UNIVERSITY OF KENTUCKY HOSPITAL LABORATORIES 3/26/14 Lexington, KY Page 1 of 6

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1 Lexington, KY Page 1 of 6 Affected Sites: X Enterprise Chandler Good Samaritan CRITICAL VALUES: Critical Values are defined as an analytic result that suggests a clinical condition that may be lifethreatening and may require immediate clinical intervention: a qualitative result or pathological interpretation that may impact patient care and may require timely clinical intervention. BLOOD BANK: Positive Coombs test in investigation of hemolytic disease of newborn when mother is identified as also having alloantibodies. 1. Any of following during investigation of a transfusion reaction: a. Visible unexplained hemolysis in post-transfusion reaction patient sample b. New incompatible crossmatch of transfused product c. Clerical or serological error that could cause acute hemolysis in patient, such as Group A red cells transfused to Group 0 patient. d. Presence of positive gram stain or culture of implicated blood component 2. Incompatible crossmatch of red cells transfused as uncrossmatched. 3. Positive culture of transfused platelet pheresis product. CLINICAL LAB: Absolute neutrophil count <1,000 Absolute neutrophil count > 250 (Ascites or Peritoneal fluid) Bilirubin (< 6 weeks) 12.0 mg/dl Newborn 3-5 days > 12.0 mg/dl SENTINEL EVENT (infant <6wk) 30.0 mg/dl Calcium > 13.0 mg/dl < 6.0 mg/dl Carbon dioxide 40 mmol/l 10 mmol/l Fibrinogen <80 mg/dl Glucose, plasma Inpatient and outpatient 50 mg/dl or 500 mg/dl newborn: 40 mg/dl or 300 mg/dl >11 yrs 39 mg/dl spinal fluid: OD mg/dl Hematocrit <15%

2 Lexington, KY Page 2 of 6 Hemoglobin <5.0 g/dl Ionized calcium 3.0 mg/dl 6.5 mg/dl Lactate ( whole blood) >8.0 mmol/l Lactate (plasma/fluid) >8.0 mmol/l Lithium 1.5 mmol/l Malaria smear prep Positive Magnesium 1.0 mg/dl 4.5 mg/dl (non-ob patients) Partial thromboplastin time >120 sec (inpatient) > 60 sec (outpatient) Prothrombin Time pco2 INR mmhg ph Phosphorus 1.0 mg/dl po2, Arterial 60 mmhg newborn: 50 mmhg 300 Platelet count <10,000 or >1,000,000 Potassium (inpatient) 6.5 mmol/l (outpatient) 6.0 mmol/l 2.6 mmol/l Sodium 165 mmol/l 120 mmol/l WBC count (adult) <2,000 or >80,000 (infant <7 days) < 5000 Rapid HIV Positive HIV 1/HIV 2 Confirmation Positive

3 Lexington, KY Page 3 of 6 Supratherapeutic Drug Levels Acetaminophen >35 µg/ml Amikacin trough >10 µg/ml Amikacin peak >30 µg/ml Carbamazepine >15.0 µg/ml Digoxin >2.3 ng/ml Lithium 1.5 mmol/l Phenobarbital >45.0 µg/ml Phenytoin >22.0 µg/ml Salicylate >30 mg/dl Theophylline COPD >22 µg/ml Theophylline premature, apnea >13 µg/ml Valproic acid >120 µg/ml Vancomycin trough >20.0 µg/ml Vancomycin peak >40.0 µg/ml Cyclosporine transplant >400 ng/ml Gentamicin trough >2.0 µg/ml Gentamicin peak >10.0 µg/ml Sirolimus >15 ng/ml Tacrolimus transplant >25 ng/ml Tobramycin trough >2.0 µg/ml Tobramycin peak >10.0 µg/ml Modified Critical Value List for Emergency Department ONLY Hematocrit <15% ph Potassium 6.5 mmol/l 2.0 mmol/l Sodium 165 mmol/l 120 mmol/l

4 Lexington, KY Page 4 of 6 MICROBIOLOGY: Positive blood cultures smears Positive AFB smears Positive Gram stains on CSF Recovery of organisms from smear negative CSF Recovery of Mycobacterium tuberculosis when a negative smear has been reported Positive fungal direct exam (KOH) on sterile body sites Positive Fungal cultures on sterile body sites if the direct exam (KOH) was negative Recovery of yeast from sterile body fluids if the direct exam (KOH) was negative Recovery of Pseudomonas species from eye cultures Positive Cryptococcal Antigen Positive HSV PCR on CSF Positive CMV PCR (all sources) (First positive result) Positive Streptococcus pneumonia antigen on CSF ANATOMIC PATHOLOGY RESULTS: Any tests requiring a professional interpretation may be called to the attending at the discretion of the pathologist reviewing the case. A list of critical results developed by consensus is below. This communication will be noted in the final report. Cytopathology findings: Unexpected malignancy Malignancy (suspected or not) in critical location (e.g., superior vena cava syndrome, risk of spinal cord injury) All blastic/high grade leukemias/lymphoma Immunocompromised patients with bacteria or any fungi in CSF; Pneumocystis, fungi, or viral cytopathic effect in pulmonary specimens; bacteria or fungi in FNA; and acid fast bacilli in any specimen Immunocompetent patients with Pneumocystis, fungi (except for Candida) or viral cytopathic effect in pulmonary specimens; fungi in FNA specimen; acid fast bacilli in any specimen Disagreement between immediate and final diagnosis Surgical Pathology findings: Unexpected malignancy The presence of infectious organisms not previously known to the clinician (exception: dermatophytes, histoplasmosis-like organisms in old granulomas) Transplant rejection Significant disagreement between frozen section and final diagnosis Crescents in kidney biopsy specimen Vasculitis (examples: temporal arteritis, large vessel vasculitis) Bacteria in heart biopsy specimen Absent villi from suspected intrauterine pregnancy Fat in endometrial curettage specimen Mesothelial cells in heart biopsy specimen Malignancy in superior vena cava syndrome or causing paralysis Absent ganglion cells in initial rectal biopsies from infants

5 Lexington, KY Page 5 of 6 SIGNIFICANT FINDINGS RESULTING IN COURTESY NOTIFICATION Other tests results may be sufficiently significant in nature that the laboratory will attempt to make a Courtesy Notification to the authorized caregiver to advise them of the clinical findings. Factors (all) <0.1 U/mL (<10%) Factor VIII Inhibitor Inhibitor present ( 0.5 U/mL) REFERENCE LABORATORY: Kleihaur Betke Positive for fetal maternal hemorrhage Positive EBV PCR on CSF (First positive result) Positive Enteroviral PCR on CSF or blood (First positive result) Positive PRION result Notify Infection Control who will notify Hospital Safety Officer Positive VZV PCR on CSF (First positive result) Western Blot Positive for HIV The following tests are called to Infection Control nurses for inpatients for isolation purposes: Multi Drug Resistant Organisms Positive Bordetella pertussus PCR or culture Positive Clostridium difficile by PCR Positive Legionella urinary antigen, DFA or positive culture Positive MRSA PCR on a patient in the NICU (reported to RN and Infection Control) Positive MTB PCR on all sources Positive Varicella zoster PCR or culture Recovery of Campylobacter species Recovery of E. coli 0157H7 Recovery of RSV or influenza Recovery of Salmonella species Recovery of Shigella species Serologic identification of Rotavirus Called to physician or nurse in clinic (up to 2 calls as a courtesy) Positive Chlamydia cultures Positive Clostridium difficile by PCR Positive fungal cultures

6 Lexington, KY Page 6 of 6 Positive galactomannan Positive Histoplasma, Blastomyces, Streptococcal or Legionella urinary antigen Positive O&P Positive viral cultures Recovery of mycobacterium when a negative smear has been reported HISTORY: BLOCK: Replaces: LAB Significant Changes: BLOOD BANK SECTION: removed positive Coombs test Added SENTINEL EVENT Bilirubin infant <6wk 30.0 mg/dl Added : Glucose : 11 yrs 39 mg/dl Modified Lactate: from 8mmol/L to 8.0 mmol/l Modified Lithium: from > 1.5 mmol/l to 1.5 mmol/l Modified Potasium from <2.6 mmol/l to 2.6 mmol/l Modified Vancomycin trough from >25.0 µg/ml to >20.0 µg/ml Modified Vancomycin peak from >50.0 µg/ml to >40.0 µg/ml Added : HIV 1/HIV 2 Confirmation- Positive Removed approved by Chief of Staff and Pathology Dept Chairman. Approval to be given through Medical Staff Oversight Committee. Minor Changes: Removed headings Core Lab and Special Chemistry and combined them into Clinical Lab. Corrected minor typos APPROVAL BLOCK: Written by: Barbara Bush Date: Revised by: Therese Eichhorn Date: Approved by: Barbara Bush, Laboratory Manager Approval Date: 3/26/2014 Biennial Review Medical Director: Date: Date procedure retired: Approved by: P. Bachner, MD CLIA Designated Director Date: 3/26/2014