Reflex or Supplementary 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.

Reflex testing

Test

Reflex Criteria

Additional Tests

Accucheck Glucose

< 60 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

Antibody Identification (panel)

Anti-Reticulin

C. difficile Toxin Panel
by EIA

Positive

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

Anti-Reticulin Titer

Molecular C. difficile Toxin assay

Cat Scratch Disease Abs

Positive

Cat Scratch Disease Ab Titers

CBC with Diff

Abnormal Automated Diff
(Flags Generated by Analyzer)

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

Celiac Disease
Comprehensive Panel
*   Tissue transglutaminase
     IgA

*   IgA




Positive


Below the lower limit of
reference range for that
age patient



Endomysial Ab Screen


Tissue transglutaminase IgG

Cryptococcal Antigen

Endomysial Antibody

Positive

Positive

Cryptococcal Titer

Endomysial Titer

Fetal Screen (Blood Bank)

Positive

Fetal Hemoglobin Stain

Hepatitis C Virus Antibody

Reactive

HCV Qualitative RNA, TMA

HER2NEU

2+

FISH

Hgb Electrophoresis

Band in S position

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

Hgb Electrophoresis

Band in C position

Citrate agar Hgb electrophoresis

HIV I and HIV 2 Antibody

Reactive

HIV I Western Blot

HSV, IgM Screen

Positive

HSV, IgM Titer

 

 

IFE
(Immunofixation Electrophporesis)

Abnormal electrophoresis
suggestive of
monoclonal protein

SPE
(Serum Protein Electrophoresis)

Islet Cell Ab

Positive

Islet Cell Titer

Lupus Anticoagulant Panel

• dRVVT Screen

• aPTT

 

• Positive

• Abnormal

 

• dRVVT Confirmatory
   & Ratio aPPT

• aPTT Normal Pool  Mix
   & aPPT Saline Mix

Lyme Antibody

Positive

Lyme Western Blot

Myoglobin Screen (Urine)

Positive

Myoglobin, Quantitative

Platelet Function Test

Collagen EPI >201

Collagen/ADP (CADP)

Rickettsial Antibodies

Positive

IgG or IgM Titer

Rocky Mountain Spotted Fever

Positive

IgG or IgM Titer

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

Positive

<0.27 or >4.20 uIU/mL

Anti-Streptolysin O

Free T4

Urine Glucose <10 yrs

Negative

Reducing Substances

VDRL, CSF

Reactive

Titer

 

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

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) Immunoglobulins
   (IgA,IgG,IgM)

Respiratory Culture

Gram Stain

Stool Culture

Campylobacter

Surgical Specimen Culture

Gram Stain

Physicians/Clinics Specific Testing

Physicians/Clinics requesting specific reflexing criteria must sign a reflex agreement which is kept on file in the compliance office and/or by the outreach representative. (Eg. Urinalysis)

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