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Licensed Unlicensed Requires Authentication Published by De Gruyter March 3, 2021

Using machine learning to identify clotted specimens in coagulation testing

Kui Fang, Zheqing Dong, Xiling Chen, Ji Zhu, Bing Zhang, Jinbiao You, Yingjun Xiao and Wenjin Xia



A sample with a blood clot may produce an inaccurate outcome in coagulation testing, which may mislead clinicians into making improper clinical decisions. Currently, there is no efficient method to automatically detect clots. This study demonstrates the feasibility of utilizing machine learning (ML) to identify clotted specimens.


The results of coagulation testing with 192 clotted samples and 2,889 no-clot-detected (NCD) samples were retrospectively retrieved from a laboratory information system to form the training dataset and testing dataset. Standard and momentum backpropagation neural networks (BPNNs) were trained and validated using the training dataset with a five-fold cross-validation method. The predictive performances of the models were then assessed based on the testing dataset.


Our results demonstrated that there were intrinsic distinctions between the clotted and NCD specimens regarding differences in the testing results and the separation of the groups (clotted and NCD) in the t-SNE analysis. The standard and momentum BPNNs could identify the sample status (clotted and NCD) with areas under the ROC curves of 0.966 (95% CI, 0.958–0.974) and 0.971 (95% CI, 0.9641–0.9784), respectively.


Here, we have described the application of ML algorithms in identifying the sample status based on the results of coagulation testing. This approach provides a proof-of-concept application of ML algorithms to evaluate the sample quality, and it has the potential to facilitate clinical laboratory automation.

Corresponding author: Zheqing Dong, Director, Clinical Laboratory, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou310000, P.R. China, E-mail:

Funding source: Department of Health of Zhejiang Province

Award Identifier / Grant number: 2021KY845

  1. Research funding: This work was supported by the Science Fund of the Health Department of Zhejiang Province. Project ID: 2021KY845.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Ethical approval: The study was approved by the institutional research ethics committee of The Third Affiliated Hospital of Zhejiang Chinese Medical University. Approval ID: ZSLL-KY-2021-001-01.


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Supplementary Material

The online version of this article offers supplementary material (

Received: 2021-01-18
Accepted: 2021-02-15
Published Online: 2021-03-03
Published in Print: 2021-06-25

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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