How to use this list
Read red flags first, then trends and optimal ranges. About 1 in 20 healthy people sits just outside a lab range by chance, so a single result a little out of range is often worth a repeat test, not an urgent referral. The thresholds below are where Vively sends a result back to a doctor whatever the rest of the picture looks like. They come from the Vively Biomarker Master List and Australian laboratory alert thresholds. The list is not exhaustive, so follow the reporting laboratory and your own scope of practice.
Same day: urgent medical care
Send the client to their GP the same day, or to an emergency department if the GP is not available, for:
- Chest pain, shortness of breath, fainting, confusion, vomiting blood, black stools or severe abdominal pain, whatever the blood results show
- Potassium below 2.8 or above 6.2 mmol/L, or sodium below 120 or above 155 mmol/L
- Glucose below 2.5 mmol/L, or a high glucose with vomiting, drowsiness or rapid breathing
- Haemoglobin below 70 g/L, platelets below 30 x109/L or neutrophils below 0.5 x109/L
- Corrected calcium above 3.0 or below 1.75 mmol/L
- ALT or AST above 10 times the upper limit, or jaundice (yellow skin or eyes)
Back to the GP soon, by marker
Full blood count
- Haemoglobin below the lab range (below 130 g/L in men and 120 g/L in women on the Master List)
- White cells, neutrophils or platelets outside the lab range on a repeat test
- MCV outside the lab range, especially with a low haemoglobin
Iron
- Ferritin below 30 µg/L with a low haemoglobin. This is iron deficiency anaemia, and the GP needs to find the cause, particularly in men and in women after menopause.
- Ferritin above 1,000 µg/L, or transferrin saturation of 45% or more. See the iron studies guide.
Inflammation
- CRP above 10 mg/L, or above 5 mg/L on a repeat test without a clear cause such as a recent infection
Glucose
- HbA1c of 6.5% (48 mmol/mol) or more, or fasting glucose of 7.0 mmol/L or more
- HbA1c of 6.0 to 6.4%, or fasting glucose of 6.1 to 6.9 mmol/L, for a GP assessment of diabetes and cardiovascular risk
- Fasting glucose below 3.5 mmol/L. See how to read insulin resistance in blood tests.
Lipids
- LDL cholesterol of 5.0 mmol/L or more, which can point to familial hypercholesterolaemia
- Triglycerides above 10 mmol/L, which raise the risk of pancreatitis
Kidney
- eGFR below 60, or falling across tests
- Creatinine rising across tests
- Potassium below 3.2 or above 5.5 mmol/L, or sodium below 130 or above 150 mmol/L
Liver
- ALT or AST above 3 times the upper limit, or any liver enzyme that stays raised or keeps rising
- Albumin below the lab range, or a raised conjugated bilirubin. See how to interpret liver function tests (LFTs).
Thyroid
Minerals and vitamins
- Corrected calcium outside 2.1 to 2.6 mmol/L
- Vitamin B12 below the lab range, or low-normal with numbness, tingling or memory change
- Vitamin D below 25 nmol/L
Symptoms that go with any result
- Unexplained weight loss, night sweats or fevers
- Fatigue that does not lift once the obvious causes are addressed
- New bleeding or bruising, blood in the stool or a change in bowel habit
- Any result the laboratory flags as critical
How to refer well
- Send a copy of the results with the lab ranges, and any earlier results that show the trend.
- Say what you are concerned about and how soon you think the client should be seen.
- List symptoms, medicines, supplements and herbs, including the products you recommended.
- Tell the client what you are referring and why, and agree who follows up.
- Keep working with the client on diet and lifestyle where it is safe, and coordinate with the GP.
Optimal ranges help you spot early change and track progress. They do not replace these red flags, and the lab range stays the primary reference.
Ordering through Vively
Most of the markers above are part of the Vively Baseline Health Check, and results come back in the practitioner platform beside your client’s earlier results. You need to be a verified practitioner to refer tests. Request free practitioner access.
Dr Michelle Woolhouse covers when to refer back to the GP in Vively Practitioner Masterclass Part 1.
When should a naturopath, nutritionist or dietitian refer a client back to the GP?
When a result is outside the lab range and new, rising, symptomatic or past a set threshold, such as haemoglobin below range, CRP above 10 mg/L, HbA1c of 6.5% or more, eGFR below 60, or TSH outside 0.5 to 5.0 mIU/L. Acute symptoms or very abnormal results need same-day care.
Is a result just outside the lab range a red flag?
Not always. Lab ranges cover the middle 95% of a reference group, so about 1 in 20 healthy people falls just outside. A small, isolated result with no symptoms is often worth repeating. A result that is well outside, rising across tests or paired with symptoms goes to the GP.
Which blood results need same-day medical care?
Very abnormal potassium, sodium, glucose or calcium, haemoglobin below 70 g/L, platelets below 30, neutrophils below 0.5, ALT or AST above 10 times the upper limit, or jaundice. Chest pain, fainting, confusion or vomiting blood need urgent care whatever the results show.
Can I keep working with a client after I refer them?
Yes, where it is safe. Referral is about getting a medical assessment, and most clients keep working on diet and lifestyle alongside their GP. Share what you are doing, list any supplements, and agree who follows up which result.
Can practitioners order these tests through Vively?
Yes. You need to be a verified practitioner to refer tests. Most of the markers on this page are part of the Vively Baseline Health Check, and results come back in the practitioner platform beside your client’s earlier results. Request free practitioner access to get started.
- Australasian Association for Clinical Biochemistry and Laboratory Medicine (AACB) and RCPA. Harmonised alert thresholds for chemical pathology.
- Royal College of Pathologists of Australasia. RCPA Manual.
- Diabetes Australia and RACGP. Management of type 2 diabetes: a handbook for general practice.
- Kidney Health Australia. Chronic kidney disease management in primary care.
- Watts GF, Sullivan DR, Hare DL, et al. Integrated guidance for enhancing the care of familial hypercholesterolaemia in Australia. Heart, Lung and Circulation. 2021.
- Kwo PY, Cohen SM, Lim JK. ACG clinical guideline: evaluation of abnormal liver chemistries. American Journal of Gastroenterology. 2017.