Hematology

Upper alert

thresholds

Lower alert

thresholds

Parameter
≥۱۰۰ × ۱۰۳ /μL ≤۲.۰ × ۱۰۳ /μL White Blood Cell Count
Infant                    ≥۲۳ g/dL

Adult & Pediatric    ≥۲۰ g/dL

Infant                          ≤۸.۵ g/dL

Adult & Pediatric         ≤۷ g/dL

Hemoglobin
>71% (L/L) (L/L)  <33% Hematocrit (Infant)
> 60 % (outpatients) < 15 %(inpatients)

<25%(outpatients)

Hematocrit (Adult & Pediatric)
Pediatric      ≥۱۰۰۰ × ۱۰۳ /μL

Adult           ≥۱۰۰۰ × ۱۰۳ /μL

Pediatric           ≤۲۰ × ۱۰۳ /μL

Adult               ۲۰-۵۰ × ۱۰۳ /μL

Platelet Count
>50 × ۱۰۳ /μL <0.5× ۱۰۳ /μL Neutrophils
Presence of intracellular organisms.
Blasts on peripheral smear (1st time or relapse only), sickle cells.

[New diagnosis of leukemia , sickle cell anemia , Aplastic crisis]

Slide Review/Diff
Positive Malaria Screening
WBC ≥۱۰۰ Cells/mcL

(excluding peripheral blood contamination: traumatic tap)

Blast or Tumor cells CSF Count
Intracellular organisms, Blast or Tumor cells to be called as soon as a provider is available, which for inpatients is immediate, for others called next business day Other body fluid
>40 sec Prothrombin Time
≥ ۵.۰ INR
>75 sec Activated Partial Thromboplastin Time (APTT)
>45 sec APTT-LA
<100 mg/dL Fibrinogen
Positive Fibrin monomers
Positive D-dimers
≤ ۵% Factors II, V, VIII, IX, XI
≤ ۶% Factor VII
≤ ۷% Factor X
≤ ۵% Factor XIII, Activity
<25% Protein C
<20% Protein S
< 50% Antithrombin (AT)
<100% APCR
>42 sec DRVVT
Positive Direct & Indirect Anti Globulin Test; Coombs (DAT & IAT) on cord blood
Positive Titer of significant RBC alloantibodies during pregnancy

 

Morphology findings that trigger critical result notification

  • Acute leukaemia (>20% blasts)* and Acute Promyelocytic leukaemia*
  • Parasites including Malaria*
  • Blood film suggestive of Thrombotic micro-angiopathic anaemia*
  • Blood film showing bacteria*

 

*Urgent notification of laboratory haematologist of these cases is also required.

 

References

  1. ARUP Laboratories
  2. Stanford Anatomic Pathology & Clinical Laboratories
  3. Mayo Medical Laboratories
  4. Department of LABORATORY MEDICINE, University of Washington.
  5. Keng TB, De La Salle B, Bourner G, Merino A, Han JY, Kawai Y, Peng MT, McCafferty R. Standardization of haematology critical results management in adults: an International Council for Standardization in Haematology, ICSH, survey and recommendations. International Journal of Laboratory Hematology. 2016 Jul 1..
  6. Thomas L. Critical limits of laboratory results for urgent clinician notification. EJIFCC. 2003;14:1-8.
  7. Emancipator K. Critical values: ASCP practice parameter. American journal of clinical pathology. 1997 Sep 1;108(3):247-53.
  8. McFarlane A, Aslan B, Raby A, Bourner G, Padmore R. Critical values in Hematology. International journal of laboratory hematology. 2015 Feb 1;37(1):36-43.

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