Hematology lec 3 : Coagulation and bleeding disorders (Hemostasis)

Question 1

A 32-year old woman observes the presence of multiple petechiae, purpura and ecchymosis rashes when she wakes up in the morning . She had a history of epistaxis requiring cauterization.

• Platelet count 50 x 109/L (RI 150-400 x 109/L)
• Bleeding time 10 min (RI 2-7 min)
  This woman might be suffering from???????

Answer 1

Immune thrombocytopenic purpura

Question 2

Components of hemostasis

Answer 2

• normal blood vessels
• clotting cascade
• platelets

Question 3

Hemostasis depends on a delicate balance between ………………….and …………… mechanisms

Answer 3

procoagulant , anticoagulant

Question 4

Mechanismm of intrinsic pathway of blood coagulation

Answer 4

XIIa + XIa + lXa + Xa

اتناشر حداشر تسعة بمساعدة تمانية يبدأ الكومن باثوي ب عشرة

Question 5

Mechanism of Extrinsic pathway of blood coagulation

Answer 5

Tissue factor + VIIa + Xa

باثوي قصير وكل حاجة فيه بسيطة

Question 6

Mechanism of coagulation common pathway

Answer 6

Xa + (prothrombin) II to (thrombin) IIa , then Fibrinogen to Fibrin
نووتتسس عشرة محتاج مساعدة من خمسة(نصه التاني) والكالسيوم

Question 7

Test of intrinsic pathway :

Answer 7

PTT

Question 8

Test of Extrinsic pathway :

Answer 8

PT

Question 9

Screening tests: done for all suspected patients

Answer 9

⚫Bleeding time
⚫Platelet count
⚫Prothombin time (PT)
⚫Partial thromboplastin time (PTT)
⚫Thrombin time (TT)

Question 10

Specific tests : done according to results of……………….

Answer 10

screening tests

Question 11

Bleeding time Affected by

Answer 11

�Platelet count
�Platelet function
�Vessel wall

Question 12

Normal range OF Bleeding time

Answer 12

Ivy’s method: up to 7 min

Question 13

Causes of prolonged bleeding time:

Answer 13

1-Thrombocytopenia 
(moderate or severe). 
2-Disorders of platelet function: 
Thrombasthenia
3-Vascular abnormalities

Question 14

Normal platelet count =

Answer 14

150-400 x109/L

Question 15

Investigation of a case of thrombocytopenia

Answer 15

⚫ History
⚫ CBC
⚫ Bone Marrow
⚫ ANA

Question 16

QUALITATIVE PLATELET
DEFECT (Thrombasthenia)
In a case presenting with …………….. and
……………………………….

Answer 16

purpura , normal platelet count

Question 17

PROTHROMBIN TIME (PT) Test for ……………….

Answer 17

extrinsic pathway (FVII, FX, FV , FII, FI)
- [majority are vitamin K dependent factor].

Question 18

Normal range of PROTHROMBIN TIME (PT):

Answer 18

10-14 sec

Question 19

Causes of prolonged PT

Answer 19

�Oral anticoagulants 
�Liver disease
�Vit K deficiency (FII, VII , IX and X )
�Congenital deficiency of factors 
involved in extrinsic pathway.
�DIC
�inhibitors

Question 20

PARTIAL THROMBOPLASTIN TIME (PTT) It is a test for

Answer 20

intrinsic pathway of blood coagulation (FVIII, FIX, FXI, FXII, FII, FV, X).

Question 21

PARTIAL THROMBOPLASTIN TIME (PTT) It is a test Used for patients receiving……………. therapy

Answer 21

heparin

Question 22

Normal range of PARTIAL THROMBOPLASTIN TIME (PTT): ……………………..

Answer 22

30-40 sec

Question 23

Causes of prolonged PTT

Answer 23

�Heparin 
�Deficiency of factors involved in intrinsic 
pathway, usually congenital: 
Hemophilia A Hemophilia B and von 
Willebrand disease)
�DIC
�Massive transfusion (labile FV, FVIII)
�Inhibitors

Question 24

Prolonged (BT) + Prolonged APTT+ Normal PT

Answer 24

Von Willebrand Disease

Question 25

Prolonged (BT) + Prolonged APTT+ Prolonged PT

Answer 25

Massive Liver Disease , DIC

Question 26

- ↑ BT - ↓Platelet count - normal (PTT , PT)

Answer 26

immune thrombocytopenic purpura

Question 27

- ↑PTT | - normal( PT , BT , Platelet count)

Answer 27

Hemophilia A

Question 28

- ↑PTT | - normal (PT , BT , Platelet count)

Answer 28

Hemophilia B

Question 29

- ↓Platelet count | - ↑( PT , BT , PTT)

Answer 29

DIC

Question 30

Group of disorders that predispose to venous thrombosis

Answer 30

thrombophilia

Question 31

``` INHERETED THROMBOPHILIA (Heritable thrombophilia) ```

Answer 31

- Anti-thrombin deficiency - Protein C deficiency - Protein S deficiency - Factor V leiden (FV R 506 Q) - Prothrombin G20210A mutation - MTHFR

Question 32

Acquired thrombophilia

Answer 32

Iatrogenic: surgery -hormonal therapy - chemo/radiotherapy – drugs Environmental: Age - obesity - pregnancy – trauma –Immobility Disease related: APS –Neoplasia – MPN – PNH – TTP– Inflammation – stroke -SCD

Question 33

DIAGNOSIS of HEREDITARY THROMBOPHILIA

Answer 33

``` Assays for:  AT-III, Protein C Protein S Molecular studies for:  FV leiden  Prothrombin G20210A Homocysteinaemia ```

Question 34

DIAGNOSIS of ACQUIRED THROMBOPHILIA:

Answer 34

• Tests for APS, Lupus Anti-coagulant

Question 35

Procoagulant

Answer 35

PAI-I Antiplasmin Tissue Factor Clotting Factors

Question 36

Anticoagulant

Answer 36

``` Protein S Protein C TFPI Fibrinolytic system AT III ```

Question 37

Hemostatic Balance between

Answer 37

1-platelet 2-clotting factors (procoagulant) 3- fibrinolytic system (anticoagulant)

Question 38

Types of bleeding disorders

Answer 38

- Disorders of Blood vessels e.g. Scurvy, senile purpura - Disorders of Platelets decrease count (Thrombocytopenia) or impaired function Thrombasthenia - Disorders of Coagulation e.g decrease amount of clotting factor

Question 39

◦ Decrease platelet count less than 150.000 may be due to

Answer 39

◦ Decrease production like in aplastic anemia | ◦ Increase destruction like ITP immune thrombocytopenic purpura

Question 40

Thrombasthenia Impaired platelet function may be congenital like ................................ or acquired e.g. ................

Answer 40

von Willebrand disease , Aspirin therapy

Question 41

von Willebrand factor: Carrier of factor.................Anchors platelets to subendothelium

Answer 41

VIII

Question 42

Inheritance of von Willebrand disease

Answer 42

Autosomal dominant

Question 43

Bleeding in Liver Disease Decreased synthesis of............................... Prolongation of ..............................

Answer 43

II, VII, IX, X, XI, and fibrinogen, | PT, aPTT and Thrombin Time

Question 44

(bone marrow disorder lead to increase platelet productions from megakaryocyte ) we call it ........................

Answer 44

essential thrombocytosis

Question 45

A 31 years old previously healthy man noticed some mild swelling in his left forearm following his daily workout, which involved doing pushups and lifting weights. Two weeks later he developed left shoulder pain and some bluish discoloration of the arm. A Doppler ultrasound showed a DVT in the left subclavian and proximal internal jugular veins. He was treated with low molecular weight heparin and transitioned to warfarin. 3 days later he is developing irregular heartbeat and dyspnea , what is the most probable ?

Answer 45

PULMONARY EMBOLISM