ANA Ab w/Reflex

Infectious Disease Laboratories : Immunology

PATIENT INFO

Patient Name:

Medical Record #:

BD: / / Sex: F M

PHYSICIAN INFO

Physician Name :

Address:

Ph: ( ) - Fax: ( ) -

Additional Report to:

Ph: ( ) - Fax: ( ) -

TESTS REQUESTED
Test Name:	ICD9 Code: (required)
1. ANA Ab w/Reflex
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

ANAPR VIR4

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

Collect 6.5 mL

Cause for Rejection:

Hemolyzed, lipemic or icteric specimen; insufficient quantity; drawn in incorrect tube.

Storage:

Refrigerated

Availability:

Mon, Wed, Fri

Methodology:

Immunofluorescence (IFA) w/ reflex to Multiplex Flow Immunoassays

Special Instructions:

Serum samples should not be heat inactivated as this may cause false positive results. If ANA Ab by IFA is positive, then the specimen is reflexed to include ANA titer and pattern, Anti-Smith Antigen IgG (SMIT), Anti-Ribonucleoprotein IgG (RNPAN), Anti-SSA/Ro and Anti-SSB/La IgG (ENA2) and Anti-double-stranded DNA antibodies (NDNAB).

Lab/Phone:

330-543-8576

TAT:

24-72 hours for screen results plus an additional 48-72 hours for reflex test results if indicated

Additional Info:

Reference Value: <1:40 Negative; > or = 1:40 Positive

CPT Code:

86038

Synonyms:

Antinuclear antibody profile

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Laboratory Services

ANA Ab w/Reflex

Infectious Disease Laboratories : Immunology

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