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Hello, Welcome to Just Answer and thanks for your question. The sequence is first ANA. If that is positive, then ANA IFA screen is performed. If that is positive, then ANA IFA with Reflex to Titer/Pattern is performed. It is only with all those positives that the additional antibody tests are performed (dsDNA, Sm/RNP, RNP, Sm, and Chromatin) are tested for. If ANA IFA is negative then dsDNA wouldn't be positive.