Haematology- Clinical Cases and Thrombosis

Question 1

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

Likely diagnosis?
A. Acute lymphoblastic leukaemia
B. Osteomyelitis
C. Von Willebrand Disease
D. Haemophilia

Answer 1

D- Haemophilia

->clue is the pattern: young, just staring walking, articular bleed.
Clotting factor issue

Question 2

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

Answer 2

C- only way to find out, phenotype is the same

Question 3

How is haemophilia A inherited?
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Answer 3

X-linked

Question 4

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. 1in 2
B. Can’t say because it depends on mothers status
C. 1 in 4
D. Random chance

Answer 4

C- she has to be the carrier as her dad has passed on the x-chromosome

Question 5

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

Answer 5

D- recombinant factor VIII

->always going to be recombinant factor first line

Question 6

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

A. Allergic reactions
B. Increased risk of thrombosis
C. Development of inhibitory antibodies
D. Addiction to factor VIII

Answer 6

C- development of inhibitory antibodies

Question 7

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

Answer 7

C

Question 8

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

Answer 8

A

->follow up with urgent FBC to haematology

Question 9

She has thrombocytopenia as a cause of the symptoms

Which of the following is not a cause of thrombocytopenia ?

A. Acute myeloid leukaemia
B. Vitamin K deficiency
C. Aplastic anaemia
D. ITP

Answer 9

B

->bone marrow failure in A and C

Question 10

AML, Aplastic Anaemia, ITP, may all cause thrombocytopenia. Vit K deficiency does not

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

A. 30
B. 10
C. 50
D. 100

Answer 10

B- 10

Question 11

Which underlying illness is NOT associated with ITP?

A. HIV infection
B. Vitamin C deficiency
C. SLE
D. Glandular fever

Answer 11

B.

Question 12

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. Surgical

Answer 12

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

Question 13

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

Answer 13

C- Hypertension

Question 14

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

Answer 14

Aspirin inhibits platelet function by inhibiting COX-1

Question 16

A 21-year old is taking 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
D. She has a family history of her mother and sisters suffering from pulmonary embolus

Answer 16

A- increase risk of VTE and stroke

Question 17

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

A. Hypercholesterolaemia
B. Factor V Leiden
C. Von Willebrand disease
D. Diabetes Mellitus

Answer 17

B- Factor V Leidien

Question 18

Which is incorrect?

The following are risk factors for arterial thromboembolism:
A. Smoking
B. Diabetes mellitus
C. Factor V Leiden
D. Atrial fibrillation

Answer 18

C

Question 19

Which is incorrect?

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

Answer 19

C- PE caused by venous thrombus

Question 20

Which of the following patients should be considered for long term anticoagulation?

A. 65 with an MI and a history of hypertension
B. 55 with a PE following hip replacement and Factor V Leiden
C. 75 with a DVT and new diagnosis of bowel cancer
D. 60 with an unprovoked DVT

Answer 20

D- biggest predictor for reoccurrence was if the DVT was unprovoked

->A would be long-term anti-platelet

Question 21

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

Answer 21

D

Question 22

Which is incorrect?

DIC may complicate:
A. Metastatic cancer
B. Normal pregnancy
C. Severe burns
D. Septic shock

Answer 22

B- not in normal pregnancy