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Interpretation
Decision support only. Results are interpreted against the lab's ranges where pasted, otherwise typical UK adult ranges; local laboratory ranges, critical limits and referral pathways vary. Always interpret in clinical context. Pasted text stays in your browser – nothing is sent or stored.
Quick reference
Same-day thresholds used
| Test | Same-day action |
|---|---|
| Potassium | 6.5 or more, or 2.5 or less (6.0–6.4: repeat today, ECG) |
| Sodium | Under 125 (120 or less critical), or 155 or more |
| Adjusted calcium | 3.0 or more (3.5 critical), or 1.8 or less |
| Creatinine | AKI stage 2–3 (2× baseline or more); 354 or more with no baseline |
| Hb | 60 or less; under 80, or a fall of 20 g/L or more – urgent review |
| Neutrophils | 0.5 or less (under 1.0 urgent) |
| Platelets | 30 or less, or 1,000 or more |
| WCC / film | WCC 100 or more; blasts, red cell fragments |
| Glucose | 25 or more (20 or more without known diabetes) – ketones; 2.5 or less |
| ALT/AST | 600 or more |
| CRP | 300 or more (100 or more – same-day review) |
| CK | 5,000 or more |
| INR (warfarin) | 8 or more – stop warfarin, oral vitamin K |
| Lithium / digoxin | 1.5 or more / 2.5 or more |
| TSH / free T4 | TSH 100 or more / fT4 50 or more |
| Triglycerides | 20 or more – urgent lipid clinic |
| 9am cortisol | Under 100 – adrenal insufficiency likely |
Based on RCPath critical result guidance (G158) and typical UK laboratory telephone limits. Your lab's limits may differ.
Myeloma screen
- Screen: serum protein electrophoresis and serum free light chains (or urine Bence Jones protein), with FBC, calcium and creatinine (NICE NG12).
- Free light chain ratio under 0.1 or over 7, Bence Jones protein, or paraprotein with hypercalcaemia, renal impairment or anaemia → urgent haematology (2WW).
- Renal range for the ratio: 0.37–3.1.
- Paraprotein IgG 15 g/L or more, IgA/IgM 10 g/L or more, light chain or IgD → refer haematology.
- Smaller paraprotein, no CRAB, normal ratio → probable MGUS: repeat at 3–4 months, then 6–12 monthly; refer if rising by 25% or more.
Liver: BSG pattern and screen
- R ratio = (ALT ÷ ULN) ÷ (ALP ÷ ULN): over 5 hepatocellular, under 2 cholestatic, 2–5 mixed.
- Liver screen: hepatitis B sAg, hepatitis C antibody, AMA/SMA/ANA, immunoglobulins, ferritin + transferrin saturation, ultrasound; alpha-1 antitrypsin; caeruloplasmin if under 40; coeliac serology.
- FIB-4 = age × AST ÷ (platelets × √ALT): under 1.3 (2.0 if 65+) low risk; over 3.25 high risk – refer; between – ELF or FibroScan.
PSA age thresholds (NICE NG12)
| Age | Refer if PSA above (µg/L) |
|---|---|
| 40–49 | 2.5 |
| 50–59 | 3.5 |
| 60–69 | 4.5 |
| 70–79 | 6.5 |
| Under 40 or 80+ | Clinical judgement |
Double the PSA on finasteride or dutasteride. Avoid testing within 48 hours of ejaculation or vigorous exercise, or within 6 weeks of a UTI.
Autoantibodies
- ANA: 1:80 or lower is common in healthy people; usually significant at 1:160 or more with clinical features. Follow with ENA, dsDNA, C3/C4, urine.
- Anti-CCP: highly specific for RA. Refer any persistent synovitis urgently regardless of RF/CCP (NICE NG100).
- PR3/MPO-ANCA: vasculitis – same-day discussion if renal involvement.
- tTG IgA: only valid with normal total IgA and gluten in the diet for 6 weeks. 10× ULN or more – symptomatic adults may be diagnosed without biopsy (BSG).
- AMA + raised ALP: PBC. SMA/LKM + raised ALT/IgG: autoimmune hepatitis.
- Antiphospholipid: confirm with a repeat after 12 weeks.
Thyroid (NICE NG145)
- Subclinical hypothyroidism: repeat in 3 months; consider levothyroxine if TSH 10 or more twice, or a 6-month trial if under 65 with symptoms.
- Overt hyperthyroidism: refer endocrinology; TRAb.
- Low TSH with low fT4: possible pituitary disease – check 9am cortisol before levothyroxine.
- After a levothyroxine dose change, recheck TFTs at 3 months.
Sources
RCPath G158 critical results; UK Kidney Association hyperkalaemia 2020; NICE NG12, NG20, NG23, NG28, NG49, NG100, NG106, NG132, NG145, NG148, NG158, NG203, NG219, NG238, PH38, DG11, DG56; NICE CKS; BSG abnormal liver tests 2018, iron deficiency anaemia 2021 and coeliac guidance; BSH (B12/folate 2014, haemochromatosis 2018, CLL, paraproteins); BSR/SPS DMARD monitoring; Society for Endocrinology; BSSM; National Osteoporosis Society vitamin D; BNF.