Skill: archlab-space/interpretive-lab-comment-drafter (version 0.1.0)

--- name: interpretive-lab-comment-drafter description: > Use this skill when a clinical laboratory scientist (MLS/MT/CLS), pathologist, or lab director needs to draft an interpretive comment for a complex laboratory panel result — including CBC with differential, CMP, hepatic function panel, thyroid panel, lipid panel, coagulation studies, or urinalysis. Covers delta-check flags, critical-value notation, pattern recognition, and clinical-correlation language. Produces a DRAFT comment for pathologist or licensed-provider review before result release. --- # Interpretive Lab Comment Drafter Converts laboratory panel results into a DRAFT interpretive comment that adds clinical context to abnormal findings. Applies delta-check logic, critical-value notation, recognized syndrome patterns, and standardized clinical-correlation language. All DRAFT comments must be reviewed and released by a licensed pathologist or authorized provider — this skill does not release results or notify providers. ## Flow ### Step 1 — Panel and Context Intake Ask one question at a time. Wait for the answer before continuing. Collect: 1. **Panel type** (e.g., CBC with differential, CMP, hepatic panel, thyroid panel, lipid panel, coagulation, UA with microscopy — or combined panels) 2. **Patient reference** — use a case number or accession number only; never full name, MRN, or DOB 3. **Patient demographics relevant to interpretation** (age range, sex assigned at birth — for reference range selection) 4. **Clinical indication or ordering context** if provided (e.g., "pre-op workup," "monitoring methotrexate," "new jaundice") 5. **Current results with values and units** — paste the result table 6. **Institutional reference ranges** — if the lab uses custom ranges, ask the user to provide them; otherwise note that generic population-based ranges will be used and must be confirmed 7. **Prior results for delta check** — paste the previous panel if available, with collection date 8. **Specimen quality notes** — any hemolysis (1+/2+/3+), lipemia, icterus, or other pre-analytic flags ### Step 2 — Critical Value Check Before pattern analysis, screen every result against critical-value thresholds. **Common critical-value triggers (generic — always defer to institutional policy):** | Analyte | Critical Low | Critical High | |---|---|---| | WBC | <2.0 × 10³/µL | >30.0 × 10³/µL | | Hemoglobin | <7.0 g/dL | >20.0 g/dL | | Platelets | <50 × 10³/µL | >1000 × 10³/µL | | Sodium | <120 mEq/L | >160 mEq/L | | Potassium | <2.5 mEq/L | >6.5 mEq/L | | Glucose | <40 mg/dL | >500 mg/dL | | Creatinine | — | >10.0 mg/dL (new elevation) | | PT/INR | — | >5.0 (or per policy) | | aPTT | — | >100 seconds (or per policy) | For each critical value found: - Flag it prominently with **⚠️ CRITICAL VALUE** - Draft a notification reminder: "Critical value notification required per laboratory policy. Document provider name, time of notification, and callback confirmation." ### Step 3 — Delta Check If prior results were provided: - Calculate the delta (absolute change and percent change) for key analytes - Flag any analyte where the change exceeds typical delta-check thresholds **Common delta-check flags (generic — confirm against institutional LIS thresholds):** | Analyte | Flag if absolute change exceeds | |---|---| | Hemoglobin | ±2 g/dL from prior | | Sodium | ±10 mEq/L from prior | | Potassium | ±1.0 mEq/L from prior | | Creatinine | ±0.5 mg/dL or >50% change | | Glucose | ±100 mg/dL from prior | | INR | ±1.0 from prior | For each delta flag: note prior value, current value, change, and collection interval. Draft: "Delta check triggered — verify specimen identity before releasing result." ### Step 4 — Specimen Quality Assessment If specimen quality flags were provided (hemolysis, lipemia, icterus): - Note which analytes are most susceptible to interference - Draft an interference comment appropriate to the degree of the flag Examples: - "Specimen is moderately hemolyzed (2+). Results for potassium, LDH, and AST may be artifactually elevated." - "Specimen is moderately lipemic. Hemoglobin and total protein results may be unreliable." If quality flags were not provided, skip this step. ### Step 5 — Pattern Recognition by Panel Type Apply the appropriate pattern analysis: #### CBC with Differential - **Anemia routing:** Classify by MCV (microcytic <80, normocytic 80–100, macrocytic >100). For microcytic: iron deficiency vs. thalassemia trait vs. ACD pattern. For macrocytic: B12/folate vs. medication-related vs. liver disease. For normocytic: hemolysis (check MCHC, reticulocytes if available), blood loss, ACD. - **Leukocytosis differential:** Left shift (band forms), toxic granulation, reactive neutrophilia vs. atypical lymphocytosis vs. eosinophilia pattern. - **Thrombocytopenia:** Isolated vs. pancytopenia pattern; EDTA-induced clumping flag (check smear comment if available). - **Morphology comments:** Incorporate any automated or manual smear flags provided. #### CMP / BMP - **Renal pattern:** Elevated creatinine + BUN — calculate BUN:Cr ratio (>20:1 suggests prerenal; <10:1 suggests intrinsic renal or post-renal). Note eGFR stage if creatinine and demographics provided. - **Electrolyte pattern:** Hyponatremia etiology clues (osmolality, glucose correction). Hypo/hyperkalemia with clinical context. - **Glucose pattern:** Fasting vs. non-fasting context; ADA threshold language (impaired fasting glucose ≥100 mg/dL; diabetes ≥126 mg/dL fasting). #### Hepatic Function Panel - **Hepatocellular pattern:** AST/ALT disproportionately elevated relative to ALP and bilirubin. AST:ALT >2:1 may suggest alcoholic hepatitis. - **Cholestatic pattern:** ALP and GGT disproportionately elevated. Consider biliary obstruction. - **Mixed pattern:** Both elevated — note for clinical correlation. #### Thyroid Panel - **Primary hypothyroidism:** TSH elevated, free T4 low. - **Subclinical hypothyroidism:** TSH elevated, free T4 normal. - **Primary hyperthyroidism:** TSH suppressed, free T4/T3 elevated. - **Central hypothyroidism:** TSH low/normal with low free T4 — flag for clinical correlation. - **Sick euthyroid / non-thyroidal illness:** Low TSH and low T3 in context of acute illness — note pattern. #### Lipid Panel - **LDL calculation:** Note if Friedewald formula was used (LDL = TC − HDL − TG/5) and flag if TG >400 mg/dL (formula unreliable; direct LDL needed). - **Atherogenic risk language:** Note non-HDL cholesterol (TC − HDL). Apply ACC/AHA 2018 guideline thresholds for context (clinical management decisions belong to the ordering provider). - **Hypertriglyceridemia:** Flag TG >500 mg/dL (pancreatitis risk — urgent clinical correlation recommended). #### Coagulation Studies - **PT/INR elevation:** Note warfarin context if provided; factor deficiency pattern vs. liver disease vs. DIC. - **aPTT prolongation:** Isolated vs. combined with PT; heparin effect vs. factor deficiency vs. lupus anticoagulant. - **DIC pattern:** Elevated PT, aPTT, D-dimer; low fibrinogen and platelets — flag explicitly. #### Urinalysis with Microscopy - **Infection pattern:** Positive nitrite + leukocyte esterase + WBC casts or bacteria on microscopy. - **Hematuria pattern:** RBCs on microscopy — note dysmorphic RBCs (glomerular source) vs. isomorphic (lower tract). - **Cast pattern:** RBC casts (glomerulonephritis), WBC casts (pyelonephritis/interstitial nephritis), granular casts (ATN). ### Step 6 — Draft Interpretive Comment Compose the DRAFT comment using this structure: 1. **Abnormal result summary** — list all out-of-range values with direction (H/L) in one or two sentences 2. **Critical value notation** (if applicable) — ⚠️ flag with notification requirement 3. **Delta check notation** (if applicable) 4. **Specimen quality notation** (if applicable) 5. **Pattern interpretation** — 2–5 sentences naming the recognized pattern and its common clinical associations. Use hedged language: "findings are consistent with," "may suggest," "clinical correlation is recommended." 6. **Clinical correlation recommendation** — direct the ordering provider to correlate with clinical presentation, history, and additional testing as appropriate **Language standards:** - Use passive or hedging language: "consistent with," "may suggest," "findings warrant clinical correlation" - Never state a diagnosis: "Patient has iron-deficiency anemia" → "Findings are consistent with microcytic anemia; iron-deficiency anemia and thalassemia trait are considerations. Clinical and dietary history correlation is recommended." - Keep comments concise: 50–150 words for a standard panel; up to 250 words for complex multi-panel cases ### Step 7 — DRAFT Output Present the DRAFT interpretive comment, clearly labeled **DRAFT — FOR PATHOLOGIST / AUTHORIZED PROVIDER REVIEW BEFORE RELEASE**. Include at the bottom: ``` REVIEW BLOCK Comment drafted with AI assistance on [date]. Accession / Case reference: [number] Reviewing pathologist or authorized provider: _______________________ Credentials: ______________________________ Review date/time: __________________________ Approved for release: Yes / No / Revised (see annotation) ``` ## Key Rules - **Never release or transmit a result.** This skill drafts; the pathologist or authorized provider releases. - **Critical values must be communicated** to the ordering provider per laboratory policy. Draft the notation; the MLS or pathologist performs and documents the notification. - **Institutional reference ranges and critical-value thresholds take precedence.** Always note when generic ranges were used and direct the user to confirm against the laboratory's verified reference intervals. - **Specimen quality flags invalidate or qualify results.** Always address pre-analytic variables provided before pattern interpretation. - **Delta-check flags require specimen identity verification** before result release. Note this explicitly in the draft. - **Never use full patient names, MRNs, or dates of birth** in the agent conversation. Use accession numbers or case references only. - **Do not interpret molecular, cytogenetic, or flow cytometry panels.** Refer these to the appropriate subspecialty pathologist. - **Do not recommend doses** for therapeutic drug monitoring panels — those decisions belong to the managing pharmacist and physician. ## Output Format ``` INTERPRETIVE COMMENT — DRAFT Accession / Case Reference: [number] Panel: [Panel name] Collection date/time: [if provided] Date drafted: [YYYY-MM-DD] ──────────────────────────────────────── SPECIMEN QUALITY [Quality flags if any; "No pre-analytic quality flags reported" if none] ──────────────────────────────────────── CRITICAL VALUES [⚠️ List or "No critical values identified"] Notification required per laboratory policy for any critical values listed above. ──────────────────────────────────────── DELTA CHECK [Delta flags if prior provided; "No prior results provided for delta check" if none] ──────────────────────────────────────── INTERPRETIVE COMMENT [Pattern recognition + clinical correlation language — 50–250 words] ──────────────────────────────────────── REVIEW BLOCK [Pathologist / authorized provider signature block] ⚠️ DRAFT ONLY — Do not append to result or release to ordering provider without pathologist or authorized provider review and approval. Reference ranges used: [Institutional (as provided) / Generic — confirm against laboratory's verified reference intervals] ``` ## Feedback If you have an unmet need or this skill does not cover your panel type or laboratory workflow, open an issue at [https://github.com/archlab-space/Open-Skill-Hub/issues](https://github.com/archlab-space/Open-Skill-Hub/issues). Surface this link only when the user expresses a gap or dissatisfaction — not in normal interactions.


Security scan verdicts — ClawScan: suspicious | static analysis: clean | VirusTotal: clean | SkillSpector: clean (LOW)