{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T03:39:55Z","timestamp":1792381195137,"version":"4.4.0"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Lab Hematology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Lupus anticoagulant (LA) testing is essential, albeit complex, in the laboratory diagnosis of antiphospholipid syndrome (APS). Given the multi\u2010step workflow and the variability introduced by anticoagulant therapy, reagent differences, and interpretive approaches, result interpretation requires expert evaluation. To address these challenges, we implemented a middleware\u2010based automated algorithm in our four\u2010hospital institution using the HemoHub system, guided by the latest ISTH recommendations. The objectives were to automate reflex testing, standardize interpretation, and support clinical decision\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The algorithm incorporated rules aligned with good laboratory practice for LA diagnostics, including reflex testing, result interpretation, internal comments, integration of historical data, and auto\u2010validation of negative cases. Retrospective validation was performed on 190 historical cases in which the diagnosis was made conventionally and corroborated by follow\u2010up data. A subsequent prospective blind comparison with manual operator\u2010based workflow was conducted on 481 routine samples.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Concordance between automated and manual interpretations reached 100% for LA negative and positive cases, with slightly lower agreement for first\u2010time positives (88.6% and 82.4%). When automated interpretation was not assignable, the system still provided useful internal comments. Additionally, 58.4% of samples were auto\u2010validated, significantly reducing manual workload. Time comparison demonstrated substantial savings for both experienced and less\u2010experienced pathologists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The implementation of the automated algorithm improved consistency, reduced interpretation time, and minimized intra\u2010 and inter\u2010laboratory variability. By integrating clinical context and historical data, it enhanced diagnostic accuracy. These findings support the use of middleware\u2010based, rule\u2010driven interpretation as a reliable and efficient approach to standardizing LA testing and optimizing laboratory workflow.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ijlh.70153","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T10:23:32Z","timestamp":1779963812000},"page":"1181-1188","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Design and Implementation of an Automated Interpretation Algorithm for Lupus Anticoagulant Functional Testing"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9015-5599","authenticated-orcid":false,"given":"Chiara","family":"Novelli","sequence":"first","affiliation":[{"name":"Immunohematology and Transfusion Center ASST Ovest Milanese  Legnano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Gatti","sequence":"additional","affiliation":[{"name":"Immunohematology and Transfusion Center ASST Ovest Milanese  Legnano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flora","family":"Ierna","sequence":"additional","affiliation":[{"name":"Immunohematology and Transfusion Center ASST Ovest Milanese  Legnano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Riccardi","sequence":"additional","affiliation":[{"name":"Immunohematology and Transfusion Center ASST Ovest Milanese  Legnano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Cuppari","sequence":"additional","affiliation":[{"name":"Immunohematology and Transfusion Center ASST Ovest Milanese  Legnano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11082164"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.42624"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtauto.2021.100134"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.medcli.2024.06.002"},{"issue":"7","key":"e_1_2_12_6_1","article-title":"Diagnostic Challenges on the Laboratory Detection of Lupus Anticoagulant","volume":"9","author":"Tripodi A.","year":"2021","journal-title":"Biomedicine"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijlh.12234"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12206654"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/joim.13022"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/rth2.12676"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MBC.0000000000001214"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2023.02.009"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.13678"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/MBC.0000000000001288"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.37349\/ei.2023.00104"},{"key":"e_1_2_12_16_1","volume-title":"CLSI Document H60","author":"Ledford\u2010Kraemer M. 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