Hemostasis Critical Values Among Iranian Clinical Laboratories “National Survey of 157 Clinical Laboratories” Publisher Pubmed



Dorgalaleh A^{1, 2} ; Shiravand Y³ ; Dabbagh A¹ ; Tabibian S² ; Hosseini MS^{3, 4} ; Mansouri Tourghabeh H⁵ ; Rashidpanah J⁶ ; Narouei F⁷ ; Shams M⁸ ; Gholami MS^{9, 10} ; Saneei Moghaddam E¹¹ ; Shahreki H² Show Affiliations
Source: International Journal of Laboratory Hematology Published:2019

Abstract

Background: Immediate reporting of critical values or test results significantly outside the normal range has a growing role in the management of patients, especially in life-threatening conditions. Due to the lack of international consensus, diverse approaches are used for determination of thresholds, reporting, documentation, and follow-up. In this study, we assessed how Iranian laboratories manage critical values for hemostasis. Methods: We designed a standard questionnaire to assess different aspects of hemostasis critical values, including the number of coagulation tests with a defined critical value, critical values reporting, documentation, and follow-up policies. All results were self-reported and correctness of the data was not assessed by the authors. Results: A total of 166 (66.4%) out of 250 laboratories completed the questionnaire; most (52.4%) were private. About 97% of responding laboratories had a critical values policy. These were defined for 64.3% (n: 27) of all coagulation tests (n: 42) performed in Iranian laboratories. Activated partial thromboplastin time (APTT), prothrombin time/international normalized ratio (PT/INR), platelet count, factor XI, and factor XIII assays had defined critical values among all laboratories performing these tests. Almost all laboratories reported critical values within 1 hour, after confirmation of the result on the same sample (70% of the laboratories) or a new one (13.4% of the laboratories). State and private laboratories had the same critical value reporting policy for in and outpatients, with laboratory technicians reporting critical results to nurses, for the most part. Conclusion: Although critical value policy is widely used among Iranian laboratories, there is no consensus policy for the reporting of hemostasis critical values, or documentation, threshold determination, and follow-up processes. It is impossible to determine whether non-responding laboratories had any critical values reporting policy. Results thus are biased toward laboratories that did. © 2019 John Wiley & Sons Ltd