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A Haematology and Immunology > Clinical Cases - Haemostasis and Thrombosis > Flashcards

Clinical Cases - Haemostasis and Thrombosis Flashcards

1
Q
  • A 20 month old boy attends accident and emergency with his father
  • The child has refused to walk for the past 2 days having been walking unsupported for 4 months
  • The right knee is slightly swollen and feels warm to touch
  • Blood is aspirated from the knee

Which of the following is the most likely diagnosis?

A. Acute lymphoblastic leukaemia

B. Osteomyelitis

C. Von Willebrand Disease

D. Haemophilia A

A

Diagnosis is most likely haemophilia

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2
Q

How do you differentiate between haemophilia A and haemophilia B?

A. Measure the APTT

B. Measure the PT

C. Measure factor VIII and IX levels

D. Do a platelet count

A

Measure the factor VIII and IX levels

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3
Q

Patients factor VIII level was 0%

Patients factor IX level was 73%

What is the most likely diagnosis?

A

Severe haemophilia A

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4
Q

How is haemophilia A inherited?

A. Autosomal Recessive

B. X-linked

C. Y-linked

D. Autosomal Dominant

A

X-linked

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5
Q

The mother tells you that her father also has haemophilia A and wants to know the chances of haemophilia in any further children born to her.

What is the chance of any further child having haemophilia A?

A. 1 in 2

B. Can’t say because it depends on the mothers status

C. 1 in 4

D. Random chance - not quantifiable

A

The chance is 1 in 4 as the mother is an obligate carrier of haemophilia

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6
Q

Having established the diagnosis of severe haemophilia A with a joint bleed, what optimal treatment should you give?

A. Fresh frozen plasma

B. Plasma derived Factor VIII

C. DDAVP and tranexamic acid

D. Recombinant factor VIII

A

Recombinant factor VIII

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7
Q

The father is concerned about the boy receiving factor VIII because of infections in his father-in-law related to factor VIII treatment

Which of these is not a complication of plasma derived factor VIII treatment?

A. Hepatitis B

B. HIV

C. Hepatitis C

D. Hepatitis A

A

Hepatitis A is not transmitted by concentrate

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8
Q

What is the other main complication of treatment of severe haemophilia A with factor VIII concentrates?

A. Allergic reactions

B. Increased risk of thrombosis

C. Development of inhibitory antibodies

D. Addiction to factor VIII

A

Biggest complication is development of inhibitory antibodies (About 20% of cases)

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9
Q

The boy should be treated with recombinant factor VIII

What is the best treatment regimen for these patients?

A. Treat the patient as soon as possible only after he has a bleed

B. Give factor VIII regularly once weekly

C. Give factor VIII at least 3 times weekly

D. Give factor VIII every day

E. Consider bone marrow transplantation

A

C. Give factor VIII at least three times weekly

or every 48 hours

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10
Q

Treatment regiment for patients needing recombinant factor IX

A

Twice weekly

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11
Q
  • A 24 year old female student presents with a 4 day history of easy bruising and small red spots on her ankles
  • She has no previous history of abnormal bleeding
  • Previous tonsillectomy with no bleeding
  • Recently been off colour with flu like symptoms
  • Only medication COCP

What are these non-blanching spots on her arms?

A. Spider naevi

B. Bruises

C. Petechiae

D. Telangectasia

A

Petechiae

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12
Q

Case 2

Which of these symptoms is she unlikely to have?

A. Menorrhagia

B. Swollen, hot painful leg

C. Epistaxis

D. Buccal bleeding

A

She has petechiae, menorrhagia, epistaxis easy bruising, and blood blisters in her mouth

She is least likely to have a swollen leg

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13
Q

Case 2

She has petechiae, menorrhagia, epistaxis easy bruising, and blood blisters in her mouth.

What is the likely cause of her symptoms?

A. Thrombocytopenia

B. Scurvy

C .Vitamin K deficiency

D. Liver failure

A

Thrombocytopenia

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14
Q

Which of the following is not a cause of thrombocytopenia?

A. Acute myeloid leukaemia

B. Vitamin K deficiency

C. Aplastic anaemia

D. ITP

A

Vit K deficiency does not.

AML, Aplastic Anaemia, ITP, may all cause thrombocytopenia.

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15
Q

This patient has spontaneous bruising and petechiae formation which platelet count is most likely?

A. 30

B. 10

C. 50

D. 100

A

10

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16
Q

Which underlying illness is not associated with ITP?

A. HIV infection

B. Vitamin C deficiency

C. SLE

D. Glandular fever

A

Vitamin C deficiency is not associated with thrombocytopenia.

SLE, EBV and HIV infection are.

17
Q
  • A 70 year old man has excessive bleeding after a colectomy for cancer
  • He has bleeding from his abdominal wound but not from his drain or his indwelling line
  • He has had surgery in the past but had no abnormal bleeding

Which is the most likely cause of this?

A. Severe haemophilia A

B. Von Willebrand Disease

C. LMWH prophylaxis

D. Poor surgical technique

A

Most likely surgical bleeding (single site does not suggest coagulopathic bleeding)

18
Q

Which of the following was not the reason the patient was given LMWH for thromboprophylaxis?

A. Surgery

B. Old age

C. Hypertension

D. Active cancer

A

The hypertension

All of the others identify risk factors for peri-op VTE

19
Q

A 65 year old man takes aspirin because of a previous history of TIA.

How does aspirin work?

A. It inhibits thrombin

B. It reduces platelet aggregation

C. Inhibits coagulation factor production

D. Inhibits vitamin D

A

Aspirin inhibits platelet function by inhibiting COX-1

20
Q

A 21-year old medical student uses the combined oral contraceptive. She is clinically well.

Which of the following is true?

A. She has an increased risk of stroke

B. She has a reduced risk of pulmonary embolism

C. She may bleed more easily from injuries

A

She has an increased risk of stroke and VTE

Her relative risk of venous thromboembolism is approx. 5x

Her absolute risk of thrombosis is low however

21
Q

Case 5

Which of the following could be present and contribute further to her VTE risk?

A. Hypercholesterolaemia

B. Factor V Leiden

C. Von Willebrand factor deficiency

D. Diabetes Mellitus

A

Factor V Leiden increases VTE 5x

In combination with COCP RR=30

22
Q

Chose the correct answers

The following are risk factors for arterial thromboembolism:

A. Smoking

B. Diabetes mellitus

C. Factor V Leiden

D. Atrial fibrillation

A

All are risk factors for venous thromboembolism

23
Q

Choose the incorrect answer:

Arterial thrombus:

A. Is platelet rich

B. Most frequently develops on a ruptured/ulcerated plaque

C. May cause pulmonary embolism

D. Results in tissue infarction

A
24
Q

Choose the incorrect answer

Arterial thrombus

A. Is platelet rich

B. Most frequently develops on a ruptured/ulcerated plaque

C. May cause pulmonary embolism

D. Results in tissue infarction

A

C. May cause pulmonary embolism

25
Q

DIC:

A. Is shorthand for ‘Death is Coming’

B. Is a spontaneous disorder of coagulation

C. Typically results in deep vein thrombosis in the lower limbs

D. Causes tissue infarction due to microvascular thrombosis

A

D. Causes tissue infarction due to microvascular thrombosis

26
Q

Choose the incorrect answer

DIC may complicate:

A. Metastatic cancer

B. Normal pregnancy

C. Severe burns

D. Septic shock

A

B. Normal pregnancy

A Haematology and Immunology (20 decks)

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