Mixing Study Test Principle

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The page below is a sample from the LabCE course Detecting and Evaluating Coagulation Inhibitors and Factor Deficiencies. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

Learn more about Detecting and Evaluating Coagulation Inhibitors and Factor Deficiencies (online CE course)
Mixing Study Test Principle

A patient would generally need a level greater than 40% of each factor that is being detected by the test procedure to achieve a normal (non-prolonged) PT or aPTT test result. Therefore, a patient with an inadequate level, meaning less than 40%, of one or more coagulation factors will have a prolonged PT or aPTT test.
In the mixing study, an aliquot of abnormal patient plasma is mixed with an equal amount of pooled normal plasma (PNP), which contains approximately 100% of all coagulation factors. The newly mixed plasma sample contains at least 40% of each factor after the mix, including the factors that may have been present at very low levels in the original patient sample.
For example, if a patient's sample contained 10% of the normal amount of factor VII, a prolonged PT test would occur. After adding an equal amount of the pooled normal plasma, with an approximate 100% of factor VII, the resulting quantity of factor VII in the sample would be 55%, enough to "correct" the PT test result.
When this new mixture is retested for PT or aPTT, the results that were initially prolonged due to low coagulation factor concentrations will "correct". If an inhibitor is present that can counteract and nullify the newly added factors, there will be no correction in the assay, and the PT or aPTT will remain prolonged.