Phoning limits for biochemistry tests are as follows:
| Below | Above | Units | Notes | |
| 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 | Heartlands will phone Antenatal > 11 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 | Or increase > 85 umol/L in 24 h | |
| 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 | mg/L | CRP >300 mg/L phoned with other abnormal results | ||
| Salicylate | 20 | mg/L | ||
| Paracetamol | 10 | mg/L | ||
| Ammonia | All phoned | |||
| Lactate | All phoned | |||
| beta-HCG | All EPAU & A&E phoned | |||
| progesterone | All EPAU & A&E 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
| Haemoglobin | White 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 |
| Platelets | Clotting 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
