Platelets less than 60 10^3/uL. Immature Granulocyte Flag

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Heather Wade
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Title: Lab Specimen Collection Instructions - REFLEX TESTING Effective Date: 08/27/2015 Resource: Located in Specimen Collection Instructions Manual Formulated by: Lab Director TEST Point of Reflex

1 Title: Lab Specimen Collection Instructions - REFLEX TESTING Effective Date: 08/27/2015 Resource: Located in Specimen Collection Instructions Manual Formulated by: Lab Director TEST Point of Reflex Test Reflexed Automated- Hematology/Chemistry Free PSA All Values Total and % Free PSA CBC WBC - 0 to 1 Month: Less than ^3/ µl or greater than ^3/ µl WBC - 1 Month to Adult: Less than ^3/ µl or greater than ^3/ µl Neutrophils less than 30% or greater than 95% Monos greater than 20% Eos greater than 20% Platelets less than 60 10^3/uL Blast Flag Basos greater than 4% Immature Granulocyte Flag Left Shift Variant Lymph Flag MCHC less than 29 g/dl or greater than 37.5 g/dl MCV - 1 Month to Adult: Less than 60 fl or greater than 115 fl RDW greater than 20.0 % Nucleated RBC's greater than 2 per 100 WBC Platelet Clump Flag WBC greater than 50 10^3/ µl Lymphocytosis Pancytopenia Nucleated RBC's greater than 5 per 100 WBC, non-neonate Atypical Lymph - >20% Metamyelocyte greater than 5% Myelocyte greater than 3%, Tech Review Tech Review

2 Promyelocyte greater than or equal 3, any abnormal pros Blasts Questionable Cells CK with reflex to MBISO Total CK >100 U/L CKMB Fluid Cell Count with Cytology orders CSF Specimen Questionable Cells All In-patient CSF specimens. Cell Count with Diff if indicated, Glucose, Total Protein Bone Marrow All In-patient Bone Marrow specimens Flow Cytometry & Cytogenetics Glucose Screen Adults: Glucose less than 50 mg/dl or greater than 375 mg/dl Glucose Confirmation Nsy: Glucose less than 40 mg/dl or greater than 150 mg/dl NICU: Glucose less than 35 mg/dl or greater than 200 mg/dl Glucose Confirmation Glucose Confirmation ISTAT PT/INR INR greater than 4.0 Venous PT/INR to confirm Coagucheck INR INR greater than 5.0 Venous PT/INR to confirm Urinalysis Greater than or equal to 30 mg/dl Protein Positive Blood Positive Nitrite Positive Leukocyte esterase HIV Positive HIV 1 Confirmation by Western Blot Hepatitis B Surface Antigen Reactive Hepatitis B Surface Antigen Neutralization (confirmation) Hepatitis C Antibodies w/reflex Reactive Hepatitis C RNA/PCR (only applies to Hep C w/reflex) Drug Screen Positive Test Specific Confirmation (does not apply to Medical Drug Screens. Chain of custody and newborns only) Drug Screen Creatinine less than 30 mg/dl Specific Gravity DIC PANEL PT-Elevated PT Mixing Studies PTT-Elevated Thrombin-Elevated Platelet Function - PFA EPI - Elevated ADP Pathology Gastric Biopsy PTT Mixing Studies Reptilase Helicobactor Pylori immunostain

3 Breast Cancer Lymphoma Abnormal Pap Smear When indicated ER/PR/Ki67/HER2 Flow Cytometry Special Stains Oncology cytogenetics Immunohistochemical Stains TEST Point of Reflex Test Reflexed Pathology/Reference Laboratory Blood Bank All bone marrow specimens for Pathology exam collected at ARMC (excludes Regional Lab Outreach samples) On adult and pediatric bone marrows with ALL for t(9;22) On bone marrow specimens with AML exhibiting normal cytogenetics (normal karyotype) Flow cytometry and cytogenetics FISH and Cytogenetics FLT3, NPMI and CEBPA Fetal Screen Positive Kleihauer Betke Fetal Stain HLA Typed Platelets No HLA typing on record HLA type on Patient Frozen Plasma No Blood Bank armband on Patient ABO/Rh Platelets No Blood Bank armband on Patient ABO/Rh Type & Screen Crossmatch ABO Rh Antibody Screen RHIG Term RHIG 28 Weeks Titer Antibody Transfusion Reaction Direct Coombs Any discrepancies from expected results or identification of unexpected antibodies Positive Appropriate Testing to identify discrepancies or unexpected results. DAT Profile: Identify Complement or IGG, appropriate testing to identify discrepancies or unexpected results

4 Microbiology AFB Culture; Non-Sterile Fluid Receipt of Specimen by Source Auromine Stain (AFB Stain) AFB Culture; Non-Sterile Fluid Growth of AFB colonies DNA probe, DNA sequencing and other molecular techniques, AFB Sensitivities AFB Culture; Sterile Fluid Receipt of Specimen by Source Auromine Stain (AFB Stain) AFB Culture; Sterile Fluid Growth of AFB colonies DNA probe, DNA sequencing and other molecular techniques, AFB Sensitivities ANA Positive Titer and Pattern ASO (Anti Streptomycin O) Positive Titer Clostridum difficile Toxin Screen positive PCR Identification Fungal Culture Receipt of specimen (not hair, skin, nail) Fungal smear Ova and Parasites Receipt of Specimen Trichrome Stain Ova and Parasites Appearance, Liquid with suspicious forms Cryptosporidium Smear Rapid Strep Group A Screen with Negative Throat Culture Reflex to Culture Rheumatoid Arthritis Positive Titer Routine Culture or Fungus Culture; Source Sterile Fluid, CSF, Tissue and Blood Growth of Fungus or yeast ID and Susceptibility of Yeast Species, ID of Mold Species Routine Culture: Wound, Sterile Fluid, CSF, Eye/Ear, Sputum, Genital, Tissue, Bronchial Washings, BAL Routine Cultures - Blood, Sterile Fluid, Tissue, Respiratory Receipt of Specimen Isolation of Streptococcus pneumonia Gram Stain ID and MIC panel Routine Cultures, All Sources Growth of Pathogen ID or ID & Susceptibility RPR Positive Titer and/or FTA Antibody as clinically indicated Sputum Culture greater than10 Epithelial on Gram Stain OPC - Oropharyngeal Contamination; cancel culture Sterile Fluid, or Tissue Culture Source of deep tissue or specimen obtained through surgical procedure Anaerobic Culture, ID if positive Stool Culture Appearance, Growth on Selective Media ID, Sensitivities if Pathogen present Stool Culture Shiga Toxin positive Sent to state lab for strain identification

Pathology No: SHS-CASE No. Date of Procedure: Client Name Address

Pathology No: SHS-CASE No. Date of Procedure: Client Name Address TEL #: (650) 725-5604 FAX #: (650) 725-7409 Med. Rec. No.: Date of Procedure: Sex: A ge: Date Received: Date of Birth: Account No.: Physician(s): Client Name Address SPECIMEN SUBMITTED: LEFT PIC BONE MARROW,