When a specific allergen gains acess to the circulation, the allergen can react with basophils of the blood and mast cells in the tissues located immediately outside the small blood vessels, if the basophils and masts cells have been sensitized by the attachment of IgE reagins. This can be followed by a widespread allergic reaction throughout the vascular system and closely associated tissues, referred to as anaphylaxis, which can lead to forensic consequences.
In forensic medicine, critical values established in isolation without appropriate escalation policies or sophisticated algorithms can lead to tragic consequences.
The purpose of this article is not to review the formulation of a critical value list, non-critical “critical values”, setting goals and measuring your laboratory performance, establishing up-to-date, clinically oriented algorithms, escalation policy and how outpatient critical values are reported, but to show what can occur when these goals are not well thought out or implemented, the consequences of which can have a negative impact on patient safety.
For laboratory values to be clinically meaningful, both in Clinical Pathology and Forensic Medicine, an escalation policy and or a sophisticated algorithm should be in place, which interpret laboratory values, that on face are not in themselves critical, but taken in concert with other values, and if provided, the patients underlying medical condition, will recognize these values are ‘critical’ for they portend a life-threatening situation for the patient. The following case will illustrate what can occur when these goals are not met.
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