The ANA by Multiplex Flow Immunoassay has a lower positive rate in patients without connective tissue diseases and eliminates some of the very weak positives (titer 1:80) often seen by IFA that have no detectable specific antibodies. If ANA by Multiplexed Immunoassay with Reflex to IFA Titer and Pattern (ANA2) is requested and the screen is positive, a titer will be performed at an additional charge. If the Hep-2 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.