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The thromboplastin generation test, originally described by Biggs and Douglas (2), has proved to be a valuable tool in the study and diagnosis of hemorrhagic disease. Several problems have arisen from its use, however. These have centered about the preparation of the reagents for the test and the implications of an abnormal test result. This test, which measures the rate of formation and the amount of plasma thromboplastin, may be performed with platelet factor 3 supplied by either a platelet suspension or an emulsion of phosphatides from soybeans or brain. In the routine performance of the test we have used a soybean phosphatide. Early in the course of our studies with the thromboplastin generation test, we occasionally found a serum factor deficiency different from deficiencies of PTC (factor IX) or Stuart factor (factor X). This labile serum factor defect was not evident in fresh serum but developed as the serum was aged from 3 to 24 hours. The abnormality was noted in some patients with undiagnosed bleeding whose other coagulation tests were normal. Patients with liver disease, patients with polycythemia vera, and newborn infants usually had this defect. It was sometimes found, combined with other defects, in patients receiving coumarin drugs. It occured in a few "normal" control subjects. Such defective thromboplastin generation could be corrected readily by the use of any one of the following in the test system: se

A LABILE SERUM FACTOR CLOTTING DEFECT: ITS DEMONSTRATION BY THE THROMBOPLASTIN GENERATION TEST AND ITS CLINICAL SIGNIFICANCE*