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Laboratory Test Critical values, Which need immediate action

May 16, 2024Chemical pathologyLab Tests

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  • Critical values
      • Discuss the tests and their critical values?

Critical values

  • Various tests have values that require immediate action or immediate communication of the result to the hospital or referring doctors.
Critical values: Laboratory critical value and its protocol

Critical values: Laboratory critical value and its protocol

  • These values should be conveyed to the concerned person without any delay.

Discuss the tests and their critical values?

Test  Critical value>(more than) Critical value < (less than) 
Biochemical tests
Amylase Three times the normal value No value
Ammonia >40 µmol/L No value
Bilirubin level

adult= > 12 mg/dL

newborn= >15 mg/dL

No value
Blood glucose level

Adult male = > 400 mg/dL

Adult female = >400 mg/dL

Newborn = >300 mg/dL

  1. Adult male =<50 mg/dL
  2. Adult female = <40 mg/dL
  3. Infants = <40 mg/dL
  4. Newborn = <30 mg/dL
Serum sodium (Na+) > 160 meq/L < 120 meq/L
Serum potassium (K+)

Adult = > 6.5 meq/L

Newborn = >8 meq/L

Adult = < 2.5 meq/L

Newborn = <2.5 meq/L

Serum calcium (Ca++) >13 mg/dL (3.25 mmol/L) <6.5 mg/dL (1.5 mmol/L)
Ionized calcium >7 mg/dL (1.58 mmol/L) <2.2 (0.78 mmol/L)
Serum phosphate (PO4)3- < 1 mg/dL
Magnesium (Mg++) >3 meq/L <0.5 meq/L
Serum bicarbonate (HCO3–) >40 meq/L <10 meq/L
Chloride (Cl–) >115 meq/L <80 meq/L
Creatinine >4 mg/dL (>5.0 mg/dL) No value
Blood urea nitrogen (BUN) >100 mg/dL 2 mg/dL
Phosphorus No value <1.1 mg/dL
Uric acid >12 mg/dL
Triglyceride >400 mg/dL
HDL

Male = <35 mg/dl.

Female = <40 mg/dl.

Ethanol >300 mg/dL (>65 mmol/L)
Haptoglobin No value <40 mg/dL
Insulin assay >30 µU/mL
Arterial pH > 7.6 < 7.2
pCO2 >60 mm Hg <20 mm Hg
pO2 (arterial) No value <40
O saturation 75% or lower
CO2 content <6 meq/L
Osmolality >320 mOsm /Kg H2O (>600) <265 mOsm /Kg H2O
Haptoglobin <40 mg/dL
Prealbumin <10.7 mg/dL = Severe nutritional deficiency
Cardiac troponin T >0.1 µg/L No value
Cardiac troponin I >1.6 µg/L No value
Ck-MB >5% or >10 µg/L No value
Cerebrospinal fluid (CSF) Critical value>(more than) Critical value < (less than)
Glucose <80% of the blood level
Protein >45 mg/dL No value
White blood cells (WBCs) >1000/cmm No value
Gram stain Positive
AFB stain Positive
Malignant cells Positive
Blast cells Positive
Amniotic fluid
Bilirubin level Increased Hemolytic anemia of the newborn
Color Red, green, yellow, or brown
Lecithin/sphingomyelin ratio <2.0
Chromosomal abnormalities Positive
Hematology Critical value>(more than) Critical value < (less than)
Hemoglobin >20 g/dL <5 g/dL
Methemoglobin >40% of the total Hb
Hematocrit (Hct) >60% <14%
Reticulocytes > 20 %
Platelets >one million/cmm <20,000/cmm
Total leucocyte count (TLC) >50,000 /cmm <2000 /cmm
Carboxyhemoglobin (COHb) 20%
Prothrombin time >20 seconds No value
Partial thromboplastin time (PTT) >100 seconds No value
Activated partial thromboplastin (APTT) >70 seconds
INR >5.5
Fibrinogen >700 mg/dL <100 mg/dL
Fibrinogen degradation factor (FDP) >40 mcg/mL
Bone marrow Positive for malignant cells
Urine Result 
Glucose Strongly positive
Ketones Strongly positive
Pathologic crystals Cysteine, leucine, and tyrosine
WBCs Increased number >15/HPF
RBCs Increased number >10/HPF
Protein Positive 2+
Urine colony culture numbers >50,000 colonies/mL
Microbiology Result

CSF gram stain Positive
Pleural fluid gram stain
Positive
Synovial fluid gram stain
Positive
Peritoneal fluid gram stain
Positive
AFB stain Positive
Blood culture Positive
C. Diphtheria culture Positive
Peripheral blood smear
  1. Positive for malaria
  2. Positive for microfilaria
Respiratory area culture Positive growth for pathogens
Hormones Critical value>(more than) Critical value < (less than)
TSH > 7 mIU/L (hypothyroidism) < 0.5 mIU/L (hyperthyroidism)
Thyroxin (T4)

>20 mcg/dL if thyroid storm possible

Adult <2 mcg/dL if myxedema comma

Newborn = <7 mcg/dL

Estriol <40% below the average of two previous values, demand immediate evaluation of fetal well-being during pregnancy
Growth hormone Peak level = <5.1 mcg/L
Surgical pathology Result   
Fine needle aspiration Positive for malignant cells
Cervical biopsy or PAP smear Positive for malignant cells
Serology Result
HBV (Hepatitis B virus) Positive
HCV (Hepatitis C virus) Positive
Test for syphilis Positive
Coomb’s test direct /indirect Positive
Therapeutic drugs level Result
Acetaminophen >150 µg/mL
Salicylates >700 µg/mL
Gentamicin >12 µg/mL
Chloramphenicol >50 µg/mL
Tobramycin >12 µg/mL
Quinidine >10 µg/mL
Primidone >24 µg/mL
Theophylline >25 µg/mL
Phenytoin >40 µg/mL
Digoxin >2.5 ng/mL
Digitoxin >35 ng/mL
Lithium 2 meq/L
Lidocaine 9 µg/mL

Possible References Used
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Comments

Dr.Zahidi Reply
August 12, 2020

Very informatve

Dr. Riaz Reply
August 12, 2020

Thanks.

Dr.Zahidi Reply
August 12, 2020

Very informatve

Dr. Riaz Reply
August 12, 2020

Thanks.

Shivaputra patil Reply
May 22, 2023

Thanks, it’s beneficial

Dr. Riaz Reply
May 22, 2023

Thanks.

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