{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T19:46:10Z","timestamp":1776800770081,"version":"3.51.2"},"reference-count":28,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T00:00:00Z","timestamp":1754352000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Lab Hematology"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Plasma mixing tests are frequently performed in haemostasis laboratories to aid in the determination of the cause of prothrombin time or activated partial thromboplastin time (APTT) prolongation. The International Council for Standardization in Haematology (ICSH) has recently published recommendations for performing and interpreting mixing test; we evaluated the ICSH recommendations for APTT mixing tests on patient samples using automated mixing on a Sysmex CN\u2010series analyser.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Samples from patients with haemophilia A with and without inhibitors, or patients with positive lupus anticoagulant, or patients on rivaroxaban\/edoxaban, with an APTT \u2265\u20094\u2009s above normal, were tested using five different APTT reagents: Siemens Actin FS, Actin FSL, and Pathromtin SL; and Hyphen Biomed Cephen and Cephen\u2010LS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A likely\/possible inhibitor was erroneously diagnosed in all haemophilia patients when assessed using the ICSH criteria, except with Actin FS (erroneous diagnosis in 95%). Using CN\u2010series parameters with locally\u2010derived reference ranges, \u2264\u200915% of haemophilia patients were erroneously diagnosed.<\/jats:p>\n                    <jats:p>Only Cephen\u2010LS reliably detected lupus anticoagulant by any algorithm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>When using lupus\u2010insensitive reagents, APTT\u2010mixing tests are of limited value in discriminating between factor deficiencies, lupus anticoagulants, or inhibitors. Incubated mixing tests are essential when diagnosing a FVIII\u2010inhibitor.<\/jats:p>\n                    <jats:p>Rather than perform mixing tests, it is better to be guided by clinical presentation and perform further investigations as appropriate, including analysis of anti\u2010Xa activity for the presence of a direct factor\u2010Xa inhibiting anticoagulant, factor assays in patients with bleeding (or with suspected acquired haemophilia A), and lupus anticoagulant assays in patients with no bleeding.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ijlh.14537","type":"journal-article","created":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T05:59:15Z","timestamp":1754459955000},"page":"1178-1185","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Evaluation of International Council for Standardization in Haematology Recommendations on Activated Partial Thromboplastin Time Mixing Tests Using an Automated Haemostasis Analyser"],"prefix":"10.1111","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-2225-0779","authenticated-orcid":false,"given":"Shapla","family":"Kamali","sequence":"first","affiliation":[{"name":"Department of Haematology Newham University Hospital, Barts Health NHS Trust  London UK"},{"name":"National Health Service East and South East London Pathology Partnership, Barts Health NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2751-8387","authenticated-orcid":false,"given":"Minal","family":"Dave","sequence":"additional","affiliation":[{"name":"National Health Service East and South East London Pathology Partnership, Barts Health NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6365-2899","authenticated-orcid":false,"given":"Priyanka","family":"Raheja","sequence":"additional","affiliation":[{"name":"The Royal London Hospital Haemophilia Centre, Barts Health NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0344-7410","authenticated-orcid":false,"given":"Suthesh","family":"Sivapalaratnam","sequence":"additional","affiliation":[{"name":"The Royal London Hospital Haemophilia Centre, Barts Health NHS Trust  London UK"},{"name":"Precision Healthcare University Research Institute, Queen Mary University London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5466-0448","authenticated-orcid":false,"given":"Sean","family":"Platton","sequence":"additional","affiliation":[{"name":"The Royal London Hospital Haemophilia Centre, Barts Health NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,5]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102141.2011.08990.x"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742\u20101241.2011.02668.x"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1309\/AJCPDPL4G7CERYJU"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01968\u201016"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijlh.14293"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcla.22571"},{"key":"e_1_2_12_8_1","unstructured":"Clinical and laboratory standards institute (CLSI) \u201cOne\u2010Stage Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT) Test \u201d2023."},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.15047"},{"key":"e_1_2_12_10_1","unstructured":"Clinical and laboratory standards institute (CLSI) \u201cLaboratory Testing for the Lupus Anticoagulant. 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