LAB /02/2016 UNIVERSITY OF KENTUCKY HOSPITAL LABORATORIES Page 1 of 8. Section Procedure Condition Reflex test (incurs additional charge) Lab

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1 UNIVERSITY OF KENTUKY HOSPITAL LABORATORIES Page 1 of 8 REFLEX TESTING 2016 REFLEX and OUPLED TESTING LIST Section Procedure ondition Reflex test (incurs additional charge) Lab 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(oombs) test with multiple antisera Autoadsorption (or other method) to reduce effects of autoantibodies on test results old agglutinin screen to determine the presence of cold agglutinin antibody Antibody titration for pregnant female with clinically significant antibody; or to confirm the presence of HTLA antibody When a UK patient is transferred within the UK Healthare facilities onsultation report of findings/recommendation Treat reagent RBs with DTT to disrupt Darzalex (anti- D38) binding Transfusion reaction work up for Delayed Hemolytic or Serologic Transfusion Reaction ABO/Rh (A new phlebotomy specimen to perform ABO/Rh) Bone marrow/stem cell transplant recipient if reverse group is unexpected positive Indirect anti-human globulin test (indirect oombs test); consultation report of findings/recommendations Antibody screen No blood bank history ABO/Rh Red ell Genotyping When phenotyping is not possible due to recent transfusion or a positive DAT, reagent antisera discrepancies are observed, and a partial or variant antigen is present leading to conflicting antibody investigations; or to provide antigen negative blood to help prevent red cell alloimmunization Red cell genotyping (molecular testing)

2 UNIVERSITY OF KENTUKY HOSPITAL LABORATORIES Page 2 of REFLEX and OUPLED TESTING LIST Section Procedure ondition Reflex test (incurs additional charge) Lab Blood Bank DAT (direct antiglobulin test) If patient has no blood type history on file ABO/Rh Positive Elution of antibodies from red cells Type and Screen onsultation report of findings/recommendation Direct Antiglobulin Test and Indirect oombs 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 oombs Test with A1 or B cells; consultation report of findings/recommendation Antigen typing for patient Patient with sickle cell disease Baseline phenotype for patient with sickle cell disease Patient who will receive Darzalex (anti-d38) treatment for disease such as multiple myeloma Baseline phenotype for patient before Darzalex (anti-d38) treatment Antigen typing for units Patient with clinically significant antibody Screen antigen negative units Reticulocyte Harvesting Patient who has been transfused within the past three months Reticulocyte harvesting (cell separation) technique to obtain autologous cells for antigen typing rossmatch two units without orders rossmatch four units without orders Patient with clinically significant antibody rossmatch two antigen negative units Patient on EMO rossmatch four units, stay ahead until the patient is no longer on EMO rossmatch antigen negative units Patient with sickle cell disease rossmatch Rh and K antigen matched units for patient without clinically significant antibody; or phenotype matched units for patient with clinically significant antibody Transfusion reaction work up Transfusion reaction onsultation report of findings/recommendation Issuing uncrossmatched red cells Exception to standard practice; emergency transfusion onsultation report of findings/recommendation Transfusion of Rh positive red cells to Rh negative patient Exception to standard practice; emergency transfusion onsultation report of findings/recommendation Transfusion of Rh positive platelets to Rh negative patient Exception to standard practice; emergency transfusion of platelets with low inventory of Rh negative platelets onsultation report of findings/recommendation

3 UNIVERSITY OF KENTUKY HOSPITAL LABORATORIES Page 3 of 8 Section 2016 REFLEX and OUPLED TESTING LIST Procedure ondition Reflex test (incurs additional charge) Lab Blood Bank Type and Screen RB Transfusions No blood bank history on file when specimen is sent to one of the UK Healthare facilities to perform Type and Screen testing. Hypoxic pediatric patients in NIU ABO/Rh (A new phlebotomy specimen to perform ABO/Rh) Sickle cell disease testing on RB donor unit EMO patients Sickle cell disease patients ytogenetics Blood hromosome Analysis If ordered with reflex to chromosomal microarray testing and meets established clinical cytogenetics criteria or is determined to be appropriate by the ytogenetics Lab Director hromosomal microarray analysis Immunomolecular Pathology Multiple Myeloma Panel Tier 1: D3Z1/D7Z1/D9Z1/D15Z4 IGH/ND1 IGH p53/d17z1 D13S319/13q34 KS1B/DKN2 HLA antibody screen Evidence of an IGH rearrangement other than IGH/ND1 Initial positive screen; peak architectural changes or annually Multiple Myeloma Panel Tier 2: IGH/FGFR3 IGH/MAF IGH/ND3 IGH/MAFB Antibody identification,gs HLA-A,B, and DRB1 high resolution typing and low resolution DQB typing of a hematopoietic stem cell transplant recipient and potential donor(s) Hemochromatosis When high resolution HLA-A,B, and DRB1 typing of a hematopoietic stem cell transplant recipient and potential donor(s) identify a no better or worse degree of match than 7 out of 8 (9 out of 10 if low resolution HLA-DQB is included) Initially screen for 282Y mutation, if heterozygous result then test H63D ore Lab Bone Marrow Exam New adult patient or patient without bone marrow collection in past 12 mos., no recent iron stain, thrombocytopenia, adult or child with work-up for anemia, MDS or previous abnormal iron stain. High resolution HLA-DQB, DRB3, DRB4, DRB5, DPB typing on the hematopoietic stem cell transplant recipient and potential donor(s). H63D Mutation Testing Iron stain (Note: This is considered part of standard bone marrow evaluation in most institutions in addition to routine morphologic stains.),gs

4 UNIVERSITY OF KENTUKY HOSPITAL LABORATORIES Page 4 of 8 Section ore lab 2016 REFLEX and OUPLED TESTING LIST Procedure ondition Reflex test (incurs additional charge) Lab Urinalysis hild <1 y.o Reducing substances ANA Positive screen Titer and pattern (ANAP) DNA Positive screen Titer AMA Positive screen Titer SMA Positive screen Titer ANA Positive screen Titer ytology Hemoglobinopathy Peak present in S window Sickle cell prep to confirm S; if negative, perform an alkaline Evaluation gel electrophoresis. Abnormal peak(s) other than S present Alkaline gel electrophoresis Fluid cell count and NU/WB > 10 or abnormal cells requiring MD opath report delineating review differential review Malaria/Blood Parasite Unable to differentiate species based on Send out for PR morphology Differential-Peripheral Abnormal finding requiring MD review opath report delineating review Blood Dipstick Urinalysis Positive dipstick result for Blood, Nitrates, Leukocyte Esterase, and > 300 mg/dl protein Urinalysis Microscopic Sediment Examination Respiratory cytology Immunocompromised patient or suspected GMS (silver) stain or other organism stains (bronchial, BAL) infection Fine needle aspirate or Atypical lymphoid proliferation or suspicion of Flow cytometry fluid lymphoma Pediatric or selected hematologic ytogenetic analysis malignancies PAP tests Per clinician request and/or following guidelines HRHPV testing

5 UNIVERSITY OF KENTUKY HOSPITAL LABORATORIES Page 5 of REFLEX and OUPLED TESTING LIST Section Procedure ondition Reflex test (incurs additional charge) Lab Microbiology Routine bacterial culture, blood culture, anaerobic culture, mycobacterial culture and mycology culture Growth Identification Susceptibility(ies) Bacterial, mold and/or yeast identification Latex agglutination Fatty acid analysis Beta lactamase Probe ID PR, microarray, or sequencing for ID AFB Smear on sputum Positive for AFB on direct GeneXpert MTB-Rifampin Testing Blood ultures Gram stain of positive bottles positive for yeast. Biofire Blood ulture FilmArray. Gram negative cocci in pairs or pleomorphic Gram negative rods. Positive for growth of Gram negative rods Nanosphere Gram negative panel Blood ultures Positive for growth of Gram positive organisms Nanosphere Gram positive panel Blood ultures, SF, tissues or sterile fluids Positive for all andida sp. Susceptibility testing Viral culture When appropriate-improves sensitivity and Blind FA timeliness of viral detection Influenza PR Positive for Influenza A PR for grouping to predict antiviral response IABBRSVPR or RVP Indeterminant result Reflex to culture or alternate PR HSV culture Growth HSV typing omprehensive GI Panel by PR Positive test result for Salmonella, Shigella, ampylobacter, E coli 0157H7, shiga toxin, Vibrio, or Yersinia Targeted culture for isolate to be sent to the State Lab and susceptibility testing, as indicated or requested

6 UNIVERSITY OF KENTUKY HOSPITAL LABORATORIES Page 6 of REFLEX and OUPLED TESTING LIST Section Procedure ondition Reflex test (incurs additional charge) Lab Microbiology HV Genotype Positive for more than 1 Genotype Send to reference lab for confirmation Special hemistry Drug of Abuse Screen by Immunochemistry Protein Electrophoresis, Serum/Urine Positive screening test for drug class: amphetamine, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, opiates, propoxyphene, oxycodone LMSMS confirmation specific to positive drug class screening Presence of monoclonal proteins in new patients Immunofixation electrophoresis serum or urine No band detected in a known patient Rapid Plasma Reagin (RPR) Positive antibody screen onfirmation by treponemal pallidum Particle Agglutination (TPPA) HIV 1/2 antibody screen Repeatedly reactive antibody screening HIV 1/2 Multispot, HIV ½ differentiation Antibodies to Hepatitis Positive antibodies to B Surface antigen screen Hepatitis B Surface Antigen neutralization B Surface Antigen Hepatitis antibody Positive antibody screen Quantitative RT-PR performed in Microbiology Surgical Pathology* Urine alcohol by Ethanol Positive Ethanol screen onfirmation by gas chromatography enzyme assay Breast Positive for invasive carcinoma Her 2/neu Fish Lymph node/spleen/bone marrow/other tissues Tissue Biopsies/Resections Suspicious for lymphoma, leukemia and ytogenetics,gs related disorders Flow cytometry Molecular testing,gs Suspected infectious lesions ultures and/or molecular testing Pediatric tumors ytogenetics and molecular testing Molecular Anatomic Pathology ALK rearrangement in cancer Selected tumors including but not limited to NS tumors, sarcomas and kidney tumors ALK FISH *Histochemical and immunohistochemical stains may be employed at the discretion of the pathologist to work up a case to provide standard of care diagnostic and prognostic information

7 UNIVERSITY OF KENTUKY HOSPITAL LABORATORIES Page 7 of REFLEX and OUPLED TESTING LIST OULPED TESTING Section Procedure ondition Reflex test (incurs additional charge) Lab ore Lab Bone Marrow Exam Any UK/GS patient marrow with blood smear if available and not already ordered Hemoglobinopathy All-required for full interpretation Evaluation Peripheral smear (This is considered standard part of bone marrow exam.) Hemogram Malaria examination All-required for full interpretation Hemogram,reticulocyte count & Rapid Malaria screen IMP Lab HLA typings All-required for full interpretation Written pathologist's report summarizing and interpreting HLA antibody screens All-required for full interpretation Written pathologist's report summarizing and interpreting HLA antibody identifications All-required for full interpretation Written pathologist's report summarizing and interpreting HLA crossmatches All-required for full interpretation Written pathologist's report summarizing and interpreting Molecular genetic tests for All-required for full interpretation Written pathologist's report summarizing and interpreting diagnosis Molecular oncology tests for All-required for full interpretation diagnosis Microbiology Sputum culture All- for assessment of specimen Wound culture, sterile fluid cultures, tissue cultures, and routine cultures Written pathologist's report summarizing and interpreting Gram's stain quality All-good medical care Gram's stain except for University Health Mycobacterial culture All-good medical care Acid fast stain Mycology culture All-good medical care alcofluor/koh exam ulture on Tissue All needed for processing Grinding with tissue homogenizer SF culture All-good medical care India ink prep

8 UNIVERSITY OF KENTUKY HOSPITAL LABORATORIES Page 8 of 8 Section Microbiology 2016 REFLEX and OUPLED TESTING LIST ondition Procedure Reflex test (incurs additional charge) Lab ryptococcal antigen (SF) All-required by AP Mycology culture Streptococcus pneumonia All-required by AP Bacterial culture antigen (SF) Abscess specimens Aerobic culture only ordered Anaerobic culture is added on BioFire Meningitis/Encephalitis All-Required by AP Bacterial culture Panel Mycology culture Sputum AFB and All patients in negative pressure GeneXpert MTB-rifampin testing mycobacteriology culture rooms Surgical Pathology Medical Kidney Biopsy Non-neoplastic lesions Immunofluorescence EM