Chandler Medical Center
Department of Pathology and Laboratory Medicine
University Hospital Laboratories
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Department of Pathology and Laboratory Medicine
Reflex Testing
2004

Section Procedure Condition Reflex test (incurs additional charge)
Blood Bank type and screen or crossmatch screen positive antibody identification
atypical antibody present panels(reagent red cells of known antigenic activity)
elution of antibodies from red cells
phenotype determination
direct anti-human globulin(Coombs) test with multiple antisera
autoadsorbtion (or other method) to reduce effects of autoantibodies on test results
consultation report of findings/recommendation
bone marrow/stem cell transplant recipient if reverse group is unexpected positive indirect anti-human globulin test (indirect Coombs test)
Antibody screen No blood bank history ABO/Rh
Direct Antiglobulin Test and Indirect Coombs Test with A1 or B cells when BMT patient's ABO/Rh type is to be changed post-transplant to ABO/Rh type of BMT donor Direct Antiglobulin Test and Indirect Coombs Test with A1 or B cells
Bone Marrow Lab Bone Marrow specimen New adult patient or patient without bone marrow collection in past 12 mos., no recent iron stain, anemia, or previous abnormal iron stain Iron stain (Note: This is considered part of standard bone marrow evaluation in most institutions in addition to routine morphologic stains.)
Core Lab lupus inhibitor positive ratio
urinalysis with reflex micro positive blood urine microscopic
positive esterase urine microscopic
positive nitrite urine microscopic
protein > 2+ urine microscopic
child <1 y.o. Clinitest
urinalysis child <1 y.o. Clinitest
ANA positive screen titer
DNA positive screen titer
AMA positive screen titer
SMA positive screen titer
Hemoglobin Electrophoresis Band at SDG or CEO sickle cell prep to confirm S
citrate agar to confirm S or C
WBC nucleated red cells present w/ no differential ordered differential (to correct for nucleated reds miscounted as white cells)
Cytology Respiratory cytology (bronchial, BAL) Immunocompromised patient or suspected infection GMS (silver) stain
Fine needle aspirate Atypical lymphoid proliferation or suspicion of lymphoma Flow cytometry
pediatric or selected hematologic malignancies Cytogenetic analysis
Microbiology Routine bacterial, anaerobic culutre, mycobacterial cultureand mycology culture growth identification or susceptibility testing may result one or more of the following procedures:
susceptibility(ies)
bacterial, mold and/or yeast identification
latex agglutination
fatty acid analysis
beta lactamase
probe ID
Microsporidium Positive Send out for confirmation
Cryptococcal antigen postive antigen titer
Viral culture (all) postive culture flourescent antibody staining for ID
HSV typing
Special Chemistry Hepatitis C antibody screen positive Ab screen qualitative RT-PCR (Microbiology)
Drug of Abuse Screen positive screening test for: amphetamine/methamphetamine, barbiturates, benzodiazepines, cannabinoids, cocaine metabolites, methadone, opiates, propoxyphene GC/MS confirmation specific to drug class screening positive
RPR positive Ab screen confirmation by TPPA (treponemal pallidum particle agglutination)
HIV 1/2 antibody screen repeatedly reactive HIV 1 Western blot
HIV 1 Western blot negative with a positive HIV 1/2 antibody screening test HIV 2 Western blot
Hepatitis B Surface Antigen postive antigen screen Hepatitis B Surface Antigen neutralization
Surgical Pathology Breast positive for invasive carcinoma Her 2 Neu
ER/PR stain
Lymph node/spleen positive for lymphoma cytogenetics
flow cytometry
tissue frozen in OCT and no OCT
Electron Microscopy
Sentinel lymph nodes negative for carcinoma or melanoma immuno staining
Sinus contents suspicious for fungi GMS or PAS
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