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Critical Results & Findings in Hematological Pathology - Job Aid

Any clinically significant changes, should also be addressed/called.

Department of LMMD
Division of Hematological Pathology

HPG-5.3.3.1
Version: 4.0
Effective: 2021/09/07

E-Authorized by: Division Head
Hematology Critical Result List
Parameter Patient type Low High Comments
White Blood Cell Bloorview ≤ 1.0 x 109 /L ≥ 20.0 x 109 /L Call ALL critical results
White Blood Cell Adult ≤ 1.0 x 109 /L ≥ 50.0 x 109 /L
  1. ALL 1st time critical results (no previous critical result) must be called.
  2. Results from subsequent specimens that fall above/below the critical limit, and then again exceed the critical value must be called.
White Blood Cell Adult (HC site) ≤ 3.0 x 109 /L ≥ 20.0 x 109 /L
White Blood Cell Neonate ≤ 1.0 x 109 /L ≥ 50.0 x 109 /L
Hemoglobin Adult ≤ 70 g/L ≥ 190 g/L
Hemoglobin Adult (HC site) ≤ 85 g/L ≥ 190 g/L
Hemoglobin Neonate ≤ 70 g/L
Platelet Adult ≤ 50 x 109 /L ≥ 1000 x 109 /L
Platelet Adult (HC site) ≤ 100 x 109 /L ≥ 1000 x 109 /L
Platelet Neonate ≤ 50 x 109 /L ≥ 1000 x 109 /L

Neutrophil
(Absolute)

ALL ≤ 0.5 x 109 /L
  1. Call ALL 1st time critical result (no previous critical result).
  2. Call result when the patient service has changed (e.g. OCC to ED).
Body Fluid
CSF White Cells ALL > 30.0 x 106 /L

Call 1st time for current visit

Note: Research CSF specimens will not be called to the ordering physician or hematopathologist.
White Cells in Ascites/Peritoneal fluids ALL > 100.0 x 106 /L

Morphological findings

Blood Films CSF Other Body Fluids Comments
Internal External

Blasts and blast equivalents
e.g. abnormal promyelocytes (M3), promonocytes

• Call 1st occasion when criteria is encountered.

∇ Known patient
   Call 1st sample of this visit.

*If body fluid sampling site is unclear, use internal criteria

NOTE:
The findings listed must be confirmed by the senior technologist (or designate) when available.

Lymphoma cells
Abnormal cells

Microorganisms
e.g. bacteria, parasites, etc.

•∇ •∇ •∇*

Sickle cells
e.g. sickling hemoglobinopathy

Fragments & thrombocytopenia
e.g. suspicious for microangiopathic haemolytic anemia

Coagulation Critical Result List
Parameter Patient type Critical Range Comments
APTT ALL ≥ 85.0 seconds Call ALL critical results
INR ALL ≥ 5.00
Fibrinogen ALL ≤1.00 g/L
Family Practice: INR ALL ≤1.50 and ≥ 3.00
Heparin Induced Thrombocytopenia ALL Positive
Factor Assays ALL ≤0.01
Trauma Result List
Parameter Patient type Abnormal Range Comments
Hemoglobin ALL ≤100 g/L Call ALL critical results
Platelet ALL ≤100 x 106/L
Fibrinogen ALL ≤2.0 g/L
INR ALL ≥1.5

References

  1. Developed at Sunnybrook Health Science Centre, 2004. Updated 2017, 2021.