Reflex or Supplementary Testing

Reflex testing

For some laboratory tests, when certain criteria are met, additional testing will be generated to provide more conclusive laboratory information for diagnosis and treatment.

TEST

REFLEX CRITERIA

ADDITIONAL TESTS

Accucheck Glucose

< 50 or > 450 mg/dl

Glucose, Blood (no charge)

ANA Screen for Reflex

> or = 1.0

Centromere, dsDNA, SSA,SSB, RNP, SM, Scleroderma

Antibody Screen (Blood Bank)

Positive

Positive - surgery patient

Antibody Identification (panel)

Antibody Identification (panel) with 2 XM compatible units

C. difficile Toxin Panel
by EIA

Disagreement with the EIA antigen and toxin results or an invalid result

Molecular C. difficile Toxin assay

CBC with Diff

Abnormal Automated Diff
(Flags Generated by Analyzer)

Manual Diff & Peripheral Smear Review/Consult Hematology by Pathologist (as needed)

Celiac Disease
Comprehensive Panel
*   Tissue transglutaminase
     IgA

*   IgA




Positive


<10 mg/dl



Endomysial Ab Screen


Tissue transglutaminase IgG

Cryptococcal Antigen

Positive

Cryptococcal Titer

Fetal Screen (Blood Bank)

Positive

Fetal Hemoglobin Stain

Hepatitis C Virus Antibody

Reactive

HCV Quantitative RNA,
(HCV Viral Load)

Hgb Electrophoresis

Band in S position

Sickle Prep (if not previously performed) and citrate agar Hgb electrophoresis for Sickle disease confirmation.

Hgb Electrophoresis


Hgb Electrophoresis

Band in C (or other abnormal) position

Rare Hgb

Citrate agar Hgb electrophoresis

HPLC Hgb electrophoresis

HIV Combo Ab/Ag:
HIV-I and HIV-2 Antibody &
HIV-1 p24 Ag

Reactive

HIV-1 & HIV-2 Differentiation
Negative for both HIV-1 and HIV-2 Ab

HIV-1 & HIV-2 Differentiation

HIV-1 RNA, Viral Load


HSV, IgM Screen


Positive


HSV, IgM Titer

 

 

IFE
(Immunofixation Electrophoresis)

Abnormal electrophoresis
suggestive of
monoclonal protein

SPE
(Serum Protein Electrophoresis)

Islet Cell Ab

Positive

Islet Cell Titer

Lupus Anticoagulant Panel

• dRVVT Screen

• PTT La Sensitive

 

• Positive/ Elevated

• Elevated

 

• dRVVT Confirmatory

• Hepzyme Neutralization

• Hexagonal Phase Neutralization (if needed)

Lyme Antibody

Positive

Lyme Western Blot

Myoglobin/Hgb Screen (Urine)

Positive

Myoglobin, Quantitative

Platelet Function Test

Collagen EPI >201

Collagen/ADP

RPR

Reactive

RPR Titer

Sickle Prep

Positive

Hgb Electrophoresis for both C and S Hgb differentiation

SPE
(Serum Protein Electrophoresis)

Abnormal electrophoresis suggestive of monoclonal protein

IFE
(Immunofixation Electrophoresis)

Streptozyme

TSH, Reflexive

VDRL, CSF

Positive

<0.27 or >4.20 uIU/mL

Reactive

Anti-Streptolysin O

Free T4

Titer

SURGICAL PATHOLOGY

 Breast or metastatic

 Breast


 Colon resections


 Esophagogastric junction
  (distal esophagus)

 HER2NEU

 Glioma (brain)

 Lung (initial biopsy)


 

All stomach biopsies

    REFLEX CRITERIA

 Breast Cancer

 Ductal carcinoma in-situ
    (DCIS)

 Colon Cancer


 Adenocarcinoma


 2+

 Glioma

 Squamous cell/non-small cell/
 large cell, adenocarcinoma


 Adenocarcinoma

    ADDITIONAL TESTS

ER, PR, HER2, Ki-67

ER


MMR


HER2 by IHC

HER2 by FISH or CISH

MDM2

ALK gene rearrangement by FISH, EGFR and PD-L1, ROS-1


HER2 by IHC

 

Supplementary Testing

Supplementary testing will automatically be performed for the tests below, which may be billed separately.

Initial Test

Supplementary Test(s)

AFB Culture

Anaerobic Culture

Body Fluid Culture

Coagulogram


Cryptococcal Antigen, CSF

AFB Smear

Aerobic Culture

Gram Stain

Peripheral Smear Review by Pathologist plus indicated Factor Assays/Tests

CSF CUlture

Directogen CSF

CSF Culture

E. Coli 0157

Stool Culture, Campylobacter

External Culture

Gram Stain

Eye Culture

Gram Stain

Fungus Culture

KOH and/or Wright Stain

Genital Culture

Gram Stain

Electrophoresis, Hemoglobin

Peripheral Smear Review by Pathologist

Electrophoresis, Protein

Total Protein

Electrophoresis, Immunofixation (IFE) Serum


Electrophoresis, Immunofixation (IFE) Urine

Microalbumin, Random Urine

Immunoglobulins
   (IgA,IgG,IgM)

Urine Creatinine, Urine Protein

Urine Creatinine

Respiratory Culture

Gram Stain

Stool Culture

Campylobacter

Surgical Specimen Culture

Urinalysis with reflex to culture

Gram Stain

Urine Culture if >10 WBC's

1-800-948-6262

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