Coagulation + Platelets

Question 1

Which type of bleeding defect?

Hemarthrosis, hematuria, deep hematoma

Answer 1

Coagulation defect

Question 2

Which type of bleeding defect?

Petechiae, ecchymoses (bruise), mucocutaneous bleeding

Answer 2

Platelet defect

Question 3

Which type of bleeding disease?

Both coagulation and platelet defect

Answer 3

von Willebrand Disease

Question 4

PFA-100 abnormal in (2)

Answer 4

Platelet disorders:
Thrombocytopenia
Qualitative platelet defect

Question 5

Which lab test?

Warfarin prolongs ____

Answer 5

Prothrombin time (PT)

Question 6

Which lab test?

Sensitive to Factor 8 and 9

Answer 6

aPTT

Question 7

Which lab test?

Prolonged in hemophilia

Answer 7

aPTT

Question 8

Which lab test?

Prolonged in vitamin K deficiency

Answer 8

PT

Question 9

Which lab test?

Prolonged in liver disease

Answer 9

PT

Question 10

Which lab test?

Prolonged in coagulation factor inhibitors

Answer 10

aPTT

Question 11

Which lab test?

Sensitive to Factor 7

Answer 11

PT

Question 12

Which lab test?

Used to detect defect in fibrinogen

Answer 12

Thrombin time (TT)

Question 13

1:1 mix that corrects suggests ___

Answer 13

Factor deficiency

Question 14

1:1 mix that does NOT correct suggests ___

Answer 14

Factor inhibitor

Question 15

Which of the following is FALSE about Idiopathic Thrombocytopenic Purpura?
A. Children: acute, self limited
B. Adults: chronic
C. Associated w/ pathogenic E. coli harboring plasmid encoded Shiga toxin
D. Associated w/ other autoimmune disorders

Answer 15

C. This is a feature of Hemolytic Uremic Syndrome (HUS)

ITP: Anti-platelet antibodies → Severe thrombocytopenia

Question 16

Which of the following is NOT a treatment of Idiopathic Thrombocytopenic Purpura? 
A. Corticosteroids
B. Anti-D immunoglobulin
C. Rituximab
D. Desmopressin
E. Thrombopoietin receptor agonist

Answer 16

D. Used to treat mild hemophilia A

B. Anti-D immunoglobulin: bind to RBC → macrophages bind to RBC and spare platelets
C. Rituximab: reduce production of antibodies
E. TPO receptor agonist:
• Increased bone marrow production to compensate loss
• Life long therapy b/c endogenous production decreases since getting it exogenously → use only for refractory patients

Question 17

Name the disease:

vWF-cleaving protease deficiency (ADAMTS13)

Answer 17

Thrombotic Thrombocytopenic Purpura

Question 18

What would you see on blood smear of Thrombotic Thrombocytopenic Purpura?

Answer 18

schistocytes

Question 19

Which of the following is FALSE about Thrombotic Thrombocytopenic Purpura?
A. Elevated LDH
B. Normal PT
C. Prolonged aPTT 
D. Presence of ultra long multimers

Answer 19

C. aPTT normal

Schistocytes on blood smear

Question 20

Which of the following about vWF is FALSE?
A. Facilitates platelet adhesion to injured endothelium
B. Binds, carries coagulation Factor 9 in plasma
C. Binds collagen and platelets
D. Forms large multimers through disulfide bonds

Answer 20

B. Factor 8

Question 21

Name the disease:

Abnormal PFA-100 or bleeding time in absence of thrombocytopenia

Answer 21

Qualitative Platelet Disorders

Question 22

Name the disease:
Normal PT
Prolonged aPTT
Corrects 1:1 mix

Answer 22

Hemophilia

Question 23

Name the disease:
Normal PT
Prolonged aPTT
NOT corrected 1:1 mix

Answer 23

Coagulation Factor Inhibitors

Question 24

Name the disease:
Normal PT
Prolong aPTT 
Corrects 1:1 mix
Prolonged PFA-100
Normal plt ct

Answer 24

Von Willebrand Disease

Question 25

What is the expected lab result of Von Willebrand Disease?
Plt ct: 
PT:
aPTT:
Correction w/ 1:1 mix:
PFA-100:

Answer 25

Plt ct: normal
PT: normal
aPTT: prolonged
Correction w/ 1:1 mix: yes
PFA-100: prolonged