Prisma Health Laboratories Critical Values

	PROCEDURE:	Less Than/Equal To:	Greater Than/Equal To:
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1	Associated Policy:	.	Revised: 2/20/2024
2	Laboratory General Policy	.
3
4	RESPONSIBLE POSITIONS:	.
5	1. Laboratory Workforce	.
6	2. Prisma Health Providers	.
7
8	CLINICAL LABORATORIES:	.
9	Prisma Health Baptist Columbia Hospital Laboratory Taylor at Marion Street Columbia, SC 29220	Prisma Health Baptist Parkridge Hospital Laboratory 400 Palmetto Health Parkway Columbia, SC 29212	Prisma Health Richland Hospital Central Laboratory 14 Richland Medical Park Drive Columbia, SC 29203
10	Prisma Health Richland Hospital Rapid Laboratory 5 Richland Medical Park Drive Columbia, SC 29203	Prisma Health Tuomey Hospital Laboratory 129 North Washington Street Sumter, SC 29150
11	Prisma Health Baptist Easley Hospital Laboratory 200 Fleetwood Drive Easley, SC 29640	Prisma Health Greenville Memorial Hospital Laboratory 701 Grove Road Greenville, SC 29605	Prisma Health Greer Memorial Hospital Laboratory 830 S Buncombe Road Greer, SC 29650
12	Prisma Health Hillcrest Hospital Laboratory 729 SE Main Street Simpsonville, SC 29681	Prisma Health Laurens County Hospital Laboratory 22725 US-76 Clinton, SC 29325	Prisma Health North Greenville Hospital Laboratory 807 N Main Street Travelers Rest, SC 29690
13	Prisma Health Oconee Memorial Hospital Laboratory 298 Memorial Drive Seneca, SC 29672	Prisma Health Patewood Hospital Laboratory 175 Patewood Drive Greenville, SC 29615
14
15	PROCEDURE:	Less Than/Equal To:	Greater Than/Equal To:
16	Blood Bank
17	Positive Antibody Screen on a patient who has a stat crossmatch ordered
18	Post-transfusion Direct Antiglobulin Test (DAT) when the pre-transfusion DAT was negative.
19	Crossmatch incompatible with no compatible blood available or discovery of a crossmatch incompatibility on a unit which was signed out of the Blood Bank prior to completion of the crossmatch.
20	Discovery of a discrepancy involving the ABO or Rh type of a unit of blood or patient after a unit of blood has already been signed out of the Blood Bank
21
22	Chemistry and Immunoassay
23	Amnisure		Upstate: Positive
24
25	Ammonia
26	NICU/Newborn Inpatient Locations:		80 umol/L
27	All Others:
28	0 - 18 Years:		110 umol/L
29
30	Beta-Hydroxybutyric Acid		1.6 mmol/L
31
32	Bilirubin, Direct
33	NICU Inpatient Locations:		3.0 mg/dL
34	All Others:
35	0 - 14 Days:		3.0 mg/dL
36	>/= 15 Days:		9.0 mg/dL
37
38	Bilirubin, Total:
39	Newborn/NICU Inpatient Locations: 0 - 23 Hours:		6.0 mg/dL
40	Newborn/NICU Inpatient Locations: >/= 1 Day:		15.0 mg/dL
41	All Others:
42	0 - 23 Hours:		6.0 mg/dL
43	1 - 2 Days:		15.0 mg/dL
44	3 - 29 Days:		18.0 mg/dL
45	>/= 1 Months:		15.1 mg/dL
46
47	Blood Urea Nitrogen (BUN)
48	NICU Inpatient Locations:		50 mg/dL
49	Newborn Inpatient Locations:		40 mg/dL
50
51	Calcium, Total
52	NICU/Newborn Inpatient Locations:	7.0 mg/dL	12.0 mg/dL
53	All others:	6.0 mg/dL	13.0 mg/dL
54
55	Calcium, Ionized	0.76 mmol/L	1.53 mmol/L
56
57	Calcium, Ionized Pre-Filter	0.76 mmol/L	1.53 mmol/L
58
59	Calcium, Ionized Post-Filter		1.53 mmol/L
60
61	CO2
62	NICU/Newborn Inpatient Locations:	14 mmol/L	40 mmol/L
63	All Others:
64	< 1 Month:	10 mmol/L
65	>/= 1 Month:	10 mmol/L	40 mmol/L
66
67	Creatinine
68	NICU/Newborn Inpatient Locations:		1.70 mg/dL
69	All Others:
70	0 - 19 Years:		4.00 mg/dL
71
72	Glucose (Does NOT include Glucometer)
73	NICU Inpatient Locations:	50 mg/dL	150 mg/dL
74	Newborn Inpatient Locations:	39 mg/dL	150 mg/dL
75	All Others:
76	0 - 59 Days:	39 mg/dL	201 mg/dL
77	>/= 60 Days	53 mg/dL	450 mg/dL
78
79	Glucose, Glucometer
80	NICU Inpatient Locations:	50 mg/dL	150 mg/dL
81	Newborn Inpatient Locations:	39 mg/dL	150 mg/dL
82	All Others:
83	>/= 1 Year:	53 mg/dL
84
85	Glucose, CSF	25 mg/dL	450 mg/dL
86
87	HCG, Urine	GHS Only: Positive
88
89	Lactic Acid		2.3 mmol/L
90
91	Magnesium
92	NICU Inpatient Locations:	1.0 mg/dL	6.0 mg/dL
93	Newborn Inpatient Locations:	1.0 mg/dL	3.6 mg/dL
94	All Others:
95	0 - 17 Years:	1.0 mg/dL	5.1 mg/dL
96	>/= 18 Years:	1.0 mg/dL	6.0 mg/dL
97
98	Osmolality, Serum	250 mOsm/kgH2O	330 mOsm/kgH2O
99
100	Phosphorus:
101	NICU Inpatient Locations:	2.5 mg/dL
102	Newborn Inpatient Locations:	3.5 mg/dL
103	All Others:	1.2 mg/dL
104
105	Potassium:
106	NICU Inpatient Locations:	2.5 mmol/L	6.6 mmol/L
107	Newborn Inpatient Locations:	3.5 mmol/L	6.1 mmol/L
108	All Others:	2.8 mmol/L	6.5 mmol/L
109
110	Procalcitonin		2.00 ng/mL
111
112	Sodium:
113	NICU/Newborn Inpatient Locations:	130 mmol/L	150 mmol/L
114	All Others:
115	0 - 30 Days:	125 mmol/L	150 mmol/L
116	31 Days - 12 years:	125 mmol/L	160 mmol/L
117	>/=13 Years:	120 mmol/L	160 mmol/L
118
119	TCO2 (Point of Care):
120	NICU/Newborn Inpatient Locations:	14 mmol/L	40 mmol/L
121	All Others:
122	< 1 Month:	10 mmol/L
123	>/= 1 Month:	10 mmol/L	40 mmol/L
124
125	Troponin		Midlands: 0.30 ng/mL Upstate: 0.04 ng/mL
126
127	Troponin (Point of Care):		iSTAT: 0.09 ng/mL
128
129	Uric Acid & Uric Acid, Rasburicase		12.1 mg/dL
130
131	Chemistry Therapeutic Drugs
132	Acetaminophen		151 ug/mL
133
134	Alcohol/Ethanol		300 mg/dL
135
136	Amikacin, Random		35.0 ug/mL
137
138	Amikacin, Peak		60.1 ug/mL
139
140	Amikacin, Trough		10.0 ug/mL
141
142	Carbamazepine (Tegretol)		15.1 ug/mL
143
144	Cyclosporine		500 ng/mL
145
146	Dilantin, Total		30.0 ug/mL
147
148	Dilantin, Free		4.1 ug/mL
149
150	Digoxin		2.1 ng/mL
151
152	Gentamicin Random		10.1 ug/mL
153
154	Gentamicin Peak		15.0 ug/mL
155
156	Gentamicin Trough		2.0 ug/mL
157
158	Lithium		1.6 mmol/L
159
160	Methotrexate
161	Methotrexate levels portend potential toxicity when in excess of:
162	At 24 Hours		50.01 umol/L
163	At 48 Hours		10.01 umol/L
164	At 72 Hours		0.51 umol/L
165
166	Phenobarbital		41 ug/mL
167
168	Salicylate		41 mg/dL
169
170	Sirolimus		15.1 ng/mL
171
172	Tacrolimus		20.1 ng/mL
173
174	Theophylline		25.0 ug/mL
175
176	Tobramycin, Random		10.1 ug/mL
177
178	Tobramycin, Peak		15.0 ug/mL
179
180	Tobramycin, Peak CF		40.0 ug/mL
181
182	Tobramycin, Trough		2.0 ug/mL
183
184	Valproic Acid, Total		150 ug/mL
185
186	Valproic Acid, Free		31.0 ug/mL
187
188	Vancomycin, Random		60.0 ug/mL
189
190	Vancomycin Peak		60.0 ug/mL
191
192	Vancomycin, Trough		25.0 ug/mL
193
194	Coagulation
195	Antithrombin III	50%
196
197	Fibrinogen	100 mg/dL
198
199	INR		5.0
200
201	PTT		128 seconds
202
203	Flow Cytometry
204	Fetal Hgb Flow Marker		0.30%
205
206	Hematology
207	POC Hematocrit:
208	NICU/Newborn Inpatient Locations:	Upstate POC Only: 7.5%
209
210	Hemoglobin
211	NICU/Newborn Inpatient Locations:	7.5 g/dL	n/a
212	All Others:
213	< 1 Month:	9.6 g/dL	20.0 g/dL
214	>/= 1 Month:	6.5 g/dL	20.0 g/dL
215	.
216	WBC
217	NICU/Newborn Inpatient Locations:	3.8 K/uL	30.0 K/uL
218	All others:	2.0 K/uL	50.0 K/uL
219
220	Platelet Count
221	NICU/Newborn Inpatient Locations:	50 K/uL	1000 K/uL
222	All Others:
223	< 2 Months:	50 K/uL	1000 K/uL
224	>/= 2 Months:	20 K/uL	1000 K/uL
225
226	CSF WBC Count
227	0 - 11 Months:		30 mm3
228	>/= 1 Year:		10 mm3
229
230	Immunology
231	Bacterial Antigen Detection, Rapid Test for:
232	Legionella urinary antigen		Positive
233	Streptococcus pneumonia antigen (CSF or Urine)		Positive
234	Cryptococcal Antigen (CSF or Serum)		Positive
235	Malaria Screen (P. falciparum, P. vivax, P. malariae, P. ovale)		Positive
236
237	Heparin Induced Thrombocytopenia IgG		Positive
238	.
239	HIV, Rapid test		Upstate: Positive
240	.
241	Influenzae A & B Antigen Screen		Positive
242	.
243	Respiratory Syncytial Virus (RSV) Antigen		Positive
244
245	Syphilis Testing
246	</= 2 Months:
247	Treponema Antibody		Reactive
248	Rapid Plasma Reagin (RPR)		Reactive
249	VDRL, CSF		Reactive
250
251	Microbiology
252	All of the following are critical calls. Critical values depend on the organism isolated.
253	Smears and/or cultures from:
254	Acid Fast Bacteria (AFB)
255	Blood Cultures
256	CSF
257	Sterile Body fluids
258	Tissue Samples from OR (to include bone and cornea samples)
259
260	Identification of the following:
261	Acid Fast Bacteria (AFB)
262	Bordetella
263	Campylobacter
264	Carbapenemase producing organisms
265	E coli 0157:H7
266	E coli, Shiga toxin-producing (STEC)
267	Haemophilus influenzae (Invasive)
268	Listeria
269	Neisseria gonorrheae
270	Neisseria meningitidis
271	Salmonella
272	Shigella
273	Streptococcus pneumoniae (Invasive)
274	MRSA (Vancomycin Intermediate/ Resistant)
275	VRE, ESBL, Penicillin Resistant Strep Pneumo
276	Multi-drug resistant Gram Negative Rods that are KPC positive
277	Chlamydia/N. gonorrhea DNA
278
279	Microbiology Other
280	Adenovirus Rapid		Detected
281	Blood Culture ID by PCR		Detected
282	Carbapenemase Resistance by PCR		Detected
283	Clostridium difficile Toxin B gene by PCR		Detected
284	GI Panel by PCR		Detected
285	Group B Strep by Rapid PCR		Detected
286	India Ink Prep		Detected
287	M. tuberculosis by PCR		Detected
288	Influenzae A/B by PCR		Detected
289
290	Molecular Pathology
291	Bordetella pertussis DNA		Positive
292	HSV 1 & 2, CSF		Positive
293	Meningitis/Encephalitis (ME) Panel by PCR, CSF		Positive
294	Respiratory Panel by PCR		Positive
295
296	Parasitology
297	Malaria Smears		Positive/Present
298	Pathologic parasites from O&P exam		Positive/Present
299	Cryptosporidium Antigen		Positive/Present
300	Cryptosporidium Stain		Positive/Present
301	Giardia Antigen		Positive/Present
302	Giardia/Cryptosporidia Antigen		Positive/Present
303
304	Reference Lab
305	Other Reference Lab Critical value results as determined by the reference lab will be called by the reference lab to the Prisma Health Richland Central Laboratory. Prisma Health Richland Central Laboratory will then call the panic value result per lab policy.
306
307	CANCER INSTITUTE LABORATORIES:
308	Prisma Health Cancer Institute – Easley 109 Fleetwood Dr Suite A Easley, SC 29640	Prisma Health Cancer Institute – Eastside 65 International Dr. Greenville, SC 29615	Prisma Health Cancer Institute – Faris Road 900 W Faris Rd. Greenville, SC 29605
309	Prisma Health Cancer Institute – Greer 340 Medical Pkwy Greer, SC 29650	Prisma Health Cancer Institute – Grove Commons 3 Butternut Dr Suite B Greenville, SC 29605	Prisma Health Cancer Institute – Seneca 131 Lila Doyle Dr Seneca, SC 29672
310	Prisma Health Cancer Institute – Spartanburg 2400 Boiling Springs Rd Spartanburg, SC 29316
311
312	PROCEDURE:	Less Than/Equal To:	Greater Than/Equal To:
313	Chemistry
314	ALT (SGPT)		150 IU/L
315	AST (SGOT		120 IU/L
316	Bilirubin, Total		15 mg/dL
317	Blood Urea Nitrogen (BUN)		50 mg/dL
318	Calcium, Total	6.6 mg/dL	12.0 mg/dL
319	Chloride	75 mmol/L	130 mmol/L
320	CO2	10 mmol/L	40 mmol/L
321	Creatinine		3.5 mg/dL
322	GGT		300 IU/L
323	Glucose, Serum	45 mg/dL	350 mg/dL
324	Lactate Dehydrogenase (LDH)		600 IU/L
325	Magnesium	1.0 mg/dL	4.9 mg/dL
326	Phosphorous	1.0 mg/dL	10.0 mg/dL
327	Potassium (K+)	2.9 mmol/L	6.0 mmol/L
328	Sodium (Na)	125 mmol/L	150 mmol/L
329	Thyroid Stimulating Hormone (TSH)	0.4 uIU/mL	20 uIU/L
330	Uric Acid		12 mg/dL
331
332	Hematology
333	Hemoglobin	8.0 g/dL	18.0 g/dL
334	Platelet	20 K/uL	800 K/uL
335
336	Coagulation
337	INR		5
338
339	Urinalysis
340	Glucose		50, 100, 150, 250, 500, 750, 1000, >500, ≥1000 mg/dL
341	Nitrite		Positive
342	Casts		Any - (Waxy, EPI, WBC, RBC, Fatty, Broad, Coarse, Fine, Cellular, Granular)
343	Hyaline Casts		3/LPF
344	Crystals		Urate, Cysteine, Leucine, Tyrosine
345
346	RESPIRATORY (Blood Gas):
347	Prisma Health Baptist Columbia Respiratory Therapy Taylor at Marion Street Columbia, SC 29220	Prisma Health Baptist Parkridge Respiratory Therapy 400 Palmetto Health Parkway Columbia, SC 29212	Prisma Health Greenville Memorial Respiratory Therapy 701 Grove Road Greenville, SC 29605
348	Prisma Health Richland Respiratory Therapy 5 Richland Medical Park Drive Columbia, SC 29203	Prisma Health Tuomey Hospital Laboratory 129 North Washington Street Sumter, SC 29150
349
350	*Unless otherwise indicated, critical values apply to all ages and genders
351	PROCEDURE:	Less Than/Equal To:	Greater Than/Equal To:
352	Blood Gas
353	Arterial:
354	pH
355	0 - 1 Year:	7.19	7.50
356	1 - 150 Years:	7.24	7.59
357	pCO2
358	0 - 1 Year:	25 mmHg	71 mmHg
359	1 - 150 Years:	20 mmHg	60 mmHg
360	pO2
361	0 - 1 Year:	40 mmHg	140 mmHg
362	1 - 150 Years:	50 mmHg	n/a
363	O2 Saturation
364	0 - 1 Year:	75.4%	n/a
365	1 - 150 Years:	86.4%	n/a
366	OxyHemoglobin
367	0 - 1 Year:	75.4%	n/a
368	1 - 150 Years:	86.4%	n/a
369	CarboxyHemoglobin
370	0 - 1 Year:	n/a	7.9%
371	1 - 150 Years:	n/a	7.9%
372	MetHemoglobin
373	0 - 1 Year:	n/a	5.10%
374	1 - 150 Years:	n/a	5.10%
375
376	Venous:
377	pH
378	0 - 1 Year:	7.19	7.50
379	1 - 150 Years:	7.19	7.55
380	pCO2
381	0 - 1 Year:	25 mmHg	70 mmHg
382	1 - 150 Years:	25 mmHg	70 mmHg
383	pO2
384	0 - 1 Year:	n/a	n/a
385	1 - 150 Years:	n/a	n/a
386	O2 Saturation
387	0 - 1 Year:	60.4%	n/a
388	1 - 150 Years:	60.4%	n/a
389	OxyHemoglobin
390	0 - 1 Year:	60.4%	n/a
391	1 - 150 Years:	60.4%	n/a
392	CarboxyHemoglobin
393	0 - 1 Year:	n/a	7.9%
394	1 - 150 Years:	n/a	7.9%
395	MetHemoglobin
396	0 - 1 Year:	n/a	5.10%
397	1 - 150 Years:	n/a	5.10%
398
399	Capillary:
400	pH
401	0 - 1 Year:	7.19	7.50
402	1 - 150 Years:	7.24	7.61
403	pCO2
404	0 - 1 Year:	25 mmHg	80 mmHg
405	1 - 150 Years:	20 mmHg	80 mmHg
406	pO2
407	0 - 1 Year:	n/a	n/a
408	1 - 150 Years:	n/a	n/a
409	O2 Saturation
410	0 - 1 Year:	n/a	n/a
411	1 - 150 Years:	n/a	n/a
412	OxyHemoglobin
413	0 - 1 Year:	n/a	n/a
414	1 - 150 Years:	n/a	n/a
415	CarboxyHemoglobin
416	0 - 1 Year:	n/a	7.9%
417	1 - 150 Years:	n/a	7.9%
418	MetHemoglobin
419	0 - 1 Year:	n/a	5.10%
420	1 - 150 Years:	n/a	5.10%
421
422	Mixed Venous:
423	pH
424	0 - 1 Year:	7.20	7.56
425	1 - 150 Years:	7.20	7.56
426	pCO2
427	0 - 1 Year:	25 mmHg	70 mmHg
428	1 - 150 Years:	25 mmHg	70 mmHg
429	pO2
430	0 - 1 Year:	25 mmHg	n/a
431	1 - 150 Years:	25 mmHg	n/a
432	O2 Saturation
433	0 - 1 Year:	60.4%	n/a
434	1 - 150 Years:	60.4%	n/a
435	OxyHemoglobin
436	0 - 1 Year:	60.1%	n/a
437	1 - 150 Years:	60.1%	n/a
438	CarboxyHemoglobin
439	0 - 1 Year:	n/a	7.9%
440	1 - 150 Years:	n/a	7.9%
441	MetHemoglobin
442	0 - 1 Year:	n/a	5.10%
443	1 - 150 Years:	n/a	5.10%
444
445	Cord Blood - Arterial
446	pH	7.15	7.50
447	pCO2	n/a	n/a
448	pO2	n/a	n/a
449	HCO3	15.4 mmol/L	n/a
450
451	Cord Blood - Venous
452	pH	7.15	7.50
453	pCO2	n/a	n/a
454	pO2	n/a	n/a
455	HCO3	15.4 mmol/L	n/a
456
457	Sodium
458	NICU/Newborn Inpatient Locations:	130 mmol/L	150 mmol/L
459	All Others:
460	0 - 30 Days:	125 mmol/L	150 mmol/L
461	31 Days - 12 years:	125 mmol/L	160 mmol/L
462	>/=13 Years:	120 mmol/L	160 mmol/L
463
464	Potassium
465	NICU Inpatient Locations:	2.5 mmol/L	6.6 mmol/L
466	Newborn Inpatient Locations:	3.5 mmol/L	6.1 mmol/L
467	All Others:	2.8 mmol/L	6.5 mmol/L
468
469	Lactate	n/a	2.3 mmol/L