If the screen is positive, a titer will be performed at an additional charge. If the Hep-2000 ANA titer is 1:80 or greater with a homogeneous, speckled, nucleolar, or atypical nuclear matrix pattern in children less than 18 years of age, the more specific tissue ANA will be performed at an additional charge. By ordering this test the clinician acknowledges that additional reflex testing will be performed and billed at a separate additional charge if indicated. The indirect immunofluorescent test has three elements to consider in the result: 1) Positive or negative fluorescence, 2) The titer (dilution) to which fluorescence remains positive, and 3) The pattern of nuclear fluorescence (reflecting specificity for various disease). A negative ANA usually rules out SLE. However, if the ANA is negative and the clinical picture suggests SLE or Sjogren's Syndrome, the physician may wish to order SS-A/RO(See Extractable Nuclear Antibody). The ANA may be positive in other autoimmune disorders and in 5-15% of normal people. It is highly recommended that follow-up testing be performed on positive ANA samples.