Coagulation tests are useful in the diagnosis and management of bleeding or thrombotic disorders. The majority of hospital and reference laboratories perform routine coagulation testing such as prothrombin time, activated partial thromboplastin time, fibrinogen, D-Dimer etc. However, the number of laboratories performing specialized coagulation testing such as coagulation factor levels, factor inhibitor levels, heparin induced thrombocytopenia panels, platelet aggregations, mixing studies etc. has declined significantly over time. This presentation seeks to bring awareness about the clinical utility of having specialized coagulation testing in-house by discussing the time sensitive nature of these tests and reviewing relevant case studies.