{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:59:49Z","timestamp":1776095989661,"version":"3.50.1"},"reference-count":60,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2023,5,21]],"date-time":"2023-05-21T00:00:00Z","timestamp":1684627200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Lab Hematology"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Coagulation factors, anticoagulants, and fibrinolytic proteins are important for hemostasis, and mutations affecting these proteins causes some rare inherited bleeding disorders that are particularly challenging to diagnose.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>This review provides current information on rare inherited bleeding disorders that are difficult to diagnose.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material &amp; Methods<\/jats:title><jats:p>A review of the literature was conducted for up to date information on rare and difficult to diagnose bleeding disorders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Some rare bleeding disorders cause an inherited deficiency of multiple coagulation factors (F), such as combined FV and FVIII deficiency and familial vitamin K\u2010dependent clotting factor deficiency. Additionally, congenital disorders of glycosylation can affect a variety of procoagulant and anticoagulant proteins and also platelets. Some bleeding disorders reflect mutations with unique impairments in the procoagulant\/anticoagulant balance, including those caused by <jats:italic>F5<\/jats:italic> mutations that secondarily increase the plasma levels of tissue factor pathway inhibitor as well as <jats:italic>THBD<\/jats:italic> mutations that increase functional thrombomodulin in plasma or cause a consumptive coagulopathy due to thrombomodulin deficiency. Some bleeding disorders accelerate fibrinolysis due to loss\u2010of\u2010function mutations in <jats:italic>SERPINE1<\/jats:italic> and <jats:italic>SERPINF2<\/jats:italic> or in the case of Quebec platelet disorder, a duplication mutation that rewires <jats:italic>PLAU<\/jats:italic> and selectively increases expression in megakaryocytes, resulting in a unique platelet\u2010dependent gain\u2010of\u2010function defect in fibrinolysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Current information on rare and difficult to diagnose bleeding disorders indicates they have unique clinical and laboratory features, and pathogenic characteristics to consider for diagnostic evaluation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Laboratories and clinicians should consider rare inherited disorders, and difficult to diagnose conditions, in their strategy for diagnosing bleeding disorders.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijlh.14084","type":"journal-article","created":{"date-parts":[[2023,5,22]],"date-time":"2023-05-22T01:25:05Z","timestamp":1684718705000},"page":"30-43","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Rare inherited coagulation and fibrinolytic defects that challenge diagnostic laboratories"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9501-0468","authenticated-orcid":false,"given":"Natalie","family":"Mathews","sequence":"first","affiliation":[{"name":"Department of Pathology and Molecular Medicine McMaster University  Hamilton Ontario Canada"},{"name":"Hamilton Regional Laboratory Medicine Program  Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8859-4119","authenticated-orcid":false,"given":"Subia","family":"Tasneem","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Medicine McMaster University  Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2843-0817","authenticated-orcid":false,"given":"Catherine P. 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