changes to hematology alert and critical values

CLIENT NOTICE
CHANGES TO HEMATOLOGY ALERT AND CRITICAL VALUES WILL BE IMPLEMENTED
ON MAY 25, 2015.
Harmonization of laboratory practices at Legacy LifeLabs and Legacy CML is important in order
to provide our clients with consistent service. In the course of harmonizing hematology
processes at Legacy CML and Legacy LifeLabs, changes to the Legacy CML hematology
critical and alert values will be implemented effective May 25, 2015. This change is required in
order to align this process with the recommendations from the Ontario Association of Medical
Laboratories (OAML) Guidelines for Reporting Laboratory Test Results.
What does this mean for our Legacy CML clients?
The changes to the Legacy CML hematology alert and critical values are listed below. Note
that values for hemoglobin and INR are no longer different on weekdays and weekends and that
total WBC, fibrinogen, and RBC fragments with low platelet count will no longer be considered
critical values. Additionally, all d-dimer results (positive or negative) will be classified as alert
values instead of critical.
Analyte
*Critical
Hemoglobin
Critical High
Absolute
Neutrophil Count
**Alert High
Absolute
Neutrophil Count
Total WBC
Morphology
Critical High INR
Alert High INR
Fibrinogen
Alert Blasts
D-Dimer
Current Limit
≤70g/L
(weekend only)
>150x109L
New Limit
<60g/L
Reason for Change
>100x109L
9
9
>20x10 /L
>50x10 /L
<0.5
>5% RBC fragments with
low platelet count
>5.9
>3.6
(weekdays only)
<0.5
>2% blasts with anemia,
neutropenia, or
thrombocytopenia
N/A
N/A
Alignment with OAML
Guideline and Legacy
LifeLabs
>6.0
>4.5-6.0
N/A
>0x109/L
>500µg/L
All values
called as alert
Alignment with Legacy
LifeLabs and
recommendation made to
OAML
Client service and patient
care improvement
*Critical values: Called to ordering physician 24hours a day, 7 days per week
**Alert values: Communicated (fax or phone) to the ordering physician between 8am and 8pm,
7 days per week
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The following hematology critical and alert values have not changed:
Analyte
*Critical
**Alert
Low
High
Low
High
Hemoglobin
<60g/L (weekdays)
<80g/L
>200g/L
Absolute Neutrophil Count
<0.5x109/L
<1.0x109/L
9
Absolute Lymphocyte Count
>250x10 /L
Platelet Count
<20x109/L
<50x109/L
Morphology
 All positive malaria smears
 Intracellular bacteria in WBC
INR
>6.0
>4.5
aPTT
>100s
>80s
*Critical values: Called to ordering physician 24hours a day, 7 days per week
**Alert values: Communicated (fax or phone) to the ordering physician between 8am and 8pm,
7 days per week
A copy of the OAML Guidelines for Reporting Laboratory Test Results can be found at
www.oaml.com.
For further information or questions regarding the above changes, please contact:
Miranda Wozniak, MD FRCPC
Discipline Head – Hematology
Medical-Scientific Department – Ontario
Email: miranda.wozniak@lifelabs.com
Tel: 416-675-4530 ext 2040
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