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Hemostasis and Thrombosis > 2.5 > Flashcards

2.5 Flashcards

1
Q

A 3 year old male was admitted with scattered petechiae and epistaxis. The patient had normal growth and had no other medical problems except chicken pox 3 weeks earlier.
Lab results: PT 11 sec (Ref. 10-13 sec)
APTT 32 sec (Ref. 28-37 sec)
PLT count: 18 (Ref. 150-450)
These clinical manifestations are consistent with which condition?

a. TTP
b. DIC
c. ITP
d. HUS

A

c. ITP

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2
Q

A 12 year old white male has the following symptoms: visible bruising, bruising after sport activities, and excessive postoperative hemorrhage after tonsillectomy 3 months ago. Family history reveals mother suffers heavy menstrual bleeding and his maternal grandfather had recurrent nosebleeds and bruising. Lab results:
PLT, PT, TT Normal. APTT Prolonged.
PLT aggregation: Normal with collagen, EPI, ADP, abnormal with ristocetin.
Confirmatory Tests: vWF:Rco, VIII:C, vWF:antigen Below reference percentages.
Which most likely diagnosis?

a. Factor VIII deficiency
b. vW disease
c. Glanzmann thrombasthenia
d. Benard-soulier syndrome

A

b. vW disease

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3
Q

The following results are obtained from a patient who developed severe bleeding:
Prolonged PT and APTT, PLT: 100, Fibrinogen 40 md/dL
Which of the following blood products would be recommended for transfusion?

a. Factor VIII conc
b. PLTs
c. FFP
d. Cryoprecipitate

A

d. Cryoprecipitate

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4
Q

A 30 year old woman develops signs and symptoms of thrombosis in her left lower leg after 5 days of heparin therapy. The patient has had open heart surgery 3 days previously and has been on heparin ever since. Which of the following would most helpful in the diagnosis?

a. Fibrinogen Assay
b. PT
c. PLT count
d. Increased heparin dose

A

c. PLT count

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5
Q

The following lab results were obtained on a 25 year old woman with menorrhagia after delivery of her second son. The patient has no previous bleeding history.
PLT count, PT, APTT Normal. Mixing patient’s plasma with normal plasma corrected the prolonged APTT on immediate testing, however mixing following 2 hour incubation caused prolonged APTT.
Which most probable cause of the lab results?

a. Lupus anticoagulant
b. Factor VIII def
c. Factor IX def
d. Factor VIII inhibitor

A

d. Factor VIII inhibitor

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6
Q

A 62 year old female presents with jaundice and the following lab data:
Peripheral: Macrocytosis, target cells.
PLT count: Normal, PT and APTT prolonged. Transaminases: elevated (AST:ALT ratio greater than 1) and T/d Bilirubin is elevated.
These clinical presentations and lab results are consistent with:

a. Inherited factor VIII def
b. DIC
c. Cirrhosis of the liver
d. vW disease

A

c. Cirrhosis of the liver

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7
Q

When performing a mixing study, the patient’s APTT is corrected to 12% of normal. What is the most appropriate interpretation of these findings?

a. the APTT is considered corrected.
b. the APTT is considered uncorrected
c. The lab protocol should be followed for the interpretation of the correction
d. a circulating anticoagulant can be ruled out.

A

c. The lab protocol should be followed for the interpretation of the correction

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8
Q

A standard blue-top tubed filled appropriately was submitted to the lab for PT and APTT testing. The results of both tests were elevated. The patients previous results from the day prior were normal and was not on heparin therapy. Which of the following is the most appropriate step to investigate the abnormal results?

a. Report the results as obtained
b. Perform a mixing study
c. Check the sample for a clot
d. Report APTT only

A

c. Check the sample for a clot

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9
Q

A plasma sample submitted to the laboratory for PT testing has been stored for 25 hours at 4 C. PT is shortened, What is the most probable cause?

a. Factor VII def.
b. Activation of factor VII caused by exposure to cold temperature
c. Lupus inhibitor
d. Factor X inhibitor

A

b. Activation of factor VII caused by exposure to cold temperature

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10
Q

APTT is not increased in a patient receiving heparin. Which of the following factors may be associated with the lab or response to heparin therapy in this patient?

a. Protein C def
b. AT def
c. Protein S def
d. Factor VIII def

A

b. AT def

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11
Q

A 50 year olf patient was admitted to the ER with a complaint of pain in the right leg. The leg was red, swollen, and warm to the touch. DVT is suspected and the patient was started on heparin therapy. Which of the following is the proper protocol(s) to evaluate patients receiving heparin therapy?

a. Baseline APTT and PLT count. APTT testing every 4-6 hours after initial heparin bolus.
b. Repeat APTT 5 days after heparin therapy to adjust therapeutic dose.
c. Monitor PLT count daily and every other day after heparin therapy is completed.
d. Monitor PT daily to adjust dose.

A

a. Baseline APTT and PLT count. APTT testing every 4-6 hours after initial heparin bolus.

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12
Q

A 46 year old female was admitted to the ER with complaints of headache, nausea, vomitting, lethargy, and weakness. The patient has undergone a gastrectomy procedure 4 months prior to remove a adenocarcinoma. Diagnostic procedures indicate reoccurrence of the carcinoma.
Heme: WBCs 17.8 (NL 4.5-11), RBCs slightly decreased. Hgb: 8 (N: 12-15) Hct 23% (NL 37-46%). PLTs: 48 (N: 150-450), N/N MCH, MCHC. Normal WBC dif, Manual PLT: 18. PT/APTT/TT normal.
Urine: Protein 30 (N:0-15), RBCs 60-100 (N:0-5) Casts: 10 hpf–hyaline/granular. Chem: Creatinine 3.1 ( N: 0.7-1.3) BUN: 39 (N: 8-22) Haptoglobin: 5 (N:50-150)
Which most consistent with?

A. ITP
B. vW Disease
C. TTP
D. DIC

A

C. TTP

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13
Q

A 1 year old infant with recurrent epistaxis for the past 5 days. Past medical history revealed easy bruising and sever nosebleed that occurred 3 months of age. The mother had a severe nosebleed 8 years ago. The father also reports to bleed easily. The patient was transfused with 2 units of packed RBCs on admission.
Hgb: 4.5 (N: 13-15) PLT count 249 (N: 150-450) PT and APTT normal.
Factor VIII assay: Normal
PLT aggregation: Abnormal to ADP, EPI, and Thrombin. Normal to ristocetin.
Most consistent with?

a. vW disease
b. BS syndrome
c. Glanzmann Thrombasthenia
d. Factor VIII def

A

c. Glanzmann Thrombasthenia

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14
Q

A 30 year was referred to the hospital for evalutation of multiple spontaneous abortions and complaint of pain and swelling in her right leg. PT, TT normal. APTT Prolonged. Mixing study APTT: Preincubation and 2 hour: Prolonged
Patient Plasma + Freeze thawed platelets: Normal APTT.
Anticardiolipin Abs via ELISA: Neg
Clinical manifestations are consistent with:

a. Factor VIII inhibitor
b. Factor VIII def
c. Anticardiolipin Antibodies
d. Lupus anticoagulant

A

d. Lupus anticoagulant

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15
Q

A 60 year old patient was admitted to a hospital for a liver biopsy. Coag results obtained at the time of admission revealed prolonged PT with an INR of 4.5. What is the physicians most appropriate course of action?

a. Proceed with biopsy because prolonged PT is expected in liver disease
b. Postpone the procedure for a couple of days
c. Cancel the procedure and start the patient on vitamin K therapy.
d. Put patient on viramin K therapy and proceed with procedure.

A

c. Cancel the procedure and start the patient on vitamin K therapy.

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16
Q

A fresh blood sample was send to the lab at 8 am for a PT test. At 4 pm, the doctor requested a APTT test to be done on the same sample. What should the technologist do?

a. rerun the APTT on the 8 am sample and report
b. request a new sample for APTT
c. run the APTT in duplicate and report average
d. mix patient plasma with normal plasma and run the APTT

A

b. request a new sample for APTT

17
Q

An APTT test is performed on a patient and the results is 50 sec (prolonged). The instrument flags the results because of failure of the delta check. The patient had a previous APTT of 35 sec. The tech calls to see if the patient is on heparin therapy. The patient has not received heparin. What is the next appropriate step?

a. Check the patients family history for inherited factor VIII def.
b. Check to see if the patient has received any other anticoagulant medications.
c. Perform mixing studies
d. perform a factor VIII assay

A

b. Check to see if the patient has received any other anticoagulant medications.

18
Q

A patient was put on heparin therapy postoperatively for prevention of thrombosis. The patient had the following lab results:
PLT count, PT, APTT Normal. After 6 days of heparin, the patient complained of pain and swelling in her left leg. Her plt count dropped to 85. The physician suspected HIT and ordered PLT aggregation test to be performed immediately. The heparin induced PLT aggregation test results was negative. Heparin was discontinued. Several days later the patient develops a massive clot and requires amputation. Which of the following should have been recognized or initiated?

a. The patient should have been on LMWH
b. The heparin dose should have been increased
c. The negative PLT aggregation does not rule out HIT
d. The patient should have been placed on warfarin therapy.

A

c. The negative PLT aggregation does not rule out HIT

19
Q

A 50 year old female was admitted to a hospital for hip replacement surgery. Preoperative tests were performed:
Everything Normal
Postoperative patient was bleeding during surgery, results as follows:
Hgb 5, HCT 16%, PT 8 sec, APTT 25 sec
Which steps should be taken before releasing these results?

a. No follow up
b. Report Hgb and Hct, adjust anticoagulant volume, and redraw new sample for PT/APTT.
c. Call the nurse to ask if patient is on heparin
d. because the patient is severely anemic, multiply the PT and APTT by 2 and report.

A

b. Report Hgb and Hct, adjust anticoagulant volume, and redraw new sample for PT/APTT.

20
Q

A 45 year old woman visiting her doctor complains of easy bruising and menorrhagia occurring every few weeks. Family History unremarkable.
PT/APTT: Prolonged
TT: N
Mixing studies (patient plasma + normal plasma) PT: Prolonged, APTT: Less Prolonged
PLT count and morphology Normal
Most consistent with?

a. Factor VIII inhibitor
b. Factor V inhibitor
c. Factor VIII deficiency
d. Lupus anticoagulant

A

b. Factor V inhibitor

Hemostasis and Thrombosis (5 decks)

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