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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: 4.2
Effective: 2022/09/29

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.

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 <110 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.