Pathology Phone Limits

Pathology Phone Limits

By Department

Clinical Chemistry

Phoning and Critical Limits

Analyte

Phone results below or equal to:

Phone results above or equal to:

Units

Notes

Sodium

120

150

mmol/L

 

Potassium

2.5

6.5

mmol/L

 

Urea

-

Adults: 30

Paediatrics: 10

mmol/L

 

Creatinine

-

Paediatrics: 200

umol/L

Except those on renal wards or under renal consultants.

eGFR

Adults: 15

-

ml/min

AKI

-

3

 

Not CKD patients

Glucose

2.5

25

mmol/L

 

Calcium adjusted

1.8

3.5

mmol/L

 

Magnesium

0.4

-

mmol/L

 

Phosphate

0.3

-

mmol/L

 

AST

-

600

U/L

 

ALT

-

600

U/L

 

Total CK

-

5000

U/L

 

Amylase

-

500

U/L

 

Digoxin

-

2.5

ng/mL

 

Theophylline

-

25

mg/L

 

Phenytoin

-

25

mg/L

 

Lithium

-

1.5

mmol/L

 

Troponin I

-

16 (female or unknown)

34 (male)

ng/L

GP only

Ammonia

-

100

umol/L

 

Ethanol

-

Paediatrics only: any detectable

mg/L

Paediatrics only

Paracetamol

-

10

mg/L

Not ED patients

Salicylate

-

300

mg/L

Not ED patients

Conj bilirubin (DBIL)

-

Paediatrics only:

25

umol/L

Paediatrics only

Total bilirubin

-

Paediatrics only: 225

umol/L

Paediatrics only

Carbamazepine

-

25

ug /mL

 

Iron

-

ED only: 70

umol/L

ED only

Phenobarbitone

-

70

mg/L

 

CSF Gluc

3.3

-

mmol/L

 

CSF Prot

-

0.45

g/L

 

Lactate

-

2.3

   

CRP

-

300

   

Total bile acids

-

20

   

Methotrexate

Phone all

umol/L

 

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.

Immunology

  • 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)

HPA Microbiology

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
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The laboratories at Heartlands Hospital, Good Hope Hospital and Solihull Hospital form part of the services provided by University Hospitals Birmingham and are UKAS (United Kingdom Accreditation Service) accredited to the ISO 15189:2012 standard. For a list of accredited tests and other information please visit the UKAS website using the following link: https://www.ukas.com/find-an-organisation/

  • Heartlands, Good Hope and Solihull Hospital pathology laboratories are a UKAS accredited medical laboratory No.8217
  • United Kingdom Health Security Agency laboratory is a UKAS accredited medical laboratory No.8213

Tests not appearing on the UKAS Schedule of Accreditation 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 test information, please visit the test database: http://www.heftpathology.com/frontpage/test-database.html.

Protection of personal information - Laboratory Medicine comply with the Trust Data Protection policy and have procedures in place to allow the Directorate and its employees to comply with the Data Protection act  1998 and associated best practice and guidance.

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

UKAS HEFT