CRITICAL VALUE

ON MEDICAL
LABORATORY
A.A.Wiradewi Lestari
 Nilai Kritis
adalah suatu hasil pemeriksaan lab yang
abnormal dan mengindikasikan kelainan
atau gangguan yang dapat mengancam
jiwa dan memerlukan perhatian/ tindakan
Regulation of Critical Values

 The Joint Commission National Patient Safety

Goals
 Documentation & read back
 Define Critical Values and Critical Tests

 CAP Checklists
 Procedure, documentation, read back,
turnaround times
Patient Safety
 No Hospital Delayed (admin, nursing and
Lab)
 Stat test (TAT <<)
 Report Critical Value Immediately

 Regarded as Stat test

 New In-Patient
 Emergency room
 ICU & NICU
Test Result Depend on :
 Patient Factor
Pre-analytical Variation
Biological Variation
Interference substances (metabolic
component)
Medicine
Test Result Depend on :
Good Laboratory Practice
Quality Management System
Test Method
Reagent

 Analytic variation < (good precision)

Reference Range
Method
Reagent
Race
Age
Time of specimen collection
HOW ARE CRITICAL CUTOFFS DETERMINED ?
 Medical Practice Committees
 Experience
 Usually represent diverse group of
physicians with unique perspectives
 Specific clinical needs: eg. Special Programs
 Understand the resources and limitations of the

system

 Value: Clinician perspective

Best Strategy for Determining
Critical Level
 Compare to peers
 Literature
 Local, national
 Medical input
 Service groups
 Medical Practice Committee
PELAPORAN
 Lakukan pengulangan pemeriksaan di alat
 Lihat histori hasil
 Publish hasil di sistem
 Menghubungi dokter/perawat/pasien
 Mencatat nama penerima laporan
 Print hasil
 Stempel nilai kritis
 Kirim hasil
DAFTAR NILAI KRITIS LAB
Parameter Batas Bawah Batas Atas
Glukosa Darah < 60 mg/dl > 400 mg/dL
Natrium < 120 mmol/l > 160 mmol/L
Kalium < 2,5 mmol/l > 6,0 mmol/L
Calcium < 7 g/dl > 12 g/dl
Hemoglobin < 8 g/dl ; > 18 g/dl
CKD < 6 g/dl
Trombosit (pertama < 100.000/l > 800.000/l
kali pemeriksaan)
WBC < 1000/l > 20.000/l
APTT ; > 100 detik
dan APTT khusus
pasien yang sedang
diheparinisasi.
Parameter Batas Batas atas
Bawah
INR >3
HCT atau ≥ 50 % saat pasien baru
masuk rumah sakit atau
peningkatan HCT ≥ 20% dari
hasil sebelumnya
CK-MB mass > 2 X batas atas Nilai Normal
Troponin positif
Myoglobin positif
PARAMETER LAIN
Parameter Batas Bawah Batas atas
pH (AGD) <7.20 >7.58
pCO2 <9 mmHg >65 mmHg
pO2 <40 mmHg
Ammonia > 100 mg/dl
(59 mmol/l)
Terima kasih