Category “A” Tests: No Further Actions Required



The Pathology Council of Alverno Laboratories has determined that follow-up testing and/or confirmation of the following tests is medically necessary in order to provide appropriate patient care. Changes are highlighted in YELLOW. February 2020Original TestOrderable with or without reflexResultFollow-up/Confirmation TestAllergen Profile: Childhood Food & Environmental PanelYesEgg white (f1).0.35 Ku/LMilk (f2)>0.35 Ku/LPeanut (f13) > 0.35 Ku/LReflex to egg, milk, and/or peanut component allergen profileAllergen Profile: Food Allergy PanelYesEgg white (f1).0.35 Ku/LMilk (f2)>0.35 Ku/LPeanut (f13) > 0.35 Ku/LReflex to egg, milk, and/or peanut component allergen profileANA by multiplex EIA, Screen YesPositiveQuantitative detection of DsDNA, semi-quantitative detection of: Chromatin, Ribosomal P, SS-A, SS-B, Sm, SmRNP, RNP, Scl-70, and Centromere B.ANA by multiplex EIA, Screen with reflex to ImmunofluorescenceYesPositiveReflex to IFA quantitative.Anaerobic Culture (only)NoAnaerobic culture only is ordered for any specimen typeAerobic culture will also be ordered and billed.Antibody ScreenNoPositiveAntibody IDAntibody ScreenNoPositiveAntigen-type units for crossmatchBlood Culture NoPositive for Staph aureus by Sepsityper assayPCR for confirmation of Staph aureus identification and mecA (MRSA) resistance marker detection.Body Fluid SlideNoAbnormal cellsPathologist reviewBreast Cancer (new diagnosis)NoCarcinomaHER-2 (reflex to FISH if applicable)Estrogen/Progesterone receptors.CBCNoSpecified abnormal flagsPathologist review and/or scan and/or manual diffClostridium difficileNoGDH + / Toxin negativePCR confirmation Colorectal carcinoma, MMRNoMLH1 deficientBRAF V600E (Alverno) with reflex to MLH1 promoter methylation in wild type cases (ARUP)Cystic Fibrosis ScreenNoHomozygous forDelta F508 mutationI506V, I507V, and F508C polymorphismsSent to Reference labCoronary Risk PanelNoTriglycerides > 400 mg/dlDirect LDLCultureNoSuspected pathogensOrganism ID & Susceptibility Testing if indicatedCulture, Acid FastNoAllAFB stainEndometrial endometroid adenocarcinoma, MMRNoMLH1 deficientMLH1 promoter methylation (ARUP)Fetal Bleed Screening TestNoPositiveKleihauer-Betke fetal cell stain or flow cytometry test for the detection of fetal hemoglobin.Group B Streptococcus by PCRNoUnresolved/IndeterminateCultureGroup B Streptococcus by PCR (Sensitivity Testing) NoPositive on Penicillin allergic patientsCulture and Antibiotic Susceptibility TestingHemoglobin A1CNoAllEstimated Average Glucose (EAG calculation) also reportedHemoglobin electrophoresisNoIf peak is in “S” zoneIf peak is in “C” zoneOther abnormal findingsSickle screenAcid PlateSent to Reference lab if indicatedHeparin Induced Platelet AntibodiesNoIf positiveSerotonin Release AssayHepatitis A CascadeYesIf Hepatitis A total is Positive or EquivocalHepatitis A IgMHepatitis B Surface AntigenNoIf Hepatitis B Surface Antigen Index value is repeatedly between 1.00 and 50.00 or result is >=50.00 in a stand-alone order without other Hep B serology assays to confirm.Hepatitis B Surface Antigen Confirmation by neutralization.Hepatitis C ScreenNoPositive & equivocalPCR Quantitative ConfirmationHIV Phenotype Comprehensive (HIVPN)NoARUP will not run HIVPN until a HIV Viral Load test is run first.HIV Viral Load TestHIV – Rapid TestNoPositiveHIV 5th Generation ScreenHIV 5th Generation ScreenNoReactiveGeenius confirmation (HIV Ab Differentiation Immunoassay)Geenius confirmation (HIV Ab Differentiation Immunoassay)NoNonreactive, Indeterminate, HIV Positive Untypable (Undifferentiated)-Nonreactive, Indeterminate or Undifferentiated sent to reference lab for HIV-1 RNA NATLDLNo LDL calculation is negativeDirect LDLLupus Anticoagulant Reflexive PanelNoIf indicatedFibrinogen, dRVVT and Silica Clotting Time(SCT) confirmation, and dRVVT and SCT mixing studies.Lyme DiseaseNoPositive or equivocal EIA/IFA testWestern Blot confirmationMalaria SmearNoPositive Sent to Reference Lab for confirmation by PCR Newborn Metabolic Error ScreenNo-- Collection required before baby leaves the hospital- if 1st screen is collected <24 hrs after 1st protein feeding, no-charge repeat is required- State does follow-up with parents and MD if any screen result is positiveOrganism IDNoAll Identified PathogensAntibiotic susceptibility if indicated.Pain Management urine with interpretationNoPositive Screen for Ethyl GlucuronideEthyl Glucuronide and Ethyl Sulfate, urine, quantitative.Pap smear / thin prepNoSuspected Abnormal CellsPathologist interpretationPap HPV Reflex if ASCUS YesPap with ASCUS resultHPVPap HPV on Any AbnormalYesPap with any abnormal resultHPVPrenatal Testing (Blood Bank)NoPositive Antibody ScreenClinically significant antibodies detected in Prenatal Antibody ScreenAntibody identification performedAntibody titer performedProstate Health IndexYesPSA between 4 and 10 ng/mLp2PSA, free PSA, %Free PSA, and phi risk score will be provided.Serum CreatinineNoAll (greater than 20 years of age)Glomerular Filtration Rate (GFR -calculation) also reportedSerum Protein ElectrophoresisYesPositiveImmunotypingStrep Screen (Group A Strep – throat screen)NoStrep screen negative for Group A StreptococcusCulture performedSyphilis Screen (RPR)NoReactive / PositiveRPR quantitative & Syphilis Screen (Treponema specific)Susceptibility TestingNoFollowing Pan Resistant Organisms: Pseudomonas speciesAcinetobacter speciesConfirmed CREElizabethkingia meningiosepticumColistinSyphilis Screen (Treponema specific)NoReactive / PositiveRPR / RPR quantitative (if indicated)RPR / RPR quantitative (if indicated)NoNonreactive (if Syphilis Screen (EIA) is reactive or equivocal)Reactive (if Syphilis Screen (EIA) is equivocal)TP-PA (Treponema pallidum Particle Agglutination)Therapeutic phlebotomyNoRequestedH/H must be performed within 24 hr prior to phlebotomyTransfusion (packed cells or platelets)NoRequestedH/H or platelet count must be performed prior to transfusionUrinalysisNoSpecified positive biochemical results: glucose value of >= 1000 mg/dL or positive blood or positive protein or positive nitrite or positive leukocyte esterase.Urine microscopicUrinalysis / Culture reflexYes> 10 WBC per HPF previously >5 WBC/HPFUrine Culture Urine Drug Screen – Chain of CustodyNoPositiveConfirmation by LC / MS (based on client)Pain Management-Saliva Drug TestNoPositiveConfirmations by GC or LC/MSVDRL (CSF)NoPositiveTiterNOTES:All routine stool cultures include examinations for Salmonella, Shigella, Campylobacter, Aeromonas, Pleisiomonas, Edwardsiella and predominant growth of Klebsiella Oxytoca. Examinations for E. coli 0157 will be automatically performed by the laboratory if a bloody stool specimen is submitted for routine stool examination. Examinations for other enteric pathogens (Vibrio, E. coli 0157, Yersinia) will be performed only upon physician request. Special physician requests for Vibrio, E. coli 0157 or Yersinia will also trigger the performance of a routine stool culture. E.coli 0157 culture will automatically include Shiga Toxin testing also.24-hour urine creatinine test will not be performed on all 24-hour urine specimens unless specifically requested by the physician. All routine body fluid, wound, sputum and “other” culture orders include a gram smear to be performed on the original specimen.Orders for a Triple Prenatal Risk Assessment Screen will be converted to a Quad Prenatal Risk Assessment Screen. The Alverno Pathology Council has determined that Alverno will no longer offer the Triple Prenatal Screen (effective 4/1/2015).Orders for "Fungal Antibody Screen" include the following:Histoplasma antibodyBlastomyces antibodyCoccidioides antibodyAspergillus antibodyNote: Any of the four fungal antibodies listed above may be ordered individually by the physician.Addendum AClinical Laboratory Interpretation ServicesThe Pathologist may automatically interpret the clinical laboratory services listed below. This professional interpretation will be written and included on the patient’s test report.Hemoglobin ElectrophoresisNucleic acid probe, with electrophoresis, with examination and reportProtein, total, serum, urine; electrophoretic fractionation and quantitationAbnormal blood smear; interpretation and reportFibrinolysin; screeningPlatelet aggregation (in vitro), any agentFluorescent antibody, screenFluorescent antibody, titerImmunoelectrophoresis / Immunotyping; serum, each specimen – capillary immunotypingImmunoelectrophoresis / Immunotyping; other fluids (e.g. urine) with concentration, each specimenDark field examination, any source (e.g. penile, vaginal, oral, skin); includes specimen collection. Mixing Studies – PT and/or APTT Smear, primary source, with interpretation; special stain for inclusion bodies or intracellular parasites (e.g. malaria, kala azar, herpes)Crystal Identification by light microscopy with or without polarizing lens analysis, any body fluid (except urine)Deviations from standard Blood Bank ProceduresTransfusion Reaction WorkupsImmunophenotyping by flow cytometryFISH AnalysisEndomysial antibodies for celiac sprueCystic Fibrosis Gene AnalysisLupus Anticoagulant Reflexive PanelAntiphospholipid Syndrome PanelCystic fibrosis ................
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