Clinical Decision Limits

Phoning limits for biochemistry tests are as follows:

Decision limits for phoning

  Below Above Units
Sodium 120 150 mmol/L
Potassium 3 6.5 mmol/L
Urea   30 mmol/L
Creatinine   500 umol/L
Glucose 2.5 20 mmol/L
Calcium adjusted 1.8 3.5 mmol/L
Magnesium 0.4   mmol/L
Phosphate 0.3   mmol/L
AST   700 U/L
ALT   400 U/L
Total CK   500 U/L
Amylase   600 U/L
TBA   20 umol/L
Iron   70 umol/L
Total bilirubin   225 umol/L
Carbamazepine   25 ug /mL
Digoxin   2.5 ng/mL
Theophylline   45 mg/L
Phenytoin   20 mg/L
Phenobarbitone   70 mg/L
Lithium  <0.2 >1.5 mmol/L
Valproate   100 mg/L
Cyclosporin A   200 ug/L
CRP  

300

phoned with other abnormal results

mg/L
Salicylate   20 mg/L
Paracetamol   10 mg/L
Ammonia All phoned    
Lactate All phoned    
beta-HCG All phoned    
progesterone All phoned    
CSF glucose All phoned    
CSF protein All phoned    
NNU results All phoned    

 

Immunology results to be telephoned:

  • CD4 count <200 cells/cumm or <10% on new patients (paediatric levels are different, but agreed with Paed consultants)
  • Lymphocyte subsets in infants <2yo: Any T cell subset below age-related normal range, any other abnormality suggesting SCID (e.g. MHC class II deficiency). (Note this is not exclusive: any abnormality may be discussed with requesting clinician)
  • New positive GBM antibodiest
  • New positive MPO antibodies
  • New positive PR3 antibodies
  • New paraprotein IgG , A or M  > 20g/L
    • IgD or IgE (any size)
    • serum monoclonal free light chains (any size, whether or not with intact paraprotein)

Abnormal Laboratory Test Results – Triggers for Telephoning Results Haematology

HaemoglobinWhite Blood Cell Count
<8.0 g/dl normochromic and normocytic Low result – neutropenia <0.5 x 10 9/L
<7.0 g/dl microcytic and hypochromic   High result – White cell count >40 x 10 9/L
<7.0 g/dl macrocytic  or Lymph count > 20 x 10 9/L
<5.0 g/dl renal patients Any presence of blast cells
PlateletsClotting Studies
Lower limit - <70 x 10 9/L   INR - >5.0
Upper limit - >1000 x 10 9/L   PTT - >180 seconds
  Fibrinogen < 1.0g/l
  • All Positive Malaria Screens
  • All Anti FXa results >1.20 iu/ml
  • If the patient is known to the department and has had a similar result within the previous 7 days then the urgent contact is not necessary.

HPA Microbiology – List of abnormal results telephoned to clinical staff

Bacteriology

  • Gram stain results of positive blood culture on Day 1
  • Positive CSF results
  • Positive sterile site results
  • Significant in-patient results from enteric bench
  • Multi resistant gram negative and gram positive isolates including mupirocin resistant MRSA
  • Group B streptococcal isolates from neonates
  • Group A in patient isolates
  • Positive Legionella urinary antigen and Pneumococcal urine antigen results
  • Smear and culture positive Mycobacteria
  • Antibiotic assay results outside normal ranges
  • Any other significant results at the discretion of Medical Microbiologists

Virology

  • Serological evidence of acute infection with Hep A, Hep B and in pregnant patients CMV, Parvovirus and Rubella
  • New diagnoses of HIV
  • VZV IgG negative from exposed patients at risk of severe VZV infection
  • New diagnosis of Hep B, Hep C and HIV in haemodialysis patients
  • Evidence of Hep B/Hep C and HIV in needle stick injury source patients
  • Clinically important positive respiratory PCR results i.e.: influenza, RSV in immunocompromised patients
  • Positive PCR results in outbreaks
  • Positive blood PCR for CMV and Adenovirus
  • Negative blood results for CMV PCR
  • Significant blood PCR results for EBV and Polyomavirus
  • All positive PCR results on CSF specimens
  • All positive Chlamydia PCR results on eye swabs
  • All positive PCR results from neonatal unit
  • Created on .
  • Last updated on .

Copyright heftpathology 2013, 2014, 2015, 2016, 2017, 2018

HTA licence number is 12366

Protection of Personal Information – Laboratory Medicine comply with the Trust Data Protection Policy and have procedures in place to allow the Directorate and it’s employees to comply with the Data Protection Act 1998 and associated best practice and guidance.

The Trust Laboratories at Heartlands Hospital, Good Hope Hospital and Solihull Hospital were awarded UKAS (United Kingdom Accreditation Service) accreditation to the internationally recognised ISO 15189 standard in May 2015. For a list of accredited tests and other information please visit the test database http://www.heftpathology.com/frontpage/test-database.html.
Tests not appearing on this scope are either under consideration or in the process of accreditation and so currently remain outside of our scope of accreditation. However, these tests have been validated to the same high standard as accredited tests and are performed by the same trained and competent staff.

For further information contact Louise Fallon, Quality Manager, 0121 424 1235

UKAS Logos