heme externship - coag 2.6

Question 1

a 3 year old male was admitted with scattered petechiae and epistaxis. the patient had normal growth and had no other medical problems except for chicken pox 3 weeks earlier. his family history was unremarkable

test results as follows:
- PT: 11 seconds
- PTT: 32 seconds
- PLT count: 18

these clinical manifestations and lab results are consistent with:
A. TTP
B. DIC
C. ITP
D. HUS

Answer 1

C. ITP
- past viral infection

Question 2

the following results are obtained from a patient who developed severe bleeding:
- prolonged PT and APTT
- PLT count: 100
- fibrinogen: 40 mg/dL

which of the following blood products should be recommended for transfusion
A. FVIII concentrate
B. PLTs
C. FFP
D. cryo

Answer 2

D. cryo
- FFP is second choice since it has all the clotting factors but cryo is more condensed

Question 3

a 30 year old woman develops signs and symptoms of thrombosis. in her left lower leg after 5 days of heparin therapy. the patient had had open heart surgery 3 days prior and has been on heparin ever since. which of the following would be most helpful in making the diagnosis
A. fibrinogen assay
B. PT
C. PLT count
D. increased heparin dose

Answer 3

C. PLT count
- suspect HIT

Question 4

the following lab resuls were obtained on a 25 yro woman with menorrhagia after delivery of her second son. The patient has no previous bleeding history
- normal: PLT, PT
- prolonged: APTT
- immediate APTT correction on mix, incubation of APTT prolonged results

what is the most likely cause of these results
A. lupus anticoagulant
B. FVIII deficiency
C. FIX deficiency
D. FVIII inhibitor

Answer 4

D. FVIII inhibitor
- time and temp specific

Question 5

a 62 yro female presents with jaundice and the following lab data:
- PS: macrocytes and target cells
- PLT: 355
- PT: 25 seconds
- APTT: 65 seconds
- transaminase level: elevated (AST:ALT ratio >1)
- total and direct bili: elevated

these clinical presentations are consistent with:
A. inherited FVII deficiency
B. DIC
C. cirrhosis of the liver
D. vWF disease

Answer 5

C. cirrhosis of the liver

Question 6

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. APTT is corrected
B. APTT uncorrected
C. lab protocol should be followed for interpretation of correction
D. circulating anticoagulant can be ruled out

Answer 6

C.

Question 7

a 4.5 mL blue top was fill appropriately for preoperative PT and APTT testing. the results of both tests were elevated. The patient’s PT and APTT from the previous day were within normal limits, and he was not on heparin therapy. Which is the most appropriate first step to investigate the abnormal results?
A. report results
B. perform a mixing study
C. check the sample for a clot
D. report APTT only

Answer 7

C. check for a clot

Question 8

a plasma sample cubmitted to the lab for PT testing has been stored for 25 hours at 4C. PT is shortened. What is the most probably cause
A. FVII deficiency
B. activation of FVII caused by exposure to cold temp
C. lupus inhibitor
D. FX inhibitor

Answer 8

B. cold activaiton of FVII

Question 9

APTT is not increased in a patients receiving heparin. which of the following factors may be associated with the lack of response to heparin therapy in this patient
A. protein C deficiency
B. AT deficiency
C. protein S deficiency
D. FVIII deficiency

Answer 9

B. AT deficiency
- increased heparin can cause a lowering of natural AT in a patient

Question 10

a 50 yro patient was admitted to the emergency department with a complaint of pain in the right leg. the leg was red, swollen, and warm to the touch. DVT was suspected, and the patient was started on heparin therapy. Which of the following is the proper protocol to evaluate the 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 the therapeutic dose
C. monitor the PLT count daily and every other day after haprin therapy is completed
D. monitor PT daily to adjust the therapeutic dose

Answer 10

A.
- check for functionality of dose and for HIT occurrence

Question 11

a 1 year old patient was admitted with recurrent epistaxis for the past 5 days. Past medical history revealed easy bruising and a severe nosebleed that had occurred when he was 3 months of age, necessitating transfusion therapy. The mother had a severe nosebleed 8 years ago. The father was reported to bleed easily after lacerations. the patient was transfused with 2 units of packed RBCs on admission.
test results as follows:
- Hgb: 4.5
- PLT count: 249
- PT: 11.2
- APTT: 34
- FVIII assay: 70%
- PLT aggregation: abrnomal to ADP, EP, and thrombin, normal to ristocetin

these clinical manifestations and lab results are consistent with:
A. vWF disease
B. bernard-soulier syndrome
C. Glanzmann thrombashtenia
D. FVIII deficiency

Answer 11

C. glanzzmans

Question 12

a 60 year old patient was admitted to the hospital for a liver biopsy. The biopsy was scheduled for 11 am. The 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 the biopsy because a 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 the patient on vitamin K therapy and proceed with the procedure immediately

Answer 12

C.
- vtiamin K should aid in correcting the PT but will need a few days to work

Question 13

a fresh blood sample was sent to the lab at 0800 for the PT test. at 1600 the doctor requested for the APTT to be done on the same sample. What should the technologist do?
A. rerun on the same sample
B. request a new sample
C. run APTT in duplicate
D. mix the patients plasma with normal plasma and run the APTT

Answer 13

B. request a new sample
- APTT should be run within 2 hours of collection or 4 hours after centrifugation and refrigeration

Question 14

an APTT test is performed on a patient and the result is 50 seconds. The instrument flags the result because of failure of the delta check. the patient had had an APTT of 35 seconds the previous day. The technologist calls the nursing unit to check whether the patient was placed on heparin. the patient is not receiving heparin. What is the next appropriate step.
A. check the family history for inherited VIII deficiency
B. check for other anticoagulant medications
C. perform mixing studies
D. perform FVIII asasy

Answer 14

B.