Critical values

[Sherif Abd El Monem]

Hello everyone, in an oncology hospital, critical values should be provided for all labs, including the blood bank. Can anyone share their SOPs that contain these critical values?

 

[Cliff]

BB critical values are not so easy.

A new titer that is a certain cut-off.

A change in a previous titer of a specific number of dilutions.

[Neil Blumberg]

We have no critical values in the Blood Bank and we have a cancer center that sees thousands of patients per month.

And it is my recommendation that critical values be restricted to truly life threatening conditions that require treatment within minutes to hours (e.g., very high or low potassium).  I would most definitely NOT have critical values for things like creatinine/BUN, liver function tests, MCV, white count, etc.  Provides no clinically actionable information acutely, and wastes a lot of time in the lab and amongst practitioners.

[Sherif Abd El Monem]

4 hours ago, Neil Blumberg said:

We have no critical values in the Blood Bank and we have a cancer center that sees thousands of patients per month.

And it is my recommendation that critical values be restricted to truly life threatening conditions that require treatment within minutes to hours (e.g., very high or low potassium).  I would most definitely NOT have critical values for things like creatinine/BUN, liver function tests, MCV, white count, etc.  Provides no clinically actionable information acutely, and wastes a lot of time in the lab and amongst practitioners.

Thanks Dr Neil.

[MAGNUM]

I have no critical values in our blood bank. Although if we have a positive DAT on a baby we call it, and we call the floors to update them if we have antibodies.

[DebbieL]

Things I have listed in my procedure:

1. If we have discovered an antibody on a patient who is about to go to surgery, we call the nurse in charge of the patient in Surgery Holding to let the physician know blood may not be available. The doc needs to know before the patient goes under the knife. Sometimes they delay the surgery and sometimes they proceed with caution.  (This issue can be avoided with a pretesting process that not all physicians use)

2. If we have a serious transfusion reaction due to ABO incompatibility, we would contact the patient physician and our pathologist immediately. 

3. We can't ID the antibody and the physician has requested RBC transfusion. Depending on the condition of the patient, they may still proceed with incompatible or least incompatible blood and sign a Medical Release or will probably wait until we can ID. It is up to the physician to make the call based on the patient. 

4. When we had babies, we considered a positive DAT as a critical result from the BB side and would call L/D.

[Neil Blumberg]

I agree with the procedures above. But these are basic urgent communications required of any clinical service,  and I wouldn't characterize them as critical values, which are emergencies.  Perhaps it's just semantics :).

Edited October 25, 2023 by Neil Blumberg

[jnadeau]

We call them "Alerts" - new hemolytic antibody identified during pregnancy, pos DAT on baby, transfusion error or serious trx, no compatible units for a specific patient or delay of product.  It's called and documented in the computer.