What stat labs can be ordered in a clinical setting?

Stat Laboratory Tests Available in Clinical Settings

Stat laboratory tests that can be ordered in a clinical setting include complete blood counts, basic metabolic panels, cardiac markers, coagulation studies, blood gases, urinalysis, and liver function tests. 1

Core Stat Laboratory Tests

Hematology

• Complete blood count (CBC) with differential, including hemoglobin, hematocrit, and platelet count 1
• Coagulation studies including prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT) 1

Chemistry

• Basic metabolic panel including:
  • Electrolytes (sodium, potassium, calcium, magnesium) 1
  • Renal function tests (blood urea nitrogen, creatinine) 1
  • Glucose 1
• Liver function tests (transaminases, bilirubin) 1
• Cardiac markers:
  • Troponin I or T (high-sensitivity assays preferred) 1, 2, 3
  • Brain natriuretic peptide (BNP) or N-terminal proBNP 1
• Blood gas analysis (arterial or venous) 1, 4
• Serum drug concentrations, particularly for medications requiring therapeutic monitoring 1

Urinalysis

• Standard urine studies including microscopic analysis 1
• Urine toxicology screens 1

Specialized Stat Tests

Critical Care Setting

• Lactate levels for sepsis evaluation 1
• Ammonia levels for altered mental status evaluation 5
• Ionized calcium 1
• Phosphorus 1

Pediatric-Specific Tests

• Serum bilirubin levels (total and direct) 1
• "Micro" samples capability for pediatric patients (samples <1 mL) 1

Bleeding/Coagulation Assessment

• Fibrinogen 1
• D-dimer 1

Important Considerations for Stat Testing

Ordering Practices

• Order diagnostic tests in response to specific clinical questions rather than at regular intervals (e.g., daily) to reduce iatrogenic anemia and unnecessary costs 1
• Consider the clinical context when interpreting results, as many conditions can cause abnormal values (e.g., elevated troponin in sepsis, renal failure) 6

Technical Aspects

• Point-of-care testing options are available for many stat tests, including troponin, blood gases, and basic chemistry panels 3
• Results should be available within minutes to hours depending on the test 1
• High-sensitivity assays (particularly for cardiac markers) provide better diagnostic accuracy 2

Pediatric Considerations

• Equipment should be available to process common tests using "micro" samples (<1 mL) for pediatric patients 1
• Age-appropriate reference ranges should be used for interpretation 1

Common Pitfalls

• Ordering routine daily labs without specific clinical indications can lead to iatrogenic anemia, unnecessary transfusions, and increased costs 1
• Interpreting elevated cardiac troponin as always indicating acute coronary syndrome when it can be elevated in many non-cardiac conditions 6, 7
• Using venous blood gases as direct substitutes for arterial measurements for oxygenation assessment 4
• Failing to consider pre-analytical factors that may affect test results, such as hemolysis affecting potassium levels 1

By understanding the range of available stat laboratory tests and their appropriate use, clinicians can make timely diagnostic and treatment decisions that directly impact patient morbidity and mortality.