blasts

Critical

 

Glucose

<40 or >500 mg/dl

Critical

 

Magnesium

<1.2 or >5.9 mg/dl

Critical

 

Phosphorus

<1.1 mg/dL

Critical

 

Potassium

<2.8 or >6.0 mmol/L

Critical

 

Sodium

<120 or >160 mmol/L

Critical

Revere Health Center

Stool guaiac

Positive

Courtesy

 

Whole blood glucose

<40 or >500 mg/dl

Critical

Mass General Waltham

 

Bilirubin, total

>15 mg/dL (0-3 mo)
>20 mg/dL (4-6 mo)

Critical

 

Calcium

<6.5 or >14.0 mg/dl

Critical

 

Carbon dioxide (total)

<11 or >40 mmol/L

Critical

 

Glucose

<40 or >500 mg/dl

Critical

 

Magnesium

<1.2 or >5.9 mg/dl

Critical

 

Phosphorus

<1.1 mg/dL

Critical

 

Potassium

<2.8 or >6.0 mmol/L

Critical

 

Sodium

<120 or >160 mmol/L

Critical

 

Initial hematocrit

>56% within 30 days (ages 1 month and above)

Critical

 

Delta values

WITHIN THE LAST 30 DAYS:
Hematocrit >25% and decrease of =8% (outpatients only)
Hematocrit >20 and =25% and decrease of =4% (outpatients only)
Platelets <50 and decrease is equal to or >50%

Courtesy

 

Differential

Presence of blasts on initial smear within 30 days

Critical

 

Initial hematocrit

< or = to 20% within 30 days

Critical

 

Initial platelet count

<40,000 or >999,000 within 30 days

Critical

 

Initial WBC

<1,500 or >50,000 within 30 days

Critical

 

INR

INR > or = to 5.0

Critical

 

Partial thromboplastin time

>120 seconds

Critical

 

Platelets

All pediatric patients <20 years old with a platelet count of <20,000

Critical

 

Differential

All pediatric patients <20 years old with the presence of blasts on peripheral blood smear

Critical

 

* Medical Policy Committee Approval pending for this critical callback.

 

     
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This page last updated on November 20, 2017